Sex is safe for most heart patients

(Health.com) -- If you've recently had a heart attack or heart surgery, you might be concerned that revving up your pulse during a moment of passion could be dangerous. Rest assured: Resuming sexual activity is perfectly safe for most heart patients, according to new guidelines from the American Heart Association (AHA).

Certain patients, such as those with severe heart disease who have symptoms while at rest, should put off sex until their condition has stabilized. But if you can walk briskly or climb two flights of stairs without experiencing chest pain, abnormal heart rhythms, or shortness of breath, you're almost certainly ready to start having sex again, the guidelines say.

The authors stress, however, that all heart patients should check with their doctor before resuming their sex life. Just as important, the guidelines encourage patients -- and their partners -- to discuss any feelings of sex-related anxiety or depression with a health professional.

"Both patients and the patient's spouse or partner often have anxieties about resuming sexual activity after the patient has been diagnosed with heart disease or has undergone a heart procedure," says Glenn N. Levine, M.D., the lead author of the guidelines and a professor of medicine at Baylor College of Medicine, in Houston. "Sometimes it is actually the partner who is more anxious than the patient."

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The guidelines, which appear in the journal Circulation and have been endorsed by a host of physicians' groups, are the first ever from the AHA to focus on heart disease and sex -- a subject that gets far too little attention, the authors say. Most cardiologists fail to raise the topic with their patients, and they are even less likely to ask about anxiety or depression, Levine says.

Stephen Kopecky, M.D., a cardiologist at the Mayo Clinic, in Rochester, Minnesota, says many patients who have a heart attack or undergo bypass surgery become depressed, which can reduce libido and affect sexual function. To make matters worse, he says, avoiding sex can in turn worsen depression.

"That's why it's so important for us to talk to patients about this, and tell them this is not the end of [their] sex life," says Kopecky, who has studied sexual activity in heart patients but did not participate in writing the new guidelines.

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Heart problems during sex are very rare. Less than 1% of all heart attacks are triggered by sexual activity, Levine and his coauthors note, and the odds are even lower for people who exercise regularly. A sedentary person's risk of having a heart attack roughly triples during sex, while an active person's risk rises by just 20%.

But in either case the absolute risk is extremely small, especially since intercourse typically lasts for minutes, rather than hours. The chances that a heart-attack survivor will experience another heart attack or die in any given hour is roughly 1 in 100,000, for instance; during sex those odds increase to no more than about 1 in 33,000.

Still, the guidelines recommend that heart-attack survivors wait at least a week after their attack to resume having sex. Patients who have had bypass surgery or other major heart surgery should wait at least six to eight weeks, the authors say, although sex is generally safe several days after minimally invasive surgery to clear blocked blood vessels.

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The new guidelines address all forms of heart disease, including coronary artery disease, heart failure, heart-rhythm disorders (arrhythmias), and valve problems.

If a heart patient's condition is at all uncertain after an initial consultation with a doctor, the guidelines recommend that he or she undergo an exercise stress test, which involves monitoring heart activity and breathing while walking (or running) on a treadmill.

Even after being cleared for sex, patients may want to take some basic precautions. According to the guidelines, doctors should advise their patients to avoid heavy meals and alcohol before sex, use a position that allows for free breathing, and avoid "unfamiliar surroundings and partners." (Most documented cases of sudden death during intercourse involve extramarital sex, the guidelines note.)

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In addition, patients may need to temporarily lower their expectations. "The achievement of orgasm may require a greater degree of exertion and may not be a realistic initial goal in some patients," Levine and his colleagues write.

Heart patients' concerns about intimacy are "one of those things that gets swept under the rug too often, by not only the caregivers but also the patient and the spouse or the family," Kopecky says. "I think having guidelines like this is very helpful -- to have it out there and talk about [sex] and say it is OK to do."

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