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Archive for the ‘cardiology -Sexual health’ Category

Cardiologists are  not  single organ  specialists . They are supposed to  be sincere guardians of the  the entire vascular system .Sexual dysfunction in  males  is almost synonymous with erectile dysfunction(ED) .The male sex organ is equally  dynamic organ like the heart . It demands a sudden gush of blood  to the tune of  500 ml  during complete  erection  .This  conveys an important  message . The penile macro and micro vasculature is as important  as coronary mIcrovascular bed. Atherosclerois of  LAD  can be as common as atherosclerosis  of pudendal artery .It can precede or follow the coronary lesion. Penile insufficiency is a early marker of endothelial dysfunction. All patients with CAD should be screened for  ED and vice versa.

This  is not a  sexual  intrusion in academics , but I am sure , a sustained  erection  that  completes  a normal sexual act  may very well  rule out a proximal LAD lesion 99 % of times .

Do you know , > 7  Mets  on a tread mill  will  rule out a  significant left main disease with high degree of accuracy   !  Sexual acts require more than that (One may do a study on this !)

There has been  some interesting guidelines for managing   issue of sexual dysfunction in CAD. .Princeton consensus conference is  the famous one.

References

princeton consensus conference sexual dysfunction in cardiology princeton 3 sexual dysfunction in cardiology

sexual activity in cardiovascular disease  circulation 2012

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Modern human life is driven by technology  . We are gradually taken over by gadgets .Heart is not an exception . Implantable cardiovertor defibrillator (ICD )  is major innovation  where in , an  electrically  wayward heart  is brought under control  by series of automatic shocks . One of my patients with old MI and significant LV  dysfunction for whom ICD was an option  taught me a lesson in physics  . During  counseling ,  he was asking me about  the quality of life issues etc .
ICD  shocks  during sex 2
First,   he wanted to know  how  stressful  the  sexual acts  are ?  . . .Then he  surprised me with this  question .  He wanted to know ,  the  risk of  developing a VT/VF  during the act and  will the ICD  shock  his spouse as  well ?  That was a real  cracker of  a  question  I thought .   I had to do  a mini  research   and found that  these are  low energy shocks (30 Joules)  and transmitted electrical injury is a non issue  .
I realised   then  . . .  we live in a era  where   physicians often get educated from their patients !
Here is the  FAQs on ICD from the patient pages of circulation . With  due courtesy I  reproduce it here.
ICD  shocks  during sex
Final message
ICD shocks are  low energy shocks delivered  Intra cardiac ,  and  rarely  reach the surface  ,  hence has little risk for electrical injury  for those in contact.
References
1. Vazquez LD, Sears SF, Shea JB, Vazquez PM. Sexual health for patients with an implantable cardioverter defibrillator.

2.Steinke EE. Sexual concerns of patients and partners after an implantable cardioverter defibrillator.
Dimens Crit Care Nurs. 2003;22:89–96
3. A  review article on the  broad issue.
sexual activity in cardiovascular disease  circulation 2012

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