Sexual Activity and Ischemic Heart Disease

Abstract

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.

This is a preview of subscription content, access via your institution.

Fig. 1

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Lindau ST, Schumm LP, Laumann EO, et al. A study of sexuality and health among older adults in the United States. New Engl J Med. 2007;357:762–74.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  2. 2.

    Davey Smith G, Frankel S, Yarnell J. Sex and death: are they related? Findings from the Caerphilly Cohort Study. BMJ. 1997;315:1641–4.

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Lindau ST, Gavrilova N. Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing. BMJ. 2010;340:c810.

    PubMed Central  PubMed  Article  Google Scholar 

  4. 4.

    Friedman S. Cardiac disease, anxiety, and sexual functioning. Am J Cardiol. 2000;86:46F–50F.

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Kriston L, Gunzler C, Agyemang A, et al. Effect of sexual function on health-related quality of life mediated by depressive symptoms in cardiac rehabilitation. findings of the SPARK project in 493 patients. J Sex Med. 2010;7:2044–55.

    PubMed  Article  Google Scholar 

  6. 6.

    Papadopoulos C, Beaumont C, Shelley SI, Larrimore P. Myocardial infarction and sexual activity of the female patient. Arch Intern Med. 1983;143:1528–30.

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Papadopoulos C, Larrimore P, Cardin S, Shelley SI. Sexual concerns and needs of the postcoronary patient's wife. Arch Intern Med. 1980;140:38–41.

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Schwarz ER, Kapur V, Bionat S, et al. The prevalence and clinical relevance of sexual dysfunction in women and men with chronic heart failure. Int J Impot Res. 2008;20:85–91.

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Bohlen JG, Held JP, Sanderson MO, Patterson RP. Heart rate, rate-pressure product, and oxygen uptake during four sexual activities. Archiv Intern Med. 1984;144:1745–8.

    CAS  Article  Google Scholar 

  10. 10.

    Carmichael MS, Warburton VL, Dixen J, Davidson JM. Relationships among cardiovascular, muscular, and oxytocin responses during human sexual activity. Arch Sex Behav. 1994;23:59–79.

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Chen X, Zhang Q, Tan X. Cardiovascular effects of sexual activity. Indian J Med Res. 2009;130:681–8.

    PubMed  Google Scholar 

  12. 12.

    Exton MS, Bindert A, Kruger T, et al. Cardiovascular and endocrine alterations after masturbation-induced orgasm in women. Psychosom Med. 1999;61:280–9.

    CAS  PubMed  Google Scholar 

  13. 13.

    Kruger T, Exton MS, Pawlak C, et al. Neuroendocrine and cardiovascular response to sexual arousal and orgasm in men. Psychoneuroendocrinology. 1998;23:401–11.

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Littler WA, Honour AJ, Sleight P. Direct arterial pressure, heart rate and electrocardiogram during human coitus. J Reprod Fertil. 1974;40:321–31.

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    Stein RA. Cardiovascular response to sexual activity. Am J Cardiol. 2000;86:27F–9F.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Exton NG, Truong TC, Exton MS, et al. Neuroendocrine response to film-induced sexual arousal in men and women. Psychoneuroendocrinology. 2000;25:187–99.

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Cheitlin MD. Sexual activity and cardiac risk. Am J Cardiol. 2005;96:24M–8M.

    PubMed  Article  Google Scholar 

  18. 18.

    DeBusk R, Drory Y, Goldstein I, et al. Management of sexual dysfunction in patients with cardiovascular disease: recommendations of the Princeton Consensus Panel. Am J Cardiol. 2000;86:62F–8F.

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Drory Y, Shapira I, Fisman EZ, Pines A. Myocardial ischemia during sexual activity in patients with coronary artery disease. Am J Cardiol. 1995;75:835–7.

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Drory Y. Sexual activity and cardiovascular risk. Eur Heart J Suppl. 2002;4:H13–8.

    Article  Google Scholar 

  21. 21.

    Drory Y, Fisman EZ, Shapira Y, Pines A. Ventricular arrhythmias during sexual activity in patients with coronary artery disease. Chest. 1996;109:922–4.

    CAS  PubMed  Article  Google Scholar 

  22. 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.

    PubMed  Article  Google Scholar 

  23. 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.

    PubMed  Article  Google Scholar 

  24. 24.

