Health

Sex after a heart attack

Heart Smart Talk

Dr Claudine Lewis

Sunday, August 13, 2017



AFTER a heart attack, the patient and their partner are usually fearful about resuming certain routine activities — such as driving, sex, and exercise — and usually have safety concerns.

Unlike issues like driving and exercise, the issue of sex after a heart attack is not one that comes up in the review with the doctor, though it is on the mind of the patient and their partner. Sex is an important part of any healthy adult relationship. It is a conversation that you should be prepared to have with your doctor and feel free to bring it up, if your doctor hasn't.

The patient or their partner may have certain fears, such as having another heart attack or dying during sexual intercourse. Up to 2012, there was no evidence to guide caregivers in advising patients and their partners about the safety of sex after a heart attack.

The American Heart Association (AHA) published guidelines in the February 28, 2012 issue of Circulation, which provide practical advice. Where there is no research evidence to give clear guidance, the guidelines offer useful recommendations in these grey areas.

Common questions

Here are some of the common questions that patients may have regarding sex after a heart attack and the guidelines.

1. Is sex safe after a heart attack?

The question of the safety of sex after a heart attack is best answered by your physician. If you have undergone revascularisation (return of normal circulation to your heart through clearing or bypassing clogged arteries) via complete bypass surgery or stenting of blocked arteries after a heart attack, you are at low risk of having a heart attack during sex.

If you have not undergone revascularisation, your physician should have you undergo a stress test. If you can pass the stress test — having no chest pain or abnormal electrocardiogram during the stress test, then it is safe for you to resume.

2. When is sex unsafe after a heart attack?

Sex may be unsafe after a heart attack in the following situations:

• Unstable angina — chest pain without any physical activity;

• Worsening heart failure;

• Abnormal heart rhythms that are not controlled;

• Significant symptoms or severe heart disease — you should be stable and optimally managed before resuming sexual activity.

3. How long after bypass surgery or stenting can sex be resumed?

After open-heart surgery, bypass surgery, sex should be delayed until after the breast bone is healed — usually six to eight weeks. For several months after, you should avoid any position that puts stress on your chest.

If you had robotic or minimally invasive surgery, you may resume as soon as you feel ready. After stenting, if it was done from the groin, you may resume as soon as the puncture site is healed. If it was done from the wrist, you may wait a few days.

4. How stressful is sex on the heart?

During sexual intercourse, the body has responses that are normal — increased blood pressure and heart rate. In young, healthy people, the physical demands of intercourse are roughly equivalent to climbing two flights of stairs. In older people and people with heart disease, the effort may require more exertion.

In any case, the greatest increase in heart rate and blood pressure occurs for only 10-15 seconds during orgasm, after which they quickly return to baseline

5. What is the risk of a heart attack or death during intercourse?

Less than one per cent of all heart attacks occur during sexual activity. Being inactive increases that risk, so it is important to include other physical activity in your routine to help lower that risk.

Only 0.6-1.7 per cent of deaths occur during intercourse. Here are the factors that increase the risk of death that have been identified:

• 82-93 per cent male gender;

• 75 per cent extramarital sexual activity, usually with a younger partner, in an unfamiliar setting, and or after excessive food and alcohol consumption.

6. What can you do to lower your risk of heart attack or death during sexual activity?

Although the risk is low, you may be able to further lower risk by improving your stamina. This will train your heart to operate more efficiently, and make physical exertion less demanding on your heart.

The best way to achieve this is through cardiac rehabilitation. This involves the introduction and gradual increase in physical activity in a monitored setting to improve your heart function.

What you need to know

Four things you should know about sex and your heart:

1. If you don't know how much exercise you can tolerate, an exercise stress test will help to guide your doctor in advising you regarding how much physical exertion is safe for you.

2. Resuming sex is safe if you pass a stress test or can walk two flights of stairs without chest pain.

3. Cardiac rehabilitation and regular exercise can reduce the risk of heart complications during sexual activity.

4. If you are having difficulty having or maintaining an erection, please discuss this with your doctor before self-medicating with drugs such as Viagra or Cialis. They can have a dangerous interaction with some of your heart medications, especially nitrates.

Dr Claudine Lewis is an adult cardiologist and medical director at Heart Smart Centre in Montego Bay. She is also a cardiologist at the Cornwall Regional Hospital, and an associate lecturer with the University of the West Indies. Questions may be sent to questions@heartsmartcentre.com. For additional information call 684-9989 or visit the website www.heartsmartcentre.com.

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