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Erectile dysfunction is a frequent condition in cardiovascular patients. Since the arrival of oral erection-supporting medication, patients want to know how safe sexual activity is in cardiovascular disease in general and during use of erection-supporting medication in particular. Sexual intercourse with a steady partner causes no more cardiovascular risk than normal daily activities such as ironing, 2 kilometers of walking without climbing, paperhanging, playing golf or gardening. The relative risk of myocardial infarction during sexual activity is not significantly higher than for healthy persons. The incidence of cardiovascular morbidity and mortality is not higher among users of sildenafil. Sildenafil is contraindicated in patients using long-acting nitrates or who may need to use short-acting nitrates, because the combination may cause a sharp fall of the blood pressure. No interactions have been observed with beta-receptor blockers, calcium antagonists, thiazide and loop diuretics and ACE inhibitors. Before prescribing a symptomatic (pharmaceutical) treatment for patients with an erection disorder, attention should be given tot the sexological, psychological and medical backgrounds of the disorder. Secondary prevention of atherosclerotic risk factors is also important: regulation of blood pressure and blood sugar level, hyperlipidaemia and obesity, as well as a change of lifestyle (giving up smoking, adapting of diet and more physical exertion). Patients with a very low cardiac capacity should be advised to refrain from treatment of the erection disorder.

From 1980 to 1988 direct arrhythmia surgery was performed in 121 patients suffering from postinfarction drug-refractory ventricular tachycardia (VT). By 1986 the initially high in-hospital mortality of 26% (18 of 69 patients) had decreased to 1.9% (1 of 52 patients). The 3-year actuarial survival of patients operated since 1986 is 90%. From 1985 the results of surgical therapy of VT have improved: 86% of the patients remained arrhythmia-free without drugs; none died suddenly. Residual left ventricular function was related to the prognosis, but the interval between the last myocardial infarction and time of surgery or the surgical technique were not. These results demonstrate that direct surgery has become a valuable method in the treatment of postinfarction VT, at least in patients with sufficient residual left ventricular function.

In 1986, 1124 patients were selected for coronary artery bypass surgery (CABG). Of patients in line for CABG 25 (2.2%) died of a cardiac cause before operation. This complies with a cardiac mortality risk of 8.3 patients per 100 patient years follow-up. To assess patient characteristics predictive for early mortality before surgery, 25 deceased patients were analysed and compared with 50 controls matched by age, gender, type of surgery and priority. Using multivariate analysis, cardiac enlargement on chest X-ray, positive exercise testing with short duration (less than 6 minutes), smoking, coumarin treatment, unstable angina just prior to angiography and left main or three-vessel disease were independent predictors for death while waiting for CABG. We conclude that patients with the above mentioned characteristics have an increased short term mortality while waiting for CABG. These indicators may contribute important information for determination of priority in patients at high risk while waiting for CABG.