    DeBusk RF. Sexual activity in patients with angina. JAMA: Journal Am Med Assoc. 2003;290:3129–32.

    CAS  Article  Google Scholar 

  25. 25.

    Baylin A, Hernandez-Diaz S, Siles X, et al. Triggers of nonfatal myocardial infarction in Costa Rica: heavy physical exertion, sexual activity, and infection. Ann Epidemiol. 2007;17:112–8.

    PubMed  Article  Google Scholar 

  26. 26.

    Masoomi M, Zare J, Kahnooj M, et al. Sex differences in potential daily triggers of the onset of acute myocardial infarction: a case-crossover analysis among an Iranian population. J Cardiovasc Med (Hagerstown). 2010;11:723–6.

    Article  Google Scholar 

  27. 27.

    Moller J, Ahlbom A, Hulting J, et al. Sexual activity as a trigger of myocardial infarction. A case-crossover analysis in the Stockholm Heart Epidemiology Programme (SHEEP). Heart. 2001;86:387–90.

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Muller JE, Mittleman MA, Maclure M, et al. Triggering myocardial infarction by sexual activity. Low absolute risk and prevention by regular physical exertion. Determinants of Myocardial Infarction Onset Study Investigators. JAMA: J Am Med Assoc. 1996;275:1405–9.

    CAS  Article  Google Scholar 

  29. 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.

    Article  Google Scholar 

  30. 30.

    Moss AJ, Benhorin J. Prognosis and management after a first myocardial infarction. New Engl J Med. 1990;322:743–53.

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Ueno M. the So-Called Coition Death. Nihon Hoigaku Zasshi. 1963;17:330–40.

    CAS  PubMed  Google Scholar 

  32. 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 

  33. 33.

    Parzeller M, Raschka C, Bratzke H. Sudden cardiovascular death in correlation with sexual activity – results of a medicolegal postmortem study from 1972–1998. Eur Heart J. 2001;22:610–1.

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Stein RA. The effect of exercise training on heart rate during coitus in the post myocardial infarction patient. Circulation. 1977;55:738–40.

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Eyada M, Atwa M. Sexual function in female patients with unstable angina or non-ST-elevation myocardial infarction. J Sex Med. 2007;4:1373–80.

    PubMed  Article  Google Scholar 

  36. 36.

    Bansal S. Sexual dysfunction in hypertensive men. A critical review of the literature. Hypertension. 1988;12:1–10.

    CAS  PubMed  Article  Google Scholar 

  37. 37.•

    Baumhakel M, Schlimmer N, Kratz M, et al. Cardiovascular risk, drugs and erectile function--a systematic analysis. Int J Clin Pract. 2011;65:289–98. Comprehensive review and analysis of the effects of common cardiovascular drugs on erectile function.

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    Dusing R. Sexual dysfunction in male patients with hypertension: influence of antihypertensive drugs. Drugs. 2005;65:773–86.

    PubMed  Article  Google Scholar 

  39. 39.

    Erdmann E. Safety and tolerability of beta-blockers: prejudices & reality. Indian Heart J. 2010;62:132–5.

    PubMed  Google Scholar 

  40. 40.

    Franzen D, Metha A, Seifert N, et al. Effects of beta-blockers on sexual performance in men with coronary heart disease. A prospective, randomized and double blinded study. Int J Impot Res. 2001;13:348–51.

    CAS  PubMed  Article  Google Scholar 

  41. 41.

    Grimm Jr RH, Grandits GA, Prineas RJ, et al. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS). Hypertension. 1997;29:8–14.

    CAS  PubMed  Article  Google Scholar 

  42. 42.

    Jackson G, Betteridge J, Dean J, et al. A systematic approach to erectile dysfunction in the cardiovascular patient: a Consensus Statement–update 2002. Int J Clin Pract. 2002;56:663–71.

    CAS  PubMed  Google Scholar 

  43. 43.

    Ko DT, Hebert PR, Coffey CS, et al. Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA: J Am Med Assoc. 2002;288:351–7.

    CAS  Article  Google Scholar 

  44. 44.

    Cocco G. Erectile dysfunction after therapy with metoprolol: the Hawthorne effect. Cardiology. 2009;112:174–7.

    CAS  PubMed  Article  Google Scholar 

  45. 45.

