Sex-related cardiovascular arrest is a rare event occurring typically among middle-aged men with cardiovascular risk. The main etiologies of sex-related sudden cardiovascular arrest are acute coronary syndrome and subarachnoid hemorrhage and, to a lesser extent, chronic coronary artery disease and structural non-ischemic heart disease.Coital angina that occurs during the minutes or hours after sexual activity represents < 5% of all anginal attacks and it is rare in patients who do not have angina during strenous physical exertion. Moreover, sexual activity is the cause of < 1% of all acute myocardial infarctions. Sudden death during sexual intercourse is reported with an incidence of 0.6%–1.7%. The investigation of sudden death related to sexual activity may be difficult as it may be regarded as shameful or disgraceful to the family members and, especially to the remaining partner. Because of rarity of epidemiological data, considerable bias in the investigation of sudden death related to sexual activity has to be expected. Extramarital sexual activity with younger partner and unfamiliar setting seems to represent risk factor as well as excessive food and alcohol consumption.
Studies have reported the increased to misuse of un-prescribed sildenafil for enhancing sexual performance among college going males, night clubbers and illicit drug users. Due its extensive use by the club going people as a recreational agent, it has also earned itself the dubious status of a club drug. It is used along with different recreational agents like cocaine, amphetamine, marijuana, steroids etc, which only further increases the risk of side effects. Increasing access to these drugs via the internet may facilitate such misuse. Misuse of sildenafil can have many adverse consequences. There have been case reports of aortic dissection resulting from sildenafil misuse. One case report described a type B dissection after the use of cocaine and sildenafil and an other type A aortic dissection in a patient who was using sildenafil without any prescriptions and with pre-existing heart disease.
Finally, a significant body of evidence now indicates that sildenafil generally has a good safety profile in men with erectile dysfunction and cardiovascular disease. Sildenafil therapy does not appear to be associated with ischemic events and it does not interact in a potentially hazardous way with antihypertensive or antianginal therapy, with the exception of nitrates.It may be speculated though that chronic sildenafil use induces some changes in the aortic wall that ultimately makes dissection a possibility, neverthless, until more evidence is accumulated, it appears the role of sildenafil in the causation of aortic dissection shall remain speculative.
Reference: D’Errico S, Bonuccelli D, Neri M. Post-coital death in chronic sildenafil abuser. J Geriatr Cardiol. 2020 Mar;17(3):169-172. doi: 10.11909/j.issn.1671-5411.2020.03.002. PMID: 32280335; PMCID: PMC7118010.
D’Errico S
