Sildenafil in the Treatment of Erectile Dysfunction

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Abstract
In their study of sildenafil in men with erectile dysfunction, Goldstein et al. (May 14 issue)1 found that the drug had few major side effects. I would like to bring to your attention two cases of ventricular tachycardia that occurred within one hour after ingestion of sildenafil. Patient 1 was a 52-year-old man who had a large myocardial infarction of the anterior wall 20 years ago, which resulted in an enlarged left ventricle and a severely depressed ejection fraction, but he had never had ventricular tachycardia. One hour after taking sildenafil, during sexual activity with his girlfriend, he felt short of breath and lightheaded. He waited an hour and then drove himself to the emergency department where he was noted to have rapid sustained monomorphic ventricular tachycardia. He promptly underwent cardioversion to sinus rhythm with direct-current countershock.