"And if they're not anxious, believe me, their partner's anxious," he says.
Couples worry about triggering a second heart attack, or even that a patient could die in the bedroom. But Sotile and cardiologists tell WebMD that sex isn't nearly as risky as many patients believe. With a touch of reassurance, heart patients can once again enjoy sex after a heart attack.
Why Fear Sex After a Heart Attack?
While fears of another heart attack or dying are common, patients have also told Sotile that they're afraid of traumatizing their partner if they die during sex. As director of psychological services for the Wake Forest University Healthy Exercise and Lifestyle Programs, Sotile is also a special consultant in behavioral health for the Center for Cardiovascular Health at Carolinas Medical Center in Charlotte, North Carolina.
Female patients have told Nieca Goldberg, MD, a cardiologist and chief of Women's Cardiac Care at Lenox Hill Hospital in New York City, about concerns about increased heart rate and sweating during sex after a heart attack. They fear triggering heart attack symptoms.
According to Goldberg, depression also sidelines many patients, especially women.
Men are also prone to problems that cause them to put sex on the back burner. Randal Thomas, MD, a preventive cardiologist and director of the Cardiovascular Health Clinic at the Mayo Clinic, says, "A person's life is essentially thrown upside-down. They see their frailty and how close they came to dying, and it can lead to a lot of psychological issues and need for recuperation."
Some patients give up sex after a heart attack, and they're too embarrassed to talk to their doctor about it. Goldberg encourages you to bring up the subject if your doctor doesn't.
"Your doctor should talk to you about sex. With all the high-tech procedures that we do for people to get them back into the community, I also think that we have to ensure them a high quality of life, and sexual activity is part of that."
When Can You Resume Sex After a Heart Attack?
Most people can safely resume sexual activity a couple of weeks after a heart attack, if they have no serious complications, cardiologists say.
In fact, the chance of another heart attack during sex is so low that it's not worth worrying about, says James E. Muller, MD, a researcher who published a 2000 study, "Triggering of Cardiac Events by Sexual Activity," in the American Journal of Cardiology.
"The absolute risk is very low and should not be a consideration for those with stable coronary disease," he says.
"Sex is generally physical activity, and some doctors have even said it's the equivalent of walking up a flight of steps," Goldberg says. "It's not as vigorous an activity as some people perceive."
Patients may not even need an exercise stress test first to check how much physical activity their heart can handle according to Thomas. In general, patients can resume sex after a heart attack if they are "able to walk a couple of flights of stairs, if they're able to walk on a treadmill, or do moderate-intensity activity without any chest discomfort or without any severe shortness of breath," says Thomas.
Sex after a heart attack is safe even after successful bypass surgery or angioplasty in which stents are placed inside arteries to keep them open, according to Goldberg. However, bypass patients may need additional time to recover from their surgical wounds.
Certain high-risk patients do need to be more cautious, however. If they've developed complications from a heart attack--for example, heart failure or dangerous heart rhythms that make them prone to heart attack, cardiac arrest, or fainting-they may need additional treatment. Until these treatments work to reduce their cardiac risk, they should ask their doctor when it will be safe to resume sexual activity.
A Few Words of Caution
Viagra and Other Erectile Dysfunction Drugs: These drugs do not mix well with nitroglycerin, which many heart patients take to relieve angina, or chest pain. The FDA warns that the combination can send blood pressure plummeting to unsafe levels and cause dizziness, fainting, heart attack or stroke. "There have been some reports of death," Thomas says. "Anybody who's had a heart attack or heart surgery should definitely be cleared through their doctor before they think of using any of the medications for sexual dysfunction."
These drugs are used to treat high blood pressure and other heart problems. They can also reduce risk of heart attack in people who have already had one. These drugs can increase risk of sexual dysfunction for both men and women. That's especially true at high doses, according to Thomas. Beta blockers may cause you to feel depressed, Goldberg says. "You may not feel like having sex."
- Warning Signs to Stop: If you have chest pain, extreme shortness of breath, or an irregular heartbeat during sex, stop and rest. If the problem doesn't go away, call 911. "With any kind of physical activity, we'll breathe harder and our heart will beat faster," Thomas says. "If it's more than the usual type of shortness of breath or more than a moderate increase in heart rate, that would be a sign to stop and to potentially seek medical attention."
Sex After a Heart Attack: Resuming Your Romantic Life
In the weeks and months after a heart attack, it's normal for patients to have sex less frequently. But when they're ready to resume, they should proceed gradually and without fear, experts say.
"Think of sex as a particularly enjoyable workout," Sotile writes in his book, "Thriving with Heart Disease."
He advises heart attack patients to pace themselves and ease back into sexual activity. It's also best to try to have sex only when patients feel rested and relaxed.
Experts also recommend waiting from one to three hours after eating a meal to allow for digestion.
Regular exercise helps, too. "We encourage people with heart problems to get in the best shape of their lives," Thomas says. When people become more fit, their hearts are better able to handle the demands of physical activity, including sex.
Sex After a Heart Attack: Remember the Relationship
"Don't forget the relationship aspect of it," Sotile says. "To the extent that your relationship is comfortable, you will be relaxed and you will much more likely be able to function sexually.
"Heart disease gives you a second chance. Most of us in long-term relationships could use some do-overs," he adds. "I encourage people to respond to the wake-up call that heart disease delivers to make your life better."
Many heart attack survivors have told Sotile that they've become more "caring, loving and patient" after their heart attacks.
"If you take that same set of attitudes into the bedroom, your sex life can be better than it was," he says.