Ask a doctor on the topic of Internal medicine

Am I at risk of a heart attack?

August 29, 2016 | 15,00 EUR | answered by Dr. med. Ralf Berg

Hello,

this is a kind of continuation (partly also repetition) of my question that I already posted on Saturday.

http://frag-einen.com/arzt/allgemeinmedizin/erektionsprobleme-und-sexuelle-unlust-502786.html

I still have a few questions - especially in the cardiological area, because I am seriously concerned that I may have narrowed blood vessels and could have a heart attack or stroke. That's why I'm asking here again for safety. (This doesn't mean that I don't trust Dr. Höllering's answer - I do - but that I made the mistake of not focusing enough on the cardiological factor of my problem).

To summarize my problem again:

I (28 years old, student, severely overweight, non-smoker, hypothyroidism, no other known illnesses) have been suffering from erectile problems since Wednesday. When I masturbated in the evening, I noticed that my erection was incomplete. My penis did not become completely hard, only about 75 percent. If at all. I did reach orgasm, but with great difficulty.

I was totally surprised. I had never experienced anything like this before. Normally, I even have TOO MUCH desire. Some days I even masturbate 3 times. That's why this surprised me. But I didn't worry too much yet. I thought maybe I had just overdone it in the days before. And decided to take a day or two off.

Here comes the second surprise: because this break was easy for me. Normally, I already have a strong desire after one day without masturbating, and by the second day I am completely aroused. But this time it was easy for me. I got through Thursday easily. Friday as well (although I was very busy, so I couldn't even think about sex). But in the evening, I decided to try again. Not out of desire, but just to test if everything was okay again. But it wasn't. I reached orgasm again, but with a very soft erection. Fifteen minutes later, I tried again. Same result.

The weird thing: while masturbating, I tried to arouse myself by looking at erotic images. I found them very attractive and sexy, but still my penis wouldn't get completely hard. So I thought it couldn't be a mental problem, because then nothing would have happened. But since I found the images sexy and something did happen, that means to me as a layman: it's not a lack of desire. Not a psychological issue either. It's the blood flow.

Well, I did some research and read on various medical websites that erectile dysfunction can be a sign that important blood vessels are blocked and the penis cannot be properly supplied with blood as a result. And that these blockages can also lead to a heart attack or stroke. And now I'm terribly afraid that I could have a heart attack or stroke. I have been very nervous since then and fear the moment of impact every moment.

I have to admit that I don't really take care of myself. I have been eating too much fast food for years, getting fatter. I don't move enough. I constantly worry about all sorts of things. The only thing I don't do - and have never done - is smoke. And take drugs.

On the other hand, due to another problem (extrasystoles), I have already had 3 long-term ECGs in the last 6 years (the last one in January of this year). All these ECGs were always normal and absolutely inconspicuous. However, I have never had a stress ECG or an ultrasound. And I have read that circulatory disorders can be overlooked in a resting ECG. I didn't engage in any physically strenuous activities during the measurements.

Oh, and last month I had a blood test because my doctor wanted to see if my thyroid tablet dose was still appropriate and if the values that were elevated last year (liver values, uric acid, cholesterol) are still elevated. Result: All values have improved, although not yet optimal. But she recommended that I increase my thyroid tablet dose from 75 mg to 100 mg. I must admit that I haven't done that yet, because I still have over 60 tablets and wanted to use them up before taking the new ones. Was that maybe a mistake?

So, now you have all the information and I have talked enough. I have repeated a lot of what was already in the other question, but I think I have made my main fear a bit clearer here - the fear that I may be facing a heart attack or stroke. Is this fear justified? If so, what could be the cause of my problem? And if it's psychological, why doesn't the penis stay completely flaccid?

Thank you in advance!

P.S.: In my first question, I wrote that I still have a typical morning erection upon

Dr. med. Ralf Berg

Hello,
I have not read Mrs. Höllering's response and therefore you will receive a second medical opinion.

1. Your fear is unfounded.
2. The cause of erectile dysfunction can only be speculated about through the internet.

Regarding 1: You have no cardiac symptoms. You do have risk factors which could lead to coronary heart disease (CHD), but this takes some time. It would be a good idea to have a stress test done at some point. If this test shows abnormalities, further investigations would be justified. Negative stress tests cannot rule out CHD, but they can exclude a significant narrowing of the coronary arteries assuming maximal stress.

Regarding 2: Regarding erectile dysfunction at your age, the following should be noted:
1. They are more common than one might think.
2. They are often temporary.
3. Often, no cause can be found even after exploration.
4. Erectile dysfunction as an early symptom of CHD is rare, as the penile arteries have a larger diameter than the coronary arteries. They are more likely a secondary symptom of existing CHD. In this case, I would advise seeking sexual counseling from a specialized practice (andrologist) if the problem persists.

In summary: While heart attacks can occur at almost any age over 25, there are usually many more risk factors present than those you have described (family history, diabetes, severe lipid metabolism disorder, smoking, etc.). Erectile dysfunction is generally not an early symptom of CHD. I would advise you to pursue the two options mentioned if you continue to have great fear of a heart attack, and/or if the erectile problem persists.

Best regards,
R. Berg

PS: I do not see a direct connection with the thyroid medication.