Dr. John Ryan offers some reassurance and says there’s a simple test you can do on your own to determine if your heart is ready. Find out the real deal when it comes to returning to sex after a heart attack, if enhancement drugs change things and what you need to know if you have a pacemaker.">

Feb 24, 2016 — Fewer than 20 percent of heart attack victims discuss with their doctors when it’s OK to have sex again. As a result, some patients worry about when is too soon and whether something bad happen. Cardiologist Dr. John Ryan offers some reassurance and says there’s a simple test you can do on your own to determine if your heart is ready. Find out the real deal when it comes to returning to sex after a heart attack, if enhancement drugs change things and what you need to know if you have a pacemaker.

Interview

Interviewer: You're recovering from a heart attack and want to know when your heart is healthy enough for sex again. Cardiologist Dr. John Ryan answers that question, next on The Scope.

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Interviewer: Dr. Ryan, this conversation is for somebody who has had heart issues or a heart attack, and now they want to, or their spouse wants to get back to having sex again. How will they know it's okay? First of all, is this a question you get asked a lot?

Dr. Ryan: It's not a question we get asked a lot, but I think it's a question that people have a lot, but sex, in clinic at least, can be such a taboo subject. Either folks who've the heart attack don't want to bring it up, or their spouses don't want to bring it up, and the providers don't want to bring it up even though it's a very important subject to address.

Interviewer: Because we're talking quality of life, right? We're talking just like anything else that we look for a quality of life. So you would encourage your patients to ask if they have any questions.

Dr. Ryan: Yeah, and oftentimes we bring it up, and as I said, they have these concerns in the background. The American Heart Association and others have given us some guidance about sex after a heart attack, and one of the key issues is that if you've started being able to walk up two flights of stairs. It's an exertional activity like anything else. It's actually not as strenuous as many people also think.

Interviewer: Yeah I was just going to ask. Well, if you're talking two flights of stairs, that doesn't sound like . . . okay.

Dr. Ryan: So it's often important to reinforce it's not like the movies. It's not quite as rigorous and stressful on their heart as people make it out to be. Ultimately, it is probably the equivalent of briskly going up two flights of stairs. It's about three to four metabolic equivalence, which is about a six-minute walk.

Some people may say, "Well, I can't go up two flights of stairs because I have arthritis," or something along those lines, but if you can walk for six minutes without symptoms, namely without chest pain, without shortness of breath, without feeling a pressure sensation in your chest or angina, then you're likely healthy enough to for sex.

And when you look at folks who've had heart attacks, there is so much anxiety about having sex after a heart attack. There's anxiety on the person who's had the heart attack, there's anxiety on the partner of the person who's had a heart attack because they're afraid they're going to trigger them into another heart attack by asking them to have sex with them or initiating sex. So in that regard it ends up being a significant issue.

Then you run into issues such as Sildenafil or Viagra or Tadalafil or Cialis, the erectile dysfunction medicines which always come with a disclaimer, "Ask your doctor if your heart is healthy enough for sex." That almost further triggers anxiety because now there's actually an ad at the intervals . . . at every time out in a football game there's an ad asking you to ask your doctor if your heart is healthy enough for sex. That raises more concerns.

But I think it is an important question to ask, and by and large, the use of erectile dysfunction medicine such as Viagra and Cialis have been shown to be safe in people with heart disease, and have shown not to be associated with increased risk of having a heart attack during sex or after taking it. So in that regard, that's safe.

Ultimately, when this issue does come up and when we introduce this issue with the folks who've had heart attacks, ultimately it ends up being reassurance and reassurance that yes, your heart is healthy enough for sex; yes, your heart is healthy enough to take erectile dysfunction medicines with sex; and yes, it is okay for your wife to have sex with you or you to have sex with your partner and you can feel comfortable about that.

Interviewer: Does it depend on the kind of heart issues that you've had or is it if you can walk, what is it, six minutes?

Dr. Ryan: I think if you can do a six-minute walk test without developing symptoms and without stopping, or if you can briskly go up two flights of stairs you should be good, or you're not at an increased risk of having any adverse events during sex.

Interviewer: If you have some sort of an assist device that doesn't . . . none of that changes it?

Dr. Ryan: No, that's fair. Yeah, the ventricular assist devices for heart failure, which are obviously increasingly common, that doesn't seem to change it, and then defibrillators or pacemakers doesn't seem to change it either. I think all in all it's another exertional activity. Also some people, if you're going to the gym, if you're going to the gym lifting weights, doing rowing machines, doing elliptical machines, if you're spinning, then you are okay to end up having sex.

Interviewer: Because you set the bar at a six-minute brisk walk.

Dr. Ryan: I know, I know.

Interviewer: And you seem very confident with this so this is very . . .

Dr. Ryan: No, it is. It's a normal activity that you can engage in.

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