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Erectile Dysfunction - The Dangling Stress Test

Many men who suffer from impotence or erectile dysfunction (ED) may have underlying heart disease, high blood pressure, diabetes, and other medical conditions that have not been diagnosed or discovered. This article is intended to point out how ED can be a harbinger of other co-morbid conditions even life threatening heart disease. A normal erection requires the complex integration between the brain and the small blood vessels within the penis. The most important sex organ is not necessarily between a man’s legs but between his ears as that is where the erection begins, within a man’s brain. An erection occurs when there is sexual interest or desire that starts the erection process within the brain and sends a message to the nerves in the spinal cord to the nerves within the penis. The nerves release nitric oxide which allows more blood to enter the penis and resulting in rigidity of penis which is adequate for vaginal penetration.

The causes of ED are usually multifactorial. In most men over the age of 50 there are risk factors such as obesity, smoking, diabetes, hypertension, or elevated cholesterol levels that result in narrowing of the blood vessels to the penis by a process called atherosclerosis. This process decreases the blood supply to penis and subsequently leads to erectile dysfunction.

Heart disease and ED share many of the same risk factors, and they commonly coexist. The prevalence of ED in patients with heart disease is higher than in the general population. In men with a history of heart disease or previous myocardial infarction (MI), the incidence of ED is nearly 75%.

The most common condition associated with ED is undoubtedly hypertension; two-thirds of men with hypertension have ED. High cholesterol levels or hypercholesterolemia is also strongly associated with ED. In men over the age of 50 who have a problem of ED, nearly half were found to have significant underlying narrowing of the coronary arteries which supply the blood to the heart muscles and which, if they become blocked, causes a heart attack.

Because of the coexistence of ED and heart disease, it is suggested that all men over the age of 50 who present with ED be evaluated for heart disease, especially in men with other risk factors such as smoking, hypertension, diabetes, hypercholesterolemia, and obesity. It is recommended that a man with ED be screened for heart disease. This usually means an EKG, a few blood tests, and possibly a stress test which consists of running on a tread mill while attached to a heart monitor.

Treating ED and resumption of normal sexual activity is important to most men with heart disease. Men with ED often feel that their concept of themselves as a man is threatened, their relationship with their partner, family, and friends can be impaired, and their productivity in the workplace can also be affected. If left untreated, ED can even lead to depression. There are now guidelines for the assessment and management of ED in the man with heart disease. Most heart disease patients can be successfully treated for ED with oral medication such as Viagra, Cialis, or Levitra. These drugs can be taken 15-30 minutes before engaging in sexual intimacy and the effect will last from 8-36 hours. The main contraindication for treatment with oral medication is the use of nitroglycerin. These men who use nitroglycerin are usually referred to a urologist for other treatment options.

In patients with documented low testosterone levels, testosterone supplements are used in place of or in addition to a oral medication. Addressing other risk factors for ED, such as removing the patient from medications that cause ED; treating sleep disorders; reducing stress; counseling the patient to limit or quit smoking, alcohol, and recreational drug use; and educating the patient and his partner about the factors that can escalate ED, may help to improve treatment outcomes in addition to the use of oral medication.

Conclusion

ED and heart disease are often coexisting conditions, and ED may be a sign of a serious, even life threatening heart disease. Therefore, it is in a man’s best medical interest, if he has ED, to see his physician in order to discover any underlying heart disease.

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Reprinted with permission from Dialog Medical, dialogmedical.com.

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