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Journal of Cardiovascular Electrophysiology , 11: 1022-1028. Prediction of defibrillation outcome by epicardial activation patterns following shocks near the defibrillation threshold. Journal of Cardiovascular Electrophysiology , 11: 1014-1021. Chattipakorn N, Banville I, Gray RA & Ideker RE (2004). Effects of shock strengths on ventricular defibrillation failure. Sildenafil in patients with cardiovascular disease. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Alloggiamento T, Zipp C, Raxwal VK, Ashley E, Dey S, Levine S & Froelicher VF (2001). Padma-Nathan H, Eardley I, Kloner RA, Laties AM & Montorsi F (2002). A 4-year update on the safety of sildenafil citrate (Viagra). McGovern PG, Jacobs Jr DR, Shahar E, Arnett DK, Folsom AR, Blackburn H & Luepker RV (2001). Trends in acute coronary viagra 100mg tablet online shopping heart disease mortality, morbidity, and medical care from 1985 through 1997: the Minnesota heart survey. Sildenafil: a 4-year update in the treatment of 20 million erectile dysfunction patients. Geelen P, Drolet B, Rail J, Berube J, Daleau P, Rousseau G, Cardinal R, O'Hara GE & Turgeon J (2000). Sildenafil (Viagra) prolongs cardiac repolarization by blocking the rapid component of the delayed rectifier potassium current. Swissa M, Ohara T, Lee MH, Kaul S, Shah PK, Hayashi H, Chen PS & Karagueuzian HS (2002). Sildenafil-nitric oxide donor combination promotes ventricular tachyarrhythmias in the swine right ventricle. Vardi Y, Bulus M, Reisner S, Nassar S, Aboud L, Sprecher E & Gruenwald I (2003). Effects of sildenafil citrate (Viagra) on hemodynamic parameters during exercise testing and occurrence of ventricular arrhythmias in patients with erectile dysfunction and cardiovascular disease. Kaya D, Guler C, Esen AM, Barutcu I & Dincel C (2004). Sildenafil citrate does not alter ventricular repolarization properties: novel evidence from dynamic QT analysis. Annals of Noninvasive Electrocardiology , 9: 228-233. Sildenafil (Viagra) reduces arrhythmia severity during ischaemia 24 h after oral administration in dogs. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Sildenafil induces delayed preconditioning through inducible nitric oxide synthase-dependent pathway in mouse heart. Das S, Maulik N, Das DK, Kadowitz PJ & Bivalacqua TJ (2002). Cardioprotection with sildenafil, a selective inhibitor of cyclic 3',5'-monophosphate-specific phosphodiesterase 5. Drugs under Experimental and Clinical Research , 28: 213-219. Effects of sildenafil on myocardial infarct size, microvascular function, and acute ischemic left ventricular dilation. Ockaili R, Salloum F, Hawkins J & Kukreja RC (2002). Sildenafil (Viagra) induces powerful cardioprotective effect via opening of mitochondrial K(ATP) channels in rabbits. The pharmacology of sildenafil, a novel and selective inhibitor of phosphodiesterase (PDE) type 5. Japanese Journal of Pharmacology , 114 (Suppl 1): 22P-26P. Late preconditioning elicited by activation of adenosine A(3) receptor in heart: role of NF-kappa B, iNOS and mitochondrial K(ATP) channel. Journal of Molecular and Cellular Cardiology , 34: 263-277. The role of mitochondrial KATP channels in cardioprotection. Protein kinase C plays an essential role in sildenafil-induced cardioprotection in rabbits. Chattipakorn, Cardiac Electrophysiology Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. Research supported in part by the Thailand Research Fund (TRF) grant RSA4680010 (N. Chattipakorn) and the funding from the China Medical Board, Faculty of Medicine, Chiang Mai University (N. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Bandeirantes, 3900 14049-900 Ribeirao Preto SP Brazil Tel. Use of Sildenafil in Patients with Cardiovascular Disease. Armenio Costa Guimaraes, Marcus Vinicius Bolivar Malachias, Otavio Rizzi Coelho, Emilio Cesar Zilli, Rafael Leite Luna. Erectile dysfunction, formerly called impotence, is the inability of the male to achieve or maintain penile erection and thus engage in coitus 1 . It is common among patients with cardiovascular diseases or their risk factors. This dysfunction occurs mainly among individuals with coronary artery disease, after episodes of acute ischemic syndrome, hypertensive patients underpharmacologic treatment, and among viagra 25 mg buy online patients with heart failure. In approximately 85% of these cases, the fear of a cardiac event during viagra tablets online purchase coitus constitutes an important factor for erectile dysfunction 2-4 . Discovery of sildenafil citrate has represented a great development in the treatment of erectile dysfunction; it may benefit, among many others, those patients with cardiovascular diseases or with their risk factors 5 . Even though clinical trials including more than 3,700 patients with erectile dysfunction, 2,000 of them in controlled studies with placebo, have shown a good tolerance for the medication, more intense circulatory side effects may occur in individuals with cardiovascular disease, mainly those patients using medications with organic nitrates 6 . These circumstances require recommendations by specialists so that sildenafil can be safely used. In the Massachusetts Male Aging Study (MMAS), erectile dysfunction significantly correlated with 3 groups of diseases: atherosclerosis, hypertension, and diabetes mellitus 7 . The most important organic factor involved in this dysfunction is impairment of penile blood flow, common in men above 50 years of age with atherosclerosis or diabetes. It is estimated that 50% (ranging from 28% to 59%) of diabetic patients have erectile dysfunction.
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