#AskDrKK:Can heart patients have sex?

#DrKKAnswers:
1. Low risk patients can safely initiate or resume sexual activity and should receive treatment for sexual dysfunction.
2. Intermediate risk patients should receive further evaluation by stress testing.
3. High risk patients should be stabilized by appropriate therapy before resuming sexual activity or being treated for sexual dysfunction.

#AskDrKK:Can heart patients have sex?

#DrKKAnswers:
1. Low risk patients can safely initiate or resume sexual activity and should receive treatment for sexual dysfunction.
2. Intermediate risk patients should receive further evaluation by stress testing.
3. High risk patients should be stabilized by appropriate therapy before resuming sexual activity or being treated for sexual dysfunction.

#AskDrKK:Which patients are at intermediate risk for getting heart attack after sex?

#DrKKAnswers:
1. No symptoms and three or more cardiovascular risk factors (excluding gender); a sedentary lifestyle is considered a risk factor
2. Moderate, stable angina
3. A recent heart attack (> 2 weeks but less than 6 weeks); in patients who have not undergone revascularization. The risk can be assessed with stress testing.
4. Asymptomatic left ventricular dysfunction with left ventricular pumping ejection fraction <40 percent or New York Heart Association class II heart failure. 5. Non cardiac manifestations of atherosclerotic disease, such as peripheral vascular disease or prior stroke or transient ischemic attack.


Source: Am J Cardiol 2005; 96:313.

#AskDrKK: Which patients are at low risk for getting heart attack after sex?

#DrKKAnswers
1. Patients with no symptoms and less than three cardiovascular risk factors (excluding gender)
2. Patients with controlled blood pressure
3. Patients with mild, stable angina
4. After bypass surgery
5. After six to eight weeks of acute heart attack (asymptomatic and negative exercise-induced ischemia)
6. After 3-4 weeks of acute heart attack who have undergone successful revascularization
7. Mild valvular disease
8. Pericarditis, mitral valve prolapse, or atrial fibrillation with a controlled ventricular response.
Source: Am J Cardiol 2005; 96:313.

#AskDrKK:Which patients are at high risk for getting heart attack after sex?

#DrKKAnswers:
1. Patients with unstable or refractory angina
2. Uncontrolled hypertension
3. New York Heart Association class III or IV heart failure
4. A heart attack within the past two weeks
5. High-risk irregular heart rhythms
6. Patients with obstructive hypertrophic cardiomyopathy
7. Patients with moderate-to-severe valvular disease, particularly aortic stenosis

Source: Am J Cardiol 2005; 96:313

#AskDrKK: Does exercise reduces chances of heart attack after sex in heart patients?

#DrKKAnswers:

1. The risk of acute heart attack after sexual act is reduced in patients who exercise regularly (1,2).
2. Regular physical exercise should be done at levels of ≥6 METs to reduce the risk (3).
3. The more regularly a person exercises the lower will be the heart attack risk.
4. Regular exercise also reduces the risk of heart attack and sudden death from heavy physical exertion (4,5)
5. Exercise training increases the aerobic capacity and decreases the peak heart rate in post-heart attack subjects engaging in sexual act (6).

References
1. JAMA 1996; 275:1405.
2. Heart 2001; 86:387.
3. Am J Cardiol 2000; 86:14F.
4. N Engl J Med 1993; 329:1677.
5. N Engl J Med 2000; 343:1355.
6. Circulation 1977; 55:738.

#AskDrKK:What is the absolute risk of acute heart attack after sex?

DrKKAnswers:


Sexual act is a transient trigger that increases risk of heart attack for only a two hour period. The absolute increase in risk is very small.

A 50 year-old man with no cardiac disease with an annual baseline risk of heart attack of 1 percent would increase his annual risk of heart attack to only 1.01 percent from weekly sexual activity.

A person with a high annual risk for a heart attack of 10 percent would increase the annual risk to only 10.1 percent from weekly sexual activity.

Source: Am J Cardiol 2000; 86:10F.

#AskDrKK: Which position is better for sex in heart patients?

#DrKKAnswers:
There is no difference in heart rate (114 vs 117) or blood pressure (163/81 vs 161/77 mmHg) between man on top or man on bottom [1]. However there is slightly lower minute oxygen consumption for men in the supine position, but this lasts only for a brief period during orgasm [2].

References
1. Am Heart J 1976; 92:274.
2. Arch Intern Med 1984; 144:1745.