• Cardiovascular

    TUESDAY Q & A: Different factors to consider before resuming sexual activity after heart attack

DEAR MAYO CLINIC: How long after a heart attack do I need to wait to resume sexual activity?

ANSWER: For men and women with cardiovascular disease — no matter how young or old — sexual activity is important to quality of life. But after a heart attack, it’s not uncommon to lose confidence in your heart’s ability to work properly under stress. In addition, your partner may worry that resuming sexual activity might harm you or cause physical pain, especially if you had open-chest surgery.

The good news is, it may be safe for you to resume sexual activity sooner than you think. But because each person’s situation after a heart attack is unique, be sure to talk with your doctor about your specific situation.

According to the American Heart Association (AHA), which released a statement on sexual activity and heart disease, less than 1 percent of heart attacks occur during sexual activity. Men and women have similar increases in heart rate and blood pressure during sexual activity. The greatest increases occur during the 10 to 15 seconds of orgasm and then there’s a rapid return to normal. For young to middle-aged adults, the actual physical demand is comparable to climbing two flights of stairs or walking briskly. In older adults or those with cardiovascular disease, the degree of exertion may be greater.

The risk of heart attack during sexual activity is just as low in men who have had a heart attack as it is in men with no coronary artery disease.

When discussing follow-up care with your doctor, the AHA’s recommendations can help guide your decisions. Different factors may need to be considered, such as:

Whether you’re able to pass a stress test — An exercise stress test evaluates how your heart performs during mild to moderate activity. If you experience no heart-stress signs or symptoms — such as angina (chest pain), excessive breathlessness, abnormal heart rhythm (arrhythmia) or decreased blood pressure (hypotension) — you pass the stress test. In that case, and in consultation with your doctor, it may be reasonable to resume sexual activity.

If you’re capable of mild to moderate activity without heart-stress symptoms, a cardiac rehabilitation exercise program is typically begun a week after a heart attack. This program increases exercise capacity and lowers the peak heart rate during sexual activity. In addition, regular exercise itself may help decrease risk of a heart attack triggered by sexual activity.

Whether revascularization (percutaneous coronary intervention, or PCI) was done — If angioplasty and stenting were necessary to restore blood flow to your heart’s coronary arteries and complete blood flow was restored, resumption of sexual activity may be possible in only a matter of days. The delay is necessary for healing at the puncture site — usually in the upper groin area or arm — where the catheter was introduced during the PCI procedure.

Whether you had open-chest surgery — If you’ve had coronary artery bypass surgery, sexual activity is generally not recommended for six to eight weeks so that the chest’s sternum has time to heal. Avoid for several months positions that put too much stress on the chest. With robotic surgery or minimally invasive procedures, the healing time may be considerably less.

There are circumstances where resuming sexual activity isn’t advised. Among these are having uncontrolled heart rhythm problems (arrhythmias) and having symptoms of heart failure that are worsening.  

After a heart attack, you’ll likely need medication to support your ongoing cardiovascular health.

Drugs used to treat high blood pressure and heart failure — such as diuretics, beta blockers, calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors — sometimes lower blood pressure more than anticipated. If this occurs, you may experience dizziness, lightheadedness or even fainting. Hypotension may also occur if you take medication for erectile dysfunction — such as sildenafil (Viagra) — or if you are prescribed drugs classified as alpha blockers.

Nitrate drugs, which are commonly prescribed for chest pain (angina), shouldn’t be taken if you use erectile dysfunction drugs. The combination may result in a dangerous drop in blood pressure. Tell your doctor about all medications you take.  

Your doctor may counsel you to be well rested prior to sexual activity. Avoid unfamiliar locations and partners as well as heavy meals and alcohol before sexual activity, and avoid positions that might restrict your ability to breathe. Wayne Miller, M.D., Ph.D., Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.