All patients with ED should undergo adequate medical assessment. It is important to establish a baseline measure of the type of activities and level of physical exertion a patient normally undertakes. The risk of a cardiac event in a patient with cardiovascular disease is higher than in a patient without cardiovascular disease; therefore, cardiovascular risk assessment should focus on the risk of further cardiovascular events at a return to sexual activity. Cardiovascular status has been split into three categories defining patients at low, intermediate or high risk. A practical framework for assessing the potential level of cardiovascular risk following a return to sexual activity is shown in table 3. Most of the patients with low or intermediate risk can be managed in primary care; otherwise exercise testing can guide management when cardiovascular risk is in doubt. If a patient can perform stage I of the Bruce protocol without significant ST-segment changes, arrhythmia or drop in systolic blood pressure, the patient is not at risk during normal sexual activity. Patients falling into the high-risk category should be evaluated and treated by their cardiologist before instituting treatment for ED. Buy Cialis Soft Tabs
Cardiovascular drug-induced ED
There are a number of drugs that are suspected of contributing to ED in cardiovascular patients. Reports have indicated an incidence range of 5 to 43% with propranolol and 4 to 32% with thiazide diuretics. There is not much evidence to confirm the effectiveness of changing drug therapy to reverse ED. However, if a relation in time exists between the start of therapy and onset of symptoms it is conceivable to stop or safely change medication and evaluate the effect on improvement of ED after two to four weeks. However, physicians should realise that the development of ED might be due to the condition being treated, rather than the used.