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Q: Is having sex after a heart attack a death-defying feat?

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A: Not at all. Sexual activity is considered mild to moderate exercise-comparable to a brisk walk around the block. A patient who's had a heart attack can generally resume normal sexual activities after completing the first phase of recovery and being discharged from the hospital. Patients with complications, like intermittent chest pain, arrhythmias, or evidence of heart failure, should be evaluated and stabilized by a heart specialist first.


Be sure to advise patients to promptly report shortness of breath, persistently increased heart rate (lasting 15 minutes or more after sex), extreme fatigue, chest pain, palpitations, or sleeplessness.


Facing the fear factor

"Normal sexual activities" may not seem normal to your patient right away, though. Fear that sex could precipitate another heart attack (or worse), depression, concerns about subpar sexual performance, and even adverse effects of certain medications the patient's taking (such as antihypertensives and antidepressants) can cause problems.


You can help ease the minds of patients contemplating sex after a heart attack by passing on this advice from the American Heart Association:


* Choose a time when you're rested, relaxed, and free from stress brought on by the day's activities.


* Wait 1 to 3 hours after eating a full meal to allow for digestion.


* Select a familiar, peaceful setting that's free from interruptions.


* If prescribed by your health care provider, take medicine before sexual relations.



Your patient may also have questions about the erectile dysfunction drugs sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). Tell him that he should avoid those drugs if he's taking an organic nitrate, such as a nitroglycerin ointment or patch. The combination can cause a dangerous drop in blood pressure.


Even a patient who doesn't take an organic nitrate daily should use caution: If he's taken an erectile dysfunction drug, he shouldn't use sublingual nitroglycerin if he subsequently develops chest pain. Instead, he should call 9-1-1 immediately.


Somebody say something

Some patients may assume that because they've had a heart attack, sexual activity is just a fond memory; they won't bother to bring up the topic. Others desperately want to know but are too afraid or shy to ask. So you'll have to take the initiative. Very likely, that'll give your patient one less thing to worry about during recovery-which is always a good thing.


Learn more about it


American Heart Association. Sexual activity and heart disease or stroke. Accessed July 18, 2005.


Pfizer, Inc. Viagra prescribing information. LAB-0221-4.0. Revised July 2005. Accessed July 22, 2005.


Women's Health Advisor. Sex after a heart attack. Accessed July 18, 2005.