    Silvestri A, Galetta P, Cerquetani E, et al. Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo. Eur Heart J. 2003;24:1928–32.

    CAS  PubMed  Article  Google Scholar 

  46. 46.

    Boydak B, Nalbantgil S, Fici F, et al. A Randomised Comparison of the Effects of Nebivolol and Atenolol with and without Chlorthalidone on the Sexual Function of Hypertensive Men. Clin Drug Investig. 2005;25:409–16.

    CAS  PubMed  Article  Google Scholar 

  47. 47.

    Brixius K, Middeke M, Lichtenthal A, et al. Nitric oxide, erectile dysfunction and beta-blocker treatment (MR NOED study): benefit of nebivolol versus metoprolol in hypertensive men. Clin Exp Pharmacol Physiol. 2007;34:327–31.

    CAS  PubMed  Article  Google Scholar 

  48. 48.

    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.

    PubMed  Article  Google Scholar 

  49. 49.

    Cheitlin MD, Hutter Jr AM, Brindis RG, et al. Use of sildenafil (Viagra) in patients with cardiovascular disease. Technology and Practice Executive Committee. Circulation. 1999;99:168–77.

    CAS  PubMed  Article  Google Scholar 

  50. 50.

    Kloner RA, Brown M, Prisant LM, Collins M. Effect of sildenafil in patients with erectile dysfunction taking antihypertensive therapy. Sildenafil Study Group. Am J Hypertens. 2001;14:70–3.

    CAS  PubMed  Article  Google Scholar 

  51. 51.

    Kloner RA, Mitchell M, Emmick JT. Cardiovascular effects of tadalafil in patients on common antihypertensive therapies. Am J Cardiol. 2003;92:47M–57M.

    CAS  PubMed  Article  Google Scholar 

  52. 52.

    Kostis JB, Jackson G, Rosen R, et al. Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference). Am J Cardiol. 2005;96:85M–93M.

    PubMed  Article  Google Scholar 

  53. 53.

    Olsson AM, Persson CA. Swedish Sildenafil Investigators G. Efficacy and safety of sildenafil citrate for the treatment of erectile dysfunction in men with cardiovascular disease. Int J Clin Pract. 2001;55:171–6.

    CAS  PubMed  Google Scholar 

  54. 54.

    Kloner RA. Cardiovascular effects of the 3 phosphodiesterase-5 inhibitors approved for the treatment of erectile dysfunction. Circulation. 2004;110:3149–55.

    PubMed  Article  Google Scholar 

  55. 55.

    Morales AM, Mirone V, Dean J, Costa P. Vardenafil for the treatment of erectile dysfunction: an overview of the clinical evidence. Clin Interv Aging. 2009;4:463–72.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  56. 56.

    Padma-nathan H, Eardley I, Kloner RA, et al. A 4-year update on the safety of sildenafil citrate (Viagra). Urology. 2002;60:67–90.

    PubMed  Article  Google Scholar 

  57. 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.

    CAS  PubMed  Article  Google Scholar 

  58. 58.

    Arruda-Olson AM, Mahoney DW, Nehra A, et al. Cardiovascular effects of sildenafil during exercise in men with known or probable coronary artery disease: a randomized crossover trial. JAMA: J Am Med Assoc. 2002;287:719–25.

    CAS  Article  Google Scholar 

  59. 59.

    Mittleman MA, Maclure M, Glasser DB. Evaluation of acute risk for myocardial infarction in men treated with sildenafil citrate. Am J Cardiol. 2005;96:443–6.

    CAS  PubMed  Article  Google Scholar 

  60. 60.

    DeBusk RF, Pepine CJ, Glasser DB, et al. Efficacy and safety of sildenafil citrate in men with erectile dysfunction and stable coronary artery disease. Am J Cardiol. 2004;93:147–53.

    CAS  PubMed  Article  Google Scholar 

  61. 61.

    Fox KM, Thadani U, Ma PT, et al. Sildenafil citrate does not reduce exercise tolerance in men with erectile dysfunction and chronic stable angina. Eur Heart J. 2003;24:2206–12.

    CAS  PubMed  Article  Google Scholar 

  62. 62.

    Kloner RA, Jackson G, Hutter AM, et al. Cardiovascular safety update of Tadalafil: retrospective analysis of data from placebo-controlled and open-label clinical trials of Tadalafil with as needed, three times-per-week or once-a-day dosing. Am J Cardiol. 2006;97:1778–84.

