Many people wonder whether sex can cause a heart attack. The answer may surprise you.
The sex-heart attack connection: For a healthy, middle-aged man, sexual intercourse, performed at a typical level of exertion, translates into a risk for heart attack of about one to two in one million. (There are no comparable statistics for healthy, middle-aged women — virtually all studies on heart attack and sex have focused on men.)
Why is the risk so low? It’s because sex typically isn’t strenuous enough to trigger a heart attack. Vigorous exertion, however, raises heart attack risk because the heart has to work harder to supply blood to the body, increasing heart rate and blood pressure. If blockages in the heart’s arteries prevent the heart from receiving enough blood to do its work, a person may suffer chest pain (angina) or a heart attack.
Red flag: If a healthy, middle-aged man has sexual intercourse with an unfamiliar and/or younger partner in unfamiliar surroundings, typical exertion levels may double — partly due to the man being motivated to try more vigorous sexual activity than usual. Feelings of heightened excitement, anxiety and/or guilt also can potentially raise the risk for a heart attack.
If you have recently suffered a heart attack, sex is probably the last thing on your mind. But once your condition has stabilized — for example, your blood pressure is normalized and any chest pain you may have experienced is controlled — you should discuss sexual activity with your cardiologist.
Good news: For most heart attack patients, sexual intercourse is rarely the cause of a subsequent attack.
What you need to know to safely engage in sex if you’ve had a heart attack — or you are at risk for one…
While the risk factors described below are aimed primarily at heart attack patients, the recommendations also can serve as general guidelines for people who have had a stroke. Levels of risk…
You may be in this category if…
You’ve been diagnosed with heart disease but have no more than two identifiable risk factors, such as high cholesterol, high blood pressure, diabetes, a sedentary lifestyle or smoking, or…
You have coronary artery disease (blockage in one or more arteries of the heart severe enough to prevent the heart from getting sufficient blood) but no history of heart attack, or you had a heart attack more than six weeks ago.
Bottom line: If you don’t have shortness of breath or pains that could be due to the heart not getting enough blood (including pain in the chest, left shoulder and arm or neck) with normal activity (such as climbing one or two flights of stairs), you are most likely in the low risk category and can probably resume sexual intercourse.
You may be in this category if…
You had a heart attack two to six weeks ago, or…
You’ve been diagnosed with heart disease and have three or more risk factors (such as those described earlier), or…
You have moderate angina or heart failure that causes shortness of breath with moderate or greater exertion, such as playing tennis or shoveling snow, or…
You had a stroke two or more weeks ago.
Bottom line: You should not have sexual intercourse until your cardiovascular disease is under control and you are considered at low risk. Other physical expressions of affection, such as kissing, hugging and foreplay, are reasonably safe.
You may be in this category if…
You had a heart attack or stroke less than two weeks ago, or…
Your angina is unstable (described above), or…
You have uncontrolled high blood pressure, or…
You have been diagnosed with congestive heart failure (severe enough to limit normal activities)… a life-threatening arrhythmia (an irregularity of heart rhythm)… hypertrophic obstructive cardiomyopathy (increased thickness of the heart muscle that limits the amount of blood pumped out to the rest of the body)… or moderate-to-severe heart valve disease (a dysfunction in one or more of the four valves that help regulate blood flow into and out of the heart).
Bottom line: As with intermediate risk, do not have sexual intercourse until your cardiovascular problem is under control.
Even men who are at low risk can decrease their chance of a heart attack during sex by minimizing strain on the heart. That means…
Digest first, make love later. The heart works harder after you eat, pumping blood to the stomach, intestines, pancreas and other digestive organs. Wait one to three hours after a meal before having sexual intercourse.
Delay sex if you’ve been under stress. Stress makes the heart work harder. Don’t have sex right after you’ve had an argument, done your taxes or even watched the news. Instead, relax for several hours before engaging in sexual intercourse.
Widely used heart medications can cause erectile dysfunction (ED) in 1% to 2% of men who take them. These include…
Beta-blockers, which slow the heart rate…thiazide diuretics, which reverse fluid retention…and clonidine, which relaxes blood vessels.
If you develop ED after taking one or more heart medications, talk to your doctor about using a lower dose that would still be effective but might not cause ED… or ask about changing to a different kind of heart medication.
If you must use a heart medication that causes ED, ask your doctor about taking an ED medication, such as sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis).
Do not use any of these ED drugs if you also take a nitrate medication for angina, such as isosorbide mononitrate (Imdur) or nitroglycerin. Check with your doctor for further advice.
