Sexual dysfunction related to drugs: a critical review. Part IV: cardiovascular drugs.

INTRODUCTION: Sexual dysfunction is a potential side effect of cardiovascular drugs: this article is a critical review of the current literature. Many studies have been published on this topic. Most of these studies are not methodologically robust, few are RCTs and most did not use a validated rating scale to evaluate sexual functioning. In addition, other methodological flaws limit greatly the conclusions of these studies. Most studies relate to male populations and only a few have been conducted on women. Also, the majority of studies on sexual dysfunction induced by cardiovascular drugs relate to antihypertensive drugs. While there is evidence to suggest that older antihypertensive drugs (diuretics, beta-blockers, centrally acting agents) have a negative impact on erectile function, newer agents seem to have either neutral (ACE inhibitors, calcium antagonists) or beneficial effects (i. e., angiotensin receptor blockers, nebivolol). Other cardiovascular drugs analyzed in this review also appear to have an inhibitory action on sexual function. For men, there is some weak evidence supporting the use of specific treatment strategies for sexual dysfunction associated with these drugs. METHODS: This study was conducted in 2014 using the paper and electronic resources of the library of the "Azienda Provinciale per i Servizi Sanitari (APSS)" in Trento, Italy (http://atoz.ebsco.com/Titles/2793). The library has access to a wide range of databases including DYNAMED, MEDLINE Full Text, CINAHL Plus Full Text, The Cochrane Library, Micromedex healthcare series, BMJ Clinical Evidence. The full list of available journals can be viewed at http://atoz.ebsco.com/Titles/2793 or at the APSS web site (http://www.apss.tn.it). In completing this review, a literature search was conducted using the key words "cardiovascular", "adrenergic beta antagonist", "α1-adrenoceptor antagonist", "angiotensin converting enzyme inhibitor", "angiotensin receptor antagonist", "angiotensin receptor blocker", "beta blocker", "beta receptor antagonist", "calcium channel blocker", "diuretic", "antihypertensive", "sexual dysfunction", "sexual side effects", "treatment-emergent sexual dysfunction". All resulting listed articles were reviewed. CONCLUSION: The review includes studies that investigated the relationship between these drug treatments and sexual dysfunction. The purpose was to identify possible intervention strategies for sexual dysfunction related to these drugs.

[Hemodynamic and coronary angiographic performance at a center with medium-low activity: organization model, activity indicators, and costs]. / Performance emodinamica e coronarografica in un centro a medio-basso volume di attività: modello organizzativo, indicatori di attività e costi.

BACKGROUND: In order to evaluate the cost-effectiveness of coronary angiography performed in a low volume Center, we examined our 1-year activity. METHODS: The organizational model of the multipurpose cardiac catheterization laboratory is described. In this type of facility both coronary angiographic and electrophysiological studies are performed. To evaluate the laboratory performance we examined the utilization level, the appropriateness of the studies, the complication rates and the number of studies that had to be repeated because of inadequate data or image quality. The costs were calculated for the in-house laboratory setting (the actual scenario) and for the 25 km distant laboratory setting (the historical scenario). RESULTS: The laboratory caseload of coronary angiography was 342 studies, 46% of the overall laboratory activity; 175 patients (51%) underwent non-pharmacological therapy, 129 patients (38%) were treated with medical therapy; the percentage of patients with normal coronary arteries was 11%. Two patients (0.58%) had vascular complications, 1 patient (0.29%) developed an acute myocardial infarction 2 hours after coronary angiography without any evidence of angiographic modifications at the repeated study. In no patient the study had to be repeated because of inadequate data or image quality. The mean cost of a coronary angiography was Lit. 512,000 (265 Euro) for the actual scenario; it would have been Lit. 694,000 (359 Euro) for the historical scenario, with Lit. 182,000 (94 Euro) saved. CONCLUSIONS: These findings are consistent with the accepted criteria of good laboratory performance and cost-effectiveness. Thus coronary angiography can be performed effectively and efficiently in a low volume Center.

Pharmacological atrial defibrillation via temporarily occluded coronary sinus: first clinical experience and implications for an implantable device.

