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Is Sex Safe After A Heart Attack?

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By CHARLES R. LAMBERT, MD, PhD, MBA

Published: February 8, 2008

If you have heart disease and you are having or want to have sex, questions and anxieties almost always arise. Reduced sexual desire and avoidance of sexual activity are the most common problems encountered by heart patients. These problems can be compounded by drug therapy, depression and fear by the patient — or his or her partner — that sex will bring on a heart attack, rhythm disturbance or other cardiac abnormality.

The physical demands of sex are comparable to briskly walking up several flights of stairs, although your capacity may vary depending upon the circumstances. It is usually a sprint and not a marathon. In general, full activity may be resumed four weeks after a heart attack or heart surgery; however, this recommendation must be individualized.

Your cardiologist can make recommendations about your readiness for sexual activity by using guidelines for similar forms of exercise. After a heart attack, evaluation of exercise capacity is usually monitored in a cardiac rehabilitation program and based upon stress testing and a thorough clinical evaluation. If problems exist, medications can be prescribed to help prevent cardiac abnormalities during exercise and sex.

Unfortunately, some medications for chest pain, irregular heartbeats and high blood pressure that are very effective at preventing exercise-induced cardiac stress also may cause erectile dysfunction, depression or loss of libido. Fortunately, there is almost always a combination of agents that can correct the problem altogether — though it may take some trial and error by an experienced physician.

During recovery from a heart attack or heart surgery, a patient may feel tired, sad and afraid — psychological responses that may interfere with the desire and ability to resume sex. Some depression is normal, but in most cases, it lifts within several weeks or a few months. Continued and severe depression should be evaluated and treated in all patients with heart disease.

Optimal lipid and blood pressure control, smoking cessation, diabetes management and an exercise prescription to improve and maintain good physical condition can minimize the risk of a cardiac event with any stress. These preventive measures apply whether the stress is related to exercise, emotional distress or sexual activity.

A special note of caution is warranted for men with coronary disease who also suffer from erectile dysfunction. The coexistence of both problems is not uncommon. Patients with erectile dysfunction should never take nitrates such as nitroglycerin or isosorbide if they are using drugs such as sildenafil (Viagra) or other phosphodiesterase-5 inhibitors. The interaction of nitrates and sildenafil can cause severe low blood pressure and fainting. Alternatives to nitrates are readily available and can be substituted with relative ease.

With a comprehensive cardiac evaluation and today's range of therapeutic options, all patients with heart disease should be able to pursue an active, fulfilling sex life.

Dr. Lambert is professor of cardiology at USF Health and medical director of the Pepin Heart Hospital and Kiran Patel Research Institute at University Community Hospital.

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