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Coitus and CAD Coitus and CAD Presentation Transcript

  • 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
  • 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
  • 1.Objectives
    At the end of this presentation students will able to:-
    • Identify the cardiovascular changes during coitus.
    • Explain the pathophysiology of coronary artery disease.
    • Mention the recommendations for patient with coronary artery disease in coitus.
    • Explain the mechanism of Viagra and its cardiovascular side effects.
    9/23/2011
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    coitus and CAD
  • 2.Introduction
    The Human Sexual Response
    Classified into four phases
    1.Excitement
    2.Plateu
    3.Orgasim
    4.Resolution
    1.Excitement
    - An increase in muscle tone (myotonia) of certain muscle groups.
    • An increase in breathing rate , heart rate and blood pressure .
    • flushed skin (vasocongestion )
    9/23/2011
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    coitus and CAD
  • Introductioncont’d
    - Erect nipples.
    - Erection of the man's penis.
    2. Plateau
    Powerful surges of sexual tension or pleasure in this stage.
    • An increased blood pressure and heart rate in both sexes.
    • Increased sexual pleasure with increased stimulation, and further increased muscle tension.
    • Breathing rate continues at an elevated level.
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  • 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
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    6
  • Introductioncont’d
    3. Orgasm
    • The shortest phase of the sexual response cycle, typically lasting only several seconds.
    • In man ,orgasm is usually associated with ejaculation whereas a woman orgasms, the uterus and vaginal contraction.
    • Heart rate and blood pressure increases maximally.
    9/23/2011
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    coitus and CAD
  • Introductioncont’d
    4 . Resolution
    • Begins immediately after orgasm.
    • Allows the muscle to relax.
    • The body returns to its original, non excited state.
    • Blood pressure and heart rate drop.
    9/23/2011
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    coitus and CAD
  • 3.Cardiovascular changes during coitus
    • HR during sexual activity might reach 140-180 bpm.
    • SBP increased by 80 mmHg and DBP by 50 mmHg on average.
    • The mean ABP at coital is 162/89 mmHg and the mean value of body oxygen consumption is 16 mlO2/min/kg.
    • The highest metabolic expenditure occur orgasm.
    9/23/2011
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    coitus and CAD
  • 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
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    coitus and CAD
  • 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
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    coitus and CAD
  • Chagne in BP during coitus
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    coitus and CAD
  • Changes in HR during coitus
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  • Cardiovascular changes…cont’d
    • Heart rate increase to cope with increased demand of oxygen and nutrients on the heart.
    • Heart rate is increases at each phase to peak at orgasm with full resolution to baseline in less than two minutes after coitus.
    • Blood pressure increases to peak at orgasm and return to normal after resolution.
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    coitus and CAD
  • 4.Coronary Artery Disease
    9/23/2011
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    coitus and CAD
  • Coronary Artery Disease cont’d
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  • 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
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    coitus and CAD
  • 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
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    coitus and CAD
  • 4.2.Coital angina Incidence
    • Literature data show that erectile dysfunction is highly prevalent at time of AMI, affects 24% to 89% of the patients.
    • It is estimated that 10 to 15% patients are sexually impotent & 40 to 70% of coronary patients have lower frequency of sexual activity.
    • Less than 1% MI occur during sexual activity, the relative risk of MI is 2.5 times grater than during non coital activities
    • The duration of exposure to the increased risk appears to be 2 hours following coitus.
    9/23/2011
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    coitus and CAD
  • Coital angina …cont’d
    • Recent MI <2 weeks carries high risk of cardiac rupture, reinfarction & arrhythmias are common.
    • Most of patients able to resume sexual activity within 4 weeks.
    9/23/2011
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    coitus and CAD
  • Coital angina…… cont’d
    • In general, sexual intercourse should be safe if a patient can perform an activity equal to 5-6 metabolic equivalents (METS), such as climbing 20 stairs in 10-15 seconds without distress.
    • Post infarction patients who reach 5-6 METS on stress testing without ischemia or arrhythmia can resume their normal sexual activity without risk.
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    coitus and CAD
  • 5.Sildenafil citrate (Viagra )
    9/23/2011
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  • Cardiovascular aspects related to thetreatment of erectile dysfunction
    Erectile dysfunction
    The inability to achieve or sustain erection sufficiently to permit satisfactory sexual intercourse.
    Erectile dysfunction is frequently seen in patients
    • Heart disease
    • Diabetes mellitus
    • Alow high-density lipoprotein level and smokers.
    The two major causes of erectile dysfunction are organic and psychogenic.
    9/23/2011
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    coitus and CAD
  • cont’d
    • Organic causes
    • Vascular diseases
    • Neurogenic disorders
    • Endocrine abnormalities
    • Renal failure and medication effects.
    • The major causes of erectile dysfunction of men more than 45 years of age are vascular and neurogenic.
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  • Sildenafil ( Viagra )
    Mechanism of action
    • A selective inhibitor of specific phosphodiesterase typeV.
    • 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.
    • c-GMP causes reduction of intracellular calcium, smooth muscle relaxation in the corpus carvenosum and vasodilatation in the penis.
    9/23/2011
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    coitus and CAD
  • 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
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    coitus and CAD
  • Sildenafilcont’d
    • Sildenafil produced a modest decrease
    in blood pressure .
    ------ 8.4 mmHg systolic
    ------ 5.5 mmHg diastolic
    • mild vasodilation and have minimal effects on blood pressure.
    • In patients receiving medication containing nitrates, hypotensive effects of sildenafil can be severe.
    9/23/2011
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    coitus and CAD
  • sildenafil cont’d
    Absolute contra indicated
    • Myocardial infarction, stroke, or life threatening arrhythmia in the last 6 months.
    • Resting BP <90/50 mm Hg.
    • Active cardiac failure or unstable angina.
    • Complicated multi-drug antihypertensive regimens.
    • Retinitis pigmentosa.
    • In patients receiving treatment with long-acting nitrates.
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    coitus and CAD
  • 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
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    coitus and CAD
  • Thank You
    9/23/2011
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    coitus and CAD