Nowadays, erectile dysfunction (ED) is considered an increasingly important clinical condition in men with
heart failure (HF) which may influence the therapeutic approach to these patients. Since there is cogent evidence that ED
is a “sentinel marker” of acute cardiovascular events especially in men younger than 65 years or in those affected by type
2 diabetes mellitus, it deserves an early diagnosis and an appropriate treatment.
In NYHA III-IV class HF patients, sexual activity could lead to acute cardiovascular events and this should be taken into
account when approaching ED patients.
Moreover, it is well known that some classes of drugs, normally employed in the treatment of HF patients (e.g.thiazide
diuretics, spironolactone and β-blockers), might worsen or even contribute to ED development. On the other hand,
growing evidence suggests that PDE 5 inhibitors (vardenafil, tadalafil and sildenafil) seem to better satisfy the needs of
NYHA HF I- II class men suffering from ED. In fact, they show few side effects, while improving both cardiopulmonary
parameters and quality of life. Therefore, the aim of this review is to sum up the most recent evidence regarding the
management of ED in men suffering from HF.