    CAS  PubMed  Article  Google Scholar 

  63. 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.

    PubMed  Article  Google Scholar 

  64. 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.

    CAS  PubMed  Article  Google Scholar 

  65. 65.

    Conti CR, Pepine CJ, Sweeney M. Efficacy and safety of sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease. Am J Cardiol. 1999;83:29C–34C.

    CAS  PubMed  Article  Google Scholar 

  66. 66.

    Shakir SA, Wilton LV, Boshier A, et al. Cardiovascular events in users of sildenafil: results from first phase of prescription event monitoring in England. BMJ. 2001;322:651–2.

    CAS  PubMed  Article  Google Scholar 

  67. 67.

    Kloner RA. Cardiovascular risk and sildenafil. Am J Cardiol. 2000;86:57F–61F.

    CAS  PubMed  Article  Google Scholar 

  68. 68.

    Kloner RA, Mitchell M, Emmick JT. Cardiovascular effects of tadalafil. Am J Cardiol. 2003;92:37M–46M.

    CAS  PubMed  Article  Google Scholar 

  69. 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 

  70. 70.

    Wysowski DK, Farinas E, Swartz L. Comparison of reported and expected deaths in sildenafil (Viagra) users. Am J Cardiol. 2002;89:1331–4.

    CAS  PubMed  Article  Google Scholar 

  71. 71.

    Webb DJ, Freestone S, Allen MJ, Muirhead GJ. Sildenafil citrate and blood-pressure-lowering drugs: results of drug interaction studies with an organic nitrate and a calcium antagonist. Am J Cardiol. 1999;83:21C–8C.

    CAS  PubMed  Article  Google Scholar 

  72. 72.

    Kloner RA, Hutter AM, Emmick JT, et al. Time course of the interaction between tadalafil and nitrates. J Am Coll Cardiol. 2003;42:1855–60.

    CAS  PubMed  Article  Google Scholar 

  73. 73.

    Oh SS, Zou P, Low MY, Koh HL. Detection of sildenafil analogues in herbal products for erectile dysfunction. J Toxic Environ Health Part A. 2006;69:1951–8.

    CAS  Article  Google Scholar 

  74. 74.

    Savaliya AA, Shah RP, Prasad B, Singh S. Screening of Indian aphrodisiac ayurvedic/herbal healthcare products for adulteration with sildenafil, tadalafil and/or vardenafil using LC/PDA and extracted ion LC-MS/TOF. J Pharm Biomed Anal. 2010;52:406–9.

    CAS  PubMed  Article  Google Scholar 

  75. 75.

    Kearney T, Tu N, Haller C. Adverse drug events associated with yohimbine-containing products: a retrospective review of the California Poison Control System reported cases. Ann Pharmacother. 2010;44:1022–9.

    PubMed  Article  Google Scholar 

  76. 76.

    Aoki H, Nagao J, Ueda T, et al. Clinical assessment of a supplement of Pycnogenol(R) and L-arginine in Japanese patients with mild to moderate erectile dysfunction. Phytother Res: PTR. 2012;26:204–7.

    CAS  PubMed  Article  Google Scholar 

  77. 77.

    Musso NR, Vergassola C, Pende A, Lotti G. Yohimbine effects on blood pressure and plasma catecholamines in human hypertension. Am J Hypertens. 1995;8:565–71.

    CAS  PubMed  Article  Google Scholar 

  78. 78.

    Schulman SP, Becker LC, Kass DA, et al. L-arginine therapy in acute myocardial infarction: the Vascular Interaction With Age in Myocardial Infarction (VINTAGE MI) randomized clinical trial. JAMA: J Am Med Assoc. 2006;295:58–64.

    CAS  Article  Google Scholar 

  79. 79.

    Lukkarinen H, Lukkarinen O. Sexual satisfaction among patients after coronary bypass surgery or percutaneous transluminal angioplasty: eight-year follow-up. Heart & Lung: J Crit Care. 2007;36:262–9.

    Article  Google Scholar 

  80. 80.

    Papadopoulos C, Shelley SI, Piccolo M, et al. Sexual activity after coronary bypass surgery. Chest. 1986;90:681–5.

