June 26, 2000 -- Albert and Mary Zarlengo of Denver, Colo., both 61, always counted their sex life as one of the pluses of their marriage.
Then came Albert's heart attack and his bypass surgery. The otherwise loving couple, scared of inducing another attack, quit having sex. It got worse. Albert, a trial lawyer who was in his early 50s when the attack occurred, became so obsessed with counting fat grams and minutes of exercise that he started to neglect Mary.
They grew apart because of his heart attack, says Mary. "Everything was for him -- his diet, his exercise, his problems. I heard constantly about his heart attack and the surgery. I gave him support, but I started to feel left out."
The Zarlengos' story is a common one. Fear of a heart attack is one of the biggest obstacles that comes between a heart patient and an active sex life, according to Wayne Sotile, PhD, a Winston-Salem, N.C., sex therapist and author of Heart Illness and Intimacy. The topic was also discussed in depth at the European Society of Cardiology Conference in Barcelona, Spain, in late 1999.
Fears of having another heart attack are understandable, especially when you don't know the statistics. There you are, in the middle of a passionate moment: What if your heart starts to act up? You can imagine all sorts of embarrassing scenarios with paramedics rushing into your bedroom. Then there's the emotional trauma you'd cause your spouse if you were to die in the middle of sex.
But excessive fear is unfounded. The risk of a subsequent heart attack caused by sex is less than 1%, according to a study of nearly 2,000 men published in the Journal of the American Medical Association in May 1996. Regular exercise (as prescribed during cardiac rehabilitation) can reduce the risk even further, the study found.
Despite the increased heart rate that accompanies sex, it is often only as strenuous as gardening, experts say. If you can climb two flights of stairs, you will probably be cleared by your doctor to have sex with your spouse, according to Robert Kloner, MD, PhD, a University of Southern California professor and director of the Good Samaritan Hospital Heart Institute, Los Angeles.
The Importance of Sex
Understandably, survival is the first order of business for someone who has had a heart attack. After that, other aspects of life need attention, too. "Sex is one of the first things that should be addressed after a person has a heart attack," says Dean Ornish, MD, author of Love and Survival: Eight Pathways to Intimacy and Health, and founder of the Preventive Medicine Research Institute in San Francisco.
Many doctors don't address sexual issues for several reasons, says Ornish. "Sexuality isn't valued in our culture," he says. "Doctors weren't trained to deal with sexual issues, and they often don't have the time to talk about it."
Getting the Help You Need
In a perfect world, doctors would sit down and discuss the patient's concerns thoroughly. But in reality, it's often up to patients or their loved ones to press their doctors for information.
A couple might consider asking which medications that boost sexual functioning are safe, if help is needed, Kloner says. For instance, Viagra, the erection-inducing drug, may or may not work for men with heart problems. For those who take nitrates, Viagra can cause dangerous falls in blood pressure. It is generally deemed safe, however, in stable heart patients when taken with other high blood pressure and heart medications, according to Kloner, whose research on the topic will be published soon in the American Journal of Hypertension.
Sometimes, patients or their families also find it helpful to reach out to others who have had the same experience. Mary took action by joining a support group.
Getting Back on Track
As the bond between Mary and Albert began to dissolve, Mary sought help through a local support group for spouses of heart attack survivors and soon came home with some new rules.
"She told me we had to talk about something other than my heart attack," Albert says. "At first I was hurt because I didn't think she cared whether I lived or died, but then I realized she was correct. It was a relief because I could sense the tension between us. We worked on putting the thrill back into our love lives."
They continued to follow the doctor's orders, but they also tried to return their sex life and social life to normal. As the Zarlengos soon learned, Albert's heart attack was an opportunity to reconnect as an intimate couple. They also discovered that their improved sex life aided in his recovery, because intimacy has a positive effect on well-being, according to Ornish.
Sex Not Just for the Sake of It
A heart patient who is intimate with his or her partner, regardless of whether actual intercourse takes place, tends to enjoy a happier, healthier life, Ornish says.
That certainly holds true for Albert and Mary. Helping Albert recover from his heart surgery meant learning how to rekindle the flames after overcoming their fears. These days, they take regular romantic getaways together.
When they're at home, Mary often surprises Albert with a house filled with candles or greets him at the door wearing a sexy negligée. "He loves it," Mary says.
Elaine Marshall is a freelance writer living in Reno, Nev. She reports for Time magazine and teaches at the Reynolds School of Journalism at the University of Nevada, Reno.