Pillow Talk: When Your Valentine Has Had a Heart Attack

We’re all pretty familiar with the lifestyle changes required after a heart attack. Exercise more. Eat better. Manage stress. Take your meds. But there’s another topic that’s just as important, yet rarely discussed: resuming intimacy.

There are plenty of misconceptions about rekindling the spark after a cardiac arrest or other heart-related incident. Nobody wants to do anything to trigger another attack. But at the same time, almost nobody wants to talk about how that might impact a couple’s sexual relationship.

Talking the Talk

That’s understandable on one level. After all, sexual activity isn’t something most of us discuss in polite conservation or mixed company. Plus, it can feel embarrassing when things aren’t going exactly as planned in the bedroom.

But this isn’t just your sex life we’re talking – or not talking – about here. It’s your health. And when it comes to cardiac rehabilitation, your life and health have as strong a bond as you and your partner. That’s why it’s important to put your embarrassment aside and start talking.

“One of the toughest issues to address with patients is talking about sex,” says Dr. Cam Patterson, chief of cardiology at the University of North Carolina Hospitals in Chapel Hill. “People are understandably reluctant to talk about something so private. But it’s really important because there are so many wrong assumptions made.”

Talking the Talk

The most common assumption is that sex will cause another heart attack. Once the doctor has cleared you, the risk of inducing another attack during sex is low. Of course, partners should both be aware of the symptoms experienced with the first event and agree to stop intercourse if any of these symptoms occurs.

It’s also important to know your metabolic equivalents, or mets. A met is the amount of energy the body uses to during physical activity.

“We use exercise testing to assess tolerance for exercise and sex,” explains Dr. Paula Miller, a cardiologist and director of the Women's Heart Program at the University of North Carolina at Chapel Hill School of Medicine. Sexual intercourse requires 2 to 3 mets during the preorgasmic state and 3 to 4 mets during orgasm. That’s about the same as walking 2 to 4 miles an hour on a level surface. “This gives the patient some confidence when having intercourse.”

Talking the Talk

In most cases, patients are counseled to avoid sex for a few days or weeks after a heart attack or cardiac surgery. But beyond that, there may be issues with low libido or sexual dysfunction, particularly in men. Some medications can cause problems with sexual performance, but that doesn’t necessarily mean there aren’t alternatives.

“There are medications and other ways to aide in achieving an erection in men,” Miller says. “And spouses can provide reassurance and help in exploring these possibilities.” Being honest with your doctor will enable him or her to work with your treatment plan to address these issues.