- Encourage patients to reduce stress during sexual activity by using comfortable positions and a stress-free setting.
- When resuming sexual activity after an acute event, begin with practices that require less energy expenditure, and monitor for symptoms.
- Notify clinicians of cardiac symptoms that occur during sexual activity.
- Clarify the role of exercise in promoting intimacy and reducing the risk of myocardial infarction.
- Review medications and their potential effects on sexual function. This includes:
- Discuss that beta blockers may affect sexual function.
- Discuss role of beta blockers and nitrates in improving anginal symptoms, if present.
- Discuss the safe use of PDE-5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) for erectile dysfunction prior to initiation of these medications. Avoid the concurrent use of PDE-5 inhibitors with short- or long-acting nitrates. If chest pain develops in a patient who has taken a PDE-5 inhibitor, nitrate treatment should be delayed (ie, at least 24 hours for sildenafil, vardenafil, and avanafil* and 48 hours for tadalafil).
- For select patients, discuss whether nitrates or beta blockers can be deprescribed.
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