Use of Phosphodiesterase Inhibitors for erectile Dysfunction is contraindicated in:

Unstable/symptomatic angina represents a High-Risk patient category (Princeton Guidelines) where phosphodiesterase inhibitors are contraindicated. Previous MI > 6weeks ago represents a low risk category as does CHF NYHA Class-I. Such patients may be initiated on a Phosphodiesterase inhibitor. Low-risk patients can initiate or resume sexual activity and begin Erectile Dysfunction treatment without fuher testing or evaluation. The PDE5 inhibitors (Sildenafil, Tadalafil and vardenafil) may be used to treat erectile dysfunction (ED) in low risk individual. Sexual Inquiry Erectile Dysfunction: Clinical Evaluation for Risk Stratification: Cardiovascular risk factors are known to be associated with the presence pf erectile dyfunction (ED), and ED is more common in men with cardiovascular disease (CVD) The Princeton Guidelines provide a strategy for assessing cardiac risk and planning a safe return to sexual activity. Low Risk Intermediate Risk High Risk Asymptomatic < 3 coronary risk factors (excluding gender) Controlled hypeension Mild, stable angina Post-successful coronary revascularization Uncomplicated previous MI (> 6-8 weeks) Mild valvular disease LVD/CHF (NYHA Class I) >/= major coronary risk factors (excluding gender) Moderate, stable angina Recent MI >2, <6 weeks LVD/CHF (NYHA Class II) Non-cardiac atherosclerotic diseases, such as CVA, PVD Unstable or refractory angina Uncontrolled hypeension LVD/CHF (NYHA Class III/IV) Recent MI or CVA (<2 weeks) High-risk arrhythmias Hyperophic obstructive and other cardiomyopathies Moderate/severe valvular disease Ref: The Second Princeton consensus on sexual dysfunction and cardiac risk; new guidelines for sexual medicine