UNLABELLED: The aim of this paper is to report the first experience of pharmacological atrial defibrillation in humans via a temporarily occluded coronary sinus. PATIENTS AND METHODS: In 6 patients (3 women, 3 men; mean age 57.8y, min 31, max 71), with clinical recurrences of atrial fibrillation, an occlusive coronary venogram was carried out in order to establish the origin of the Vein of Marshall. Atrial fibrillation was then induced by atrial pacing in all the patients and after an adequate waiting period to assure that the atrial fibrillation episode was persistent and stable, a bolus of a very low dose of an antiarrhythmic drug was delivered in 3-4 seconds into the temporarily balloon occluded coronary sinus near the orifice of the vein of Marshall. For both the venogram and the pharmacological test a Baim-Turi (USCI-Bard, Billerica MA) or a Vueport (Cardima, Fremont CA) catheter was used. RESULTS AND COMMENTS: In five patients a single dose of 7 mg of propafenone was immediately effective in restoring the sinus rhythm. In the remaining patient 2 doses of 7mg of propafenone failed to interrupt the arrhythmia, which was subsequently interrupted by a bolus of 0.1mg of ibutilide fumarate given after a waiting period of 20 minutes. Retroperfusion of the left atrium could account for these results; in fact the Vein of Marshall has no valvular apparatus in contrast with other coronary sinus tributary veins which are equipped with an uni- or bicuspidal valve. CONCLUSIONS: Pharmacological atrial defibrillation with a minimal dose of an antiarrhythmic drug delivered near the orifice of the Vein of Marshall via the temporarily occluded coronary sinus is feasible and effective. This new pharmacological atrial defibrillation can offer interesting opportunities in developing an implantable pharmacological atrial defibrillator.

[Efficacy of treatment with rt-PA of massive pulmonary embolism in patients with contraindications for thrombolytic therapy]. / Efficacia del trattamento con rt-PA dell'embolia polmonare massiva in pazienti con controindicazioni alla terapia trombolitica.

Pulmonary embolism is a life-threatening condition that is accompanied by significant morbidity and mortality. In massive pulmonary embolism, where restoration of pulmonary arterial flow is urgently required, the only options available are surgical thromboembolectomy and/or thrombolytic therapy. Unfortunately, a large part of thromboembolic diseases is also considered as an absolute or relative contraindication to thrombolysis. The purpose of this paper was to emphasize the possibility of new thrombolytic agents of disregarding, according to circumstances, the contraindications to thrombolytic treatment.

High impedance and low energy stimulation with bipolar ultrasmall electrode surface area steroid eluting lead (CapSure Z)

Thirty-five patients received a Capsure Z Medtronic bipolar model 5034 for the ventricle and 5534 for the atrium. These have 1.2 mm2 totally proprous, platinized, steroid eluting distal electrodes. The control group was repesented by 14 consective patients reciving CapSure SP medtronic model 5024 for the ventricle and 5524 for the atrium. At implant and during the follow-up period (6 months), CapSure Z and SP showed similar low pacing theresholds without early peaking in atrium (0.5 +/- 0.26 V vs 0 +/- 0.21 V at 0.5 msec P=NS., 0.06 +/- 0.01 msec at 1.6 V P=NS, respectively) and while Capsure Z showed a lewr value at six months in ventricle (0.3 +/- 0.1 V vs ).4 +/- 0.23 V P=NS, respectively) and while Capsure Z showed a lower value at six months in ventricle (0.3 +/- V vs 0.4 +/- 0.23 V P=NS at 0.5 msec, 0.07 +/- 0.03 msec. vs 0.1 +/- 0.02 msec. P<0.02 at 1.6V, repectively). P and R wave sensing of CapSure Z was better thant that of CapSure SP at implant (P wave + 5 +/- 2.5 mV vs 3.80 +/- 1.95 m;R wave = 15.2 +/- 6.4 mV vs 13.13 +/- 5.5 mV, respecitively) and during the follow-up period achieving statistical significance at the 6 th mont oly for P wave (P wave = 3.33 +/- 1.6 mV vs 2.61 +/- 1.05 mV P<0.05; R wave = 13.9 +/- 5.17 vs 10.8 +/- 5.75 mV, P=NS). CapSure Z atrial and ventricular pacing impedance were double than that of CapSure SP one at implant (atrium: 1050 +/- 214 vs 491 +/- 51; ventricle: 1296 +/- 236 vs 481 +/- 81, p< 0.0001) and during the follow-up period (atrium: 1081 +/- 185vs553 +/- 60; ventricle 1186 +/- 256 vs 656+/- 68, P< 0.0001).

Acute and chronic electrophysiological effects of pentisomide on the sinus and AV nodal function, noninvasive evaluation by a pacemaker with temporary pacing inhibition.

The acute and chronic electrophysiological effects on sinus function and AV nodal conduction of pentisomide (Pen), a new antiarrhythmic agent, were studied in ten patients with sick sinus syndrome (SSS) (group I) and in ten patients with normal sinus function (group II) using a permanent pacemaker with temporary pacing inhibition (Symbios 7005 Medtronic, Inc.). We measured noninvasively the corrected sinus node recovery time (CSNRT), the sino-atrial conduction time (SACT), according to Narula's method and the Wenckebach point before and after Pen administration, acutely and orally for 10 days. In group I intravenous injection (4 mg/kg) and oral administration (450 mg bid) of Pen significantly prolonged the CSNRT (+217% and +149%, respectively) and the SACT (+63% and +49%, respectively). In group II only the intravenous injection of Pen provoked a significant modification of CSNRT (+12%) and SACT (+14%). No modification in AV nodal conduction was noted in any patient. These results suggest that Pen must be used with caution in patients with sinus nodal dysfunction.