Sexual Activity and Ischemic Heart Disease
- 795 Downloads
Human sexuality is an important aspect of health and quality of life. Many patients with ischemic heart disease – and their partners – are concerned that sexual activity could exacerbate their cardiac condition, possibly causing myocardial infarction or cardiac death. Patients with ischemic heart disease who wish to initiate or resume sexual activity should be evaluated with a thorough medical history and physical examination. Sexual activity is reasonable for individuals with no or mild angina and those who can exercise ≥3-5 METS without angina, excessive dyspnea, or ischemic ST segment changes. For the patient who is considered not be at low cardiovascular (CV) risk or in whom the CV risk is unknown, an exercise stress test is reasonable in order to determine his or her exercise capacity and to ascertain if symptoms or ischemia may occur. Regular exercise and cardiac rehabilitation can be effective in reducing the risk of CV complications associated with sexual activity for the patient with ischemic heart disease.
KeywordsSexual activity Coital angina Coital MI Ischemic heart disease
Compliance with Ethics Guidelines
Conflict of Interest
Richard A. Lange and Glenn N. Levine declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 22.••Levine GN, Steinke EE, Bakaeen FG, et al. Sexual activity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2012;125:1058–72. This Scientific Statement from the American Heart Association is a multidisciplinary expert review of studies on sexual activity and cardiovascular disease. The Scientific Statement reviews and evaluates all data relevant to sexual activity in patients with various cardiovascular diseases, and gives recommendations on the evaluation of patients with cardiovascular disease who desire to resume sexual activity and the relative safety of sexual activity in patients with various cardiovascular conditions.PubMedCrossRefGoogle Scholar
- 23.Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60:e44–e164.PubMedCrossRefGoogle Scholar
- 29.•Dahabreh IJ, Paulus JK. Association of episodic physical and sexual activity with triggering of acute cardiac events: systematic review and meta-analysis. JAMA: J Am Med Assoc. 2011;305:1225–33. This systematic review and meta-analysis calculates the relative and absolute risks of MI and sudden cardiac death related to sexual activity, and the effects of regular physical activity on these risks.CrossRefGoogle Scholar
- 32.Krauland W, Underwarteter T. Herzinfarkt und Sexualität aus der Sicht des Rechtsmediziners [Myocardial infarction and sexuality from the coroner’s point of view]. Sexualmedezin. 1976;10:xx– xxiii.Google Scholar
- 57.Thadani U, Smith W, Nash S, et al. The effect of vardenafil, a potent and highly selective phosphodiesterase-5 inhibitor for the treatment of erectile dysfunction, on the cardiovascular response to exercise in patients with coronary artery disease. J Am Coll Cardiol. 2002;40:2006–12.PubMedCrossRefGoogle Scholar
- 63.•Van Ahlen H, Zumbe J, Stauch K, Hanisch JU. The Real-Life Safety and Efficacy of vardenafil (REALISE) study: results in men from Europe and overseas with erectile dysfunction and cardiovascular or metabolic conditions. J Sex Med. 2010;7:3161–9. This is the largest study on the safety of the PDE-5 agent vardenafil in patients with sexual dysfunction. This international, "real life" study included a high percentage of patients with cardiovascular risk factors and cardiovascular disease.PubMedCrossRefGoogle Scholar
- 64.Goldstein I, Kim E, Steers WD, et al. Efficacy and safety of tadalafil in men with erectile dysfunction with a high prevalence of comorbid conditions: results from MOMENTUS: multiple observations in men with erectile dysfunction in National Tadalafil Study in the US. J Sex Med. 2007;4:166–75.PubMedCrossRefGoogle Scholar
- 69.Kloner RA, Mohan P, Norenberg C. Cardiovascular safety of vardenafil, a potent, highly selective PDE5 inhibitor in patients with erectile dysfunction: analysis of five controlled clinical trials. Pharmacol Ther. 2002;22:1371.Google Scholar
- 93.Steinke E, Jaarsma T. In: Moser D, Riegel B, editors. Cardiac nursing: A companion to Braunwald's Heart Disease. St. Louis: Saunders Elsevier; 2008. p. 241–53.Google Scholar
- 95.Froelicher ES, Kee LL, Newton KM, et al. Return to work, sexual activity, and other activities after acute myocardial infarction. Heart & Lung: J Crit Care. 1994;23:423–35.Google Scholar
- 96.Klein R, Bar-on E, Klein J, Benbenishty R. The impact of sexual therapy on patients after cardiac events participating in a cardiac rehabilitation program. Eur J Cardiovasc Prev Rehabil: Off J Eur Soc Cardiol, Work Groups Epidemiol Prev Cardiac Rehabil Exerc Physiol. 2007;14:672–8.CrossRefGoogle Scholar