Appendix

Management Recommendations for Men with ED and Cardiovascular Disease Based on Graded Cardiovascular Risk

ED management

Cardiovascular status upon

recommendations for the

Grading of risk

presentation

primary care physician

Low risk

Asymptomatic, <3 major risk

Manage within the primary

factors for CAD, excluding

care setting

age and gender

Review treatment options

Controlled hypertension

with patient and his partner

Mild, stable angina

(where possible)

Post-successful coronary

revascularization

Mild valvular disease

LVD/CHF (NYHA class I)

Intermediate

Moderate, stable angina

Specialized evaluation

risk

Recent MI or CVA

recommended (e.g., ETT

(<6 weeks)

for angina, Echo for

LVD/CHF (NYHA class II)

murmur)

Murmur of unknown cause

Patient to be placed into high

Asymptomatic but >3 risk

or low risk category,

factors for CAD, excluding

depending upon outcome

gender and age

of testing

ED treatment can be initiated

but exercise testing

recommended to risk

stratify

High risk

Unstable or refractory angina

Refer for specialized cardiac

Uncontrolled hypertension

evaluation and

(SBP > 180 mmHg)

management

CHF (NYHA class III,IV)

Treatment for ED to be

Recent MI or CVA

deferred until cardiac

(< 2 weeks)

condition stabilized and/or

High-risk arrhythmias

specialist evaluation

Hypertrophic obstructive and

completed

other cardiomyopathies

Moderate/severe valve

disease

Note: CAD, coronary artery disease; CHF, congestive heart failure; CVA, cerebral vascular accident; Echo, echocardiogram; ED, erectile dysfunction; ETT, exercise tolerance test; LVD, left ventricular dysfunction; NYHA, New York Heart Association; SBP, systolic blood pressure. Source: Reproduced with permission from Jackson et al. (108).

Note: CAD, coronary artery disease; CHF, congestive heart failure; CVA, cerebral vascular accident; Echo, echocardiogram; ED, erectile dysfunction; ETT, exercise tolerance test; LVD, left ventricular dysfunction; NYHA, New York Heart Association; SBP, systolic blood pressure. Source: Reproduced with permission from Jackson et al. (108).

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