- Intermediate or High risk for cardiovascular disease
- Inability to exercise
- Cardiac symptoms such as angina, orthostatic hypotension, untreated arrhythmias
Intermediate Risk: Patients who are intermediate risk should undergo further testing like a stress test before engaging in sexual activity.
- Mild or moderate stable angina
- A recent myocardial infarction (more than two weeks but less than eight weeks) without intervention. In patients who have not undergone revascularization, the risk can be assessed with stress testing.
- A myocardial infarction more than six to eight weeks previously
- Asymptomatic left ventricular dysfunction with left ventricular ejection fraction <40 percent or NYHA class III heart failure
- Noncardiac manifestations of atherosclerotic disease, such as peripheral vascular disease or prior stroke, or transient ischemic attack
High Risk: Patients need to be stabilized with appropriate treatment before engaging in sexual activity.
- Unstable or refractory angina
- Uncontrolled hypertension
- NYHA class IV heart failure
- An MI within the past two weeks
- High-risk arrhythmias
- Obstructive hypertrophic cardiomyopathy with severe symptoms
- Moderate to severe valvular disease, particularly aortic stenosis