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Coitus and CAD
1. Addis Ababa UniversityCollege of Health ScienceDepartment of Medical Physiology Presentation on Coitus and Coronary Artery Disease BY GIRMAY F. 9/20/2011 coitus and CAD 1
2. Presentation Out Line 1.Objectives 2.Introduction 3.Cardio vascular changes during coitus. 4.Coronary artery disease 4.1.Coitus and Angina 4.2.Coital angina incidence 5. Sildenafil(Viagra) 6. References 2 coitus and CAD 9/23/2011
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4. Explain the pathophysiology of coronary artery disease.
10. Increased sexual pleasure with increased stimulation, and further increased muscle tension.
11. Breathing rate continues at an elevated level.9/23/2011 coitus and CAD 5
12. Introductioncont’d Intensification of all the changes such that the woman's clitoris may become so sensitive that it is painful to the touch. 9/23/2011 coitus and CAD 6
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14. In man ,orgasm is usually associated with ejaculation whereas a woman orgasms, the uterus and vaginal contraction.
15. Heart rate and blood pressure increases maximally.9/23/2011 7 coitus and CAD
24. Cardiovascular changes ….cont’d Energy expenditure: - The energy expended is measured in METS. - A MET is defined as the energy expenditure at rest, or approximately 3.5mlO2/kg/min. - The maximal energy expenditure occurs at orgasm, estimated at 3 to 4 METS for man-on-top coitus which is higher than woman-on-top (2.5METS). - Woman- on- top is best for male patients with moderately severe heart disease. 9/23/2011 10 coitus and CAD
25. Cardiovascular changes…..cont’d There is no difference in the energy requirement in sexual activities and physical activities like walking, climbing stair case and doing paper works. The equivalent oxygen cost of the average maximum heart rate during sexual activity is less than that of climbing two flights of steps or walking quickly. conjugal sexual activity is not a particularly stressful on the cardiovascular system when compared with other everyday physical activities. 9/23/2011 11 coitus and CAD
26. Chagne in BP during coitus 9/23/2011 12 coitus and CAD
27. Changes in HR during coitus 9/23/2011 13 coitus and CAD
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29. Heart rate is increases at each phase to peak at orgasm with full resolution to baseline in less than two minutes after coitus.
30. Blood pressure increases to peak at orgasm and return to normal after resolution. 9/23/2011 14 coitus and CAD
33. 4.1.Coitus And Angina Coital angina represent less than 5% of all anginal attacks. Coital angina is rare in those patients who do not have angina during strenuous physical exertion. More prevalent in sedentary individuals with severe coronary disease who experience angina with minimal physical exertion. In Moderate stable angina the risk of myocardial ischemia increases with coitus . 9/23/2011 17 coitus and CAD
34. Coitus and angina cont’d Exercise testing is recommended prior to recommending sexual activity for people with moderate stable angina. For patients with coronary artery disease engaging in sexual intercourse, the symptoms tend to be silent compared to physical exercises. A patient complains of chest pain during exercise, is likely to have the pain during sexual intercourse. An abnormal rhythm common during sexual intercourse than during other physical activities. 9/23/2011 18 coitus and CAD
35.
36. It is estimated that 10 to 15% patients are sexually impotent & 40 to 70% of coronary patients have lower frequency of sexual activity.
37. Less than 1% MI occur during sexual activity, the relative risk of MI is 2.5 times grater than during non coital activities
38. The duration of exposure to the increased risk appears to be 2 hours following coitus.9/23/2011 19 coitus and CAD
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40. Most of patients able to resume sexual activity within 4 weeks. 9/23/2011 20 coitus and CAD
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42. Post infarction patients who reach 5-6 METS on stress testing without ischemia or arrhythmia can resume their normal sexual activity without risk.9/23/2011 21 coitus and CAD
46. Alow high-density lipoprotein level and smokers. The two major causes of erectile dysfunction are organic and psychogenic. 9/23/2011 23 coitus and CAD
52. The major causes of erectile dysfunction of men more than 45 years of age are vascular and neurogenic.9/23/2011 coitus and CAD 24
53.
54. During sexual stimulation, nitric oxide is released in the corpus carvenosum, This effect produces the initial mechanism of erection of the penis,Later nitric oxide activates enzyme guanylate cyclase which causes increasing levels of c-GMP.
55. c-GMP causes reduction of intracellular calcium, smooth muscle relaxation in the corpus carvenosum and vasodilatation in the penis.9/23/2011 25 coitus and CAD
56. Sildenafil Cont’d By inhibiting the breakdown of c-GMP, Sildenafil citrate enhances the effect of and prolongs the action of c-GMP. NO is released primarily from stimulation of non-adrenergic, non-cholinergic (nitroxidergic) carvernosal nerves and, therefore, Sildenafil citrate cannot work without sexual stimulation. It has a modest effect in altering cardiovascular hemodynamic. 9/23/2011 26 coitus and CAD
57.
58. In patients receiving medication containing nitrates, hypotensive effects of sildenafil can be severe.9/23/2011 27 coitus and CAD
64. In patients receiving treatment with long-acting nitrates.9/23/2011 28 coitus and CAD
65. 7.References 1.American College of Cardiology. ACC/AHA 2002 Guideline Update for Exercise Testing. Available at http://www.acc.org/qualityandscience/clinical/guidelines/exercise/exercise_clean.pdf 2. European Heart Journal (2001) 22, 201–208 3. REVIEW Sexual Activity and Chronic Heart Failure, STACY A. MANDRAS, MD; PATRICIA A. UBER, PHARMD; AND MANDEEP R. MEHRA, MD. 4.Cardiovascular Effects of the 3 Phosphodiesterase-5 Inhibitors Approved for the Treatment of Erectile Dysfunction Robert A. Kloner, MD, PhD 9/23/2011 29 coitus and CAD
