After suffering from a heart attack, or undergoing a bypass surgery or angioplasty, most patients are very apprehensive about resuming their sex life. Since sex tends to be a taboo topic, most of them do not even discuss it with their spouse, let alone their doctor, and consequently a fear develops around the subject. The fear is centred on the effects of sexual activity and of 'straining the heart'. This fear is exacerbated by movies, which often depict a person having a heart attack while in the middle of sexual activity.
Some famous people who actually died during sexual activity perpetuate the myth. Nelson Rockefeller, the Vice-President of the United States, died in 1979 while in the 'intimate company' of a young female aide. In reality, the amount of effort required for sexual activity is similar to that required to climb two flights of stairs, or walking at a pace of 4–5 km/hour. This may disappoint many men who might have overestimated their sexual prowess. Studies conducted (primarily in young married men), have shown that the heart rate rarely exceeds 130 beats/minute during sexual activity, and the physiological workload on the body is in the range of 3–5 METS. The term METS refers to the oxygen consumption of the body, with 1 MET representing the consumption at rest. In other words, during sexual activity, oxygen consumption is three to five times that of rest. While this is a small workload for the hearts of most young or middle-aged people, it can represent a higher workload for older individuals, and they need to be counselled accordingly. It's a failing on most doctors' parts that we do not discuss this subject, especially with our older patients. For some reason, we just assume that after the age of 70, most Indians will have slowed down or stopped their sex lives. Which is why when a 77-year-old patient of mine (I am not going to name him) asked me when he could resume his sex life, it took me a little by surprise, especially since he happened to be a widower.
The amount of effort required for sexual activity is similar to that required to climb two flights of stairs, or walking at a pace of 4–5 km/hour.
When can you resume sexual activity?
Sexual activity can be safely resumed in about four weeks following an uncomplicated heart attack or angioplasty. Of course, the term 'uncomplicated heart attack' itself sounds like a paradox, but it indicates that the person did not have any other organ failure or prolonged stay in the ICU or need to be put on a ventilator. After an open heart surgery, it is safe to wait for six to eight weeks after the operation to allow the chest bone (sternum) to heal completely. Research has shown that patients who are exercising in a structured cardiac rehabilitation program have a better exercise capacity and this is associated with a lower risk of angina during sexual activity. Angina d'amour is the French phrase for angina that occurs during or immediately after sexual activity, and it is rare in patients who otherwise do not experience angina on exertion.
After a heart event it is quite normal to experience a drop in sexual desire, which may also be associated with a little bit of depression. Some patients may even experience erectile dysfunction, which they often describe as a loss of 'power'. There are drugs such as Viagra which are helpful in these cases, and they can be taken safely alongside most cardiac drugs. However, if you are taking a class of drugs known as nitrates (which are usually used for angina — such as sorbitrate), then you should not take Viagra. There is a possibility that this combination can lead to a sudden and dangerous fall of blood pressure.
In summary, sex is generally safe for those with heart disease, with a very low risk of untoward events. In fact, the only situation in which there is increased risk is when older men have been involved with younger women who are not their wives in an unfamiliar setting after excessive consumption of food and alcohol. This has actually been shown in studies, and the likely explanation is that the increased excitement associated with these unfamiliar situations puts an added strain on the heart.
• After a cardiac event, it is safe to resume sexual activity when you can climb two flights of stairs without getting out of breath.
• As a general guideline, this will be a few weeks after an angioplasty, and six to eight weeks after bypass surgery.
• It is not safe to use erectile dysfunction medication (Viagra) if you are also on anti-anginal medication (nitrates).
Excerpted with permission from The Heart Truth by Dr Aashish Contractor, published by Westland.
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