    CAS  PubMed  Article  Google Scholar 

  81. 81.

    Kazemi-Saleh D, Pishgou B, Assari S, Tavallaii SA. Fear of sexual intercourse in patients with coronary artery disease: a pilot study of associated morbidity. J Sex Med. 2007;4:1619–25.

    PubMed  Article  Google Scholar 

  82. 82.

    Mosack V, Steinke EE. Trends in sexual concerns after myocardial infarction. J Cardiovasc Nurs. 2009;24:162–70.

    PubMed  Article  Google Scholar 

  83. 83.

    Nicolosi A, Moreira Jr ED, Villa M, Glasser DB. A population study of the association between sexual function, sexual satisfaction and depressive symptoms in men. J Affect Disord. 2004;82:235–43.

    PubMed  Article  Google Scholar 

  84. 84.

    Roose SP, Seidman SN. Sexual activity and cardiac risk: is depression a contributing factor? Am J Cardiol. 2000;86:38F–40F.

    CAS  PubMed  Article  Google Scholar 

  85. 85.

    Bedell SE, Duperval M, Goldberg R. Cardiologists' discussions about sexuality with patients with chronic coronary artery disease. Am Heart J. 2002;144:239–42.

    PubMed  Google Scholar 

  86. 86.

    Steinke E, Patterson-Midgley P. Sexual counseling following acute myocardial infarction. Clin Nurs Res. 1996;5:462–72.

    CAS  PubMed  Article  Google Scholar 

  87. 87.

    Akdolun N, Terakye G. Sexual problems before and after myocardial infarction: patients' needs for information. Rehabil Nurs: Off J Assoc Rehabil Nurs. 2001;26:152–8.

    CAS  Article  Google Scholar 

  88. 88.

    Steinke EE, Patterson-Midgley P. Importance and timing of sexual counseling after myocardial infarction. J Cardiopulm Rehabil. 1998;18:401–7.

    CAS  PubMed  Article  Google Scholar 

  89. 89.

    Jaarsma T, Steinke EE, Gianotten WL. Sexual problems in cardiac patients: how to assess, when to refer. J Cardiovasc Nurs. 2010;25:159–64.

    PubMed  Article  Google Scholar 

  90. 90.

    Steinke EE, Patterson-Midgley P. Sexual counseling of MI patients: nurses' comfort, responsibility, and practice. Dimens Crit Care Nurs: DCCN. 1996;15:216–23.

    CAS  PubMed  Article  Google Scholar 

  91. 91.

    Ivarsson B, Fridlund B, Sjoberg T. Information from health care professionals about sexual function and coexistence after myocardial infarction: a Swedish national survey. Heart & Lung: J Crit Care. 2009;38:330–5.

    Article  Google Scholar 

  92. 92.

    Seidl A, Bullough B, Haughey B, et al. Understanding the effects of a myocardial infarction on sexual functioning: A basis for sexual counseling. Rehabil Nurs. 1991;16:255–64.

    CAS  PubMed  Article  Google Scholar 

  93. 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 

  94. 94.

    Dhabuwala CB, Kumar A, Pierce JM. Myocardial infarction and its influence on male sexual function. Arch Sex Behav. 1986;15:499–504.

    CAS  PubMed  Article  Google Scholar 

  95. 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.

    CAS  Google Scholar 

  96. 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.

    Article  Google Scholar 

  97. 97.

    Steinke EE, Swan JH. Effectiveness of a videotape for sexual counseling after myocardial infarction. Res Nursing & Health. 2004;27:269–80.

    Article  Google Scholar 

  98. 98.

    Steinke EE, Wright DW. The role of sexual satisfaction, age, and cardiac risk factors in the reduction of post-MI anxiety. Eur J Cardiovasc Nurs: J Work Group Cardiovasc Nurs Eur Soc Cardiol. 2006;5:190–6.

    Article  Google Scholar 

Download references

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Richard A. Lange.

Additional information

This article is part of the Topical Collection on Ischemic Heart Disease

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lange, R.A., Levine, G.N. Sexual Activity and Ischemic Heart Disease. Curr Cardiol Rep 16, 445 (2014). https://doi.org/10.1007/s11886-013-0445-4

Download citation

Keywords

  • Sexual activity
  • Coital angina
  • Coital MI
  • Ischemic heart disease