Sex After Myocardial Infarction BY PRAVEEN PAWAL & DR AWADHESH KR SHARMA NITRATES SILDINAFIL USE

1. Sex after Acute MI : Tips and trics of the game Dr Praveen pawal & Dr Awadheshkrsharma, Residents Deptt of medicine Maharani LaxmiBai Medical College Jhansi ,UP

2. introduction Like most everybody else, people with heart disease spend a lot of time thinking about sex. But if your heart's in trouble, those thoughts can turn dark. You may worry that sex can kill you. You may also wonder what happened to your desire. If heart trouble has cast a shadow over your sex life, talk to your doctor. With a little help and reassurance, many people with heart disease can lead full, satisfying lives -- sex included.

4. Sexual problems Most cases of impotence do not come to light (despite involving 10% of all male population). Grossly mismanaged by ignorant patients or even doctors. Not all cases of impotence are psychological in origin , Most are eminently curable.

6. 37% of college students have trouble occasionally getting an erection or getting lubricated.

7. 30% or more of sexually active college women don't orgasm regularly.

8. 23% of college students ejaculate too soon.

10. Depends on availability of partners

12. (3) Orgasm: the shortest phase of the sexual response cycle, typically lasting only several seconds. Usually a man experiences orgasm and ejaculation whereas a woman orgasms, the uterus and orgasmic platform contract in rhythmic waves of muscular movement.HR and BP rises maximally. (4) Resolution: begins immediately after orgasm if there is no additional stimulation. The body returns to its original, nonexcited state.

14. HR during sexual activity might reach 140-180 bpm, SBP increased by 80 mmHg and DBP by 50 mmHg on average.

16. Changes in HR during sex

18. Sexual activity is often equal to 2 to 3 METS in preorgasmic phase and 3 to 4 METS in orgasmic phase

19. Duration of exposure to increase risk is 2 hrs

20. Recent MI <2 weeks carries high risk of cardiac ruptre, reinfarction & arrhythmias are common.

21. Most of patients able to resume sexual activity within 4 weeks.

23. Coital angina is rare in those patients who do not have angina during strenuous physical exertion. It is more prevalent in sedentary individuals with severe coronary disease who experience angina with minimal physical exertion

25. It is estimated that 10 to 15% patients are sexually impotent & 40 to 70% of coronary patients have lower frequency of sexual activity

26. Less than 1% MI occur during sexual activity, the relative risk of MI is 2.5 times grater than during non coital activities

28. 4% showed a good understanding of their disease, while 96% knew nothing about AMI clinical manifestations or its attendant limitation

29. Sexual relations prior to the AMI, 63%,

30. 60% expressed interest in resuming their sex life after discharge

32. Only 1.3% of patients without premonitory symptoms have sexual activities during 2 hours before onset of myocardial infarct

33. RR 2.1 (CI 0.7-6.5)

34. RR 4.4 (CI 1.5-12.9) patient on sedentary life style

35. Conclusion: absolute risk is low, exposure infrequent

36. 1 in 1 million in low risk

37. 2 in 1 million with sexual activities

39. 9% of patients had sexual activity in the 24 hours, and 3% in the two hours,preceding myocardial infarction

40. RR 2 hrs = 2.5

41. Not increased in patients with a history of previous angina pectoris or myocardial infarction

46. Resting BP <90/50 mm Hg or >170/110mm Hg

47. Active cardiac failure or unstable angina

48. Requirement for nitrates either chronically or on an as-needed basis

49. Complicated multi-drug antihypertensive regimens

51. Onset 15-30min; Half life 4-5 hrs

52. Said to be 9 fold selectivity

53. Prolongation of QT interval

54. Should NOT be used in congenital long QT syndrome or those taking quinidine, procainamide, amiodarone, or sotalol

56. Longer duration of action 36hours

57. Can be taken with food

58. Back pain / myalgia 6%.

60. 349 placebo patient-years

61. 693 sildenafil patient-years

62. 4220 patient-years in open-label studies

63. Incidence of MI lower in the sildenafil group than in the placebo group (not statistically significant)

65. Should not hesitate to ask sex history.