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.
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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 )
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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 coitus and CAD 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.
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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.
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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.
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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
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
Chagne in BP during coitus 9/23/2011 12 coitus and CAD
Changes in HR during coitus 9/23/2011 13 coitus and CAD
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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4.Coronary Artery Disease 9/23/2011 15 coitus and CAD
Coronary Artery Disease cont’d 9/23/2011 coitus and CAD 16
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
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
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.
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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.
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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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5.Sildenafil citrate (Viagra ) 9/23/2011 coitus and CAD 22
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
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
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.
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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
mild vasodilation and have minimal effects on blood pressure.
In patients receiving medication containing nitrates, hypotensive effects of sildenafil can be severe.
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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.
In patients receiving treatment with long-acting nitrates.
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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