Sexual activity after myocardial infarction: When to resume the use of erectogenic drugs

Abstract

Coital angina appears to represent less than 5% of all anginal attacks. Sexual activity is often equated with an exercise workload of 2 to 3 metabolic equivalents of task (METS) in the pre-orgasmic phase and 3 to 4 METS in the orgasmic phase. Exercise testing is often used to assess exercise tolerance and capacity for safely resuming sexual activity after myocardial infarction (MI). Less than 1% of MIs occur during sexual activity, as an attributable risk. The relative risk of coital-induced MI is 2.5 times greater than during non-coital activities; this risk is threefold greater in individuals with previous MI. The duration of exposure to this increased risk appears to be 2 hours following coitus. Past MI patients who are asymptomatic and do not exhibit treadmill-induced ischemia are at low risk for coital MI. Exercise training after acute MI improves cardiovascular efficiency and reduces myocardial oxygen demand during customary activities, including sexual activity. A patient with a recent MI (< 2 weeks) remains at high risk for coitalinduced reinfarctions, cardiac ruptures, or coital-induced arrhythmias. Post-MI individuals should be risk stratified according to the Princeton Consensus Panel II guidelines. Low-risk patients with erectile dysfunction can be safely treated with a phosphodiesterase type 5 (PDE5) inhibitor. Patients should be cautioned about the contraindication between PDE5 medications and nitrates.

Cardiovascular changes resulting from sexual activity and sexual dysfunction after myocardial infarction: integrative review

“…Some risk factors, such as diabetes mellitus, hypertension, smoking and dyslipidemia, are common to the development of coronary artery disease, heart failure and erectile dysfunction (Drory , Miner , Lunelli et al . ).…”

“…). In addition to these factors, virtually all classes of drugs used in the treatment for cardiovascular diseases may affect sexual activity (Miner , Stein & Hohmann ).…”

“…Another aspect that should be considered in these patients is that they often have sexual dysfunction that can be related to fear of having another cardiac event as the use of medications and/or to presence of the other diseases that influence this dysfunction (Drory , Miner , Stein & Hohmann , Lunelli et al . ).…”

Fear of Sexual Intercourse in Patients with Coronary Artery Disease: A Pilot Study of Associated Morbidity

“…Given that decline in sexual activity in CAD patients may enhance the quality of life [21], and that there is no reason to limit normal sexual activity in CAD patients [10,18], we believe that any approach that may upgrade subsequent sexual functioning should be considered seriously. Appropriate counseling is one of these helpful measures; in the study of Dhabuwala et al [51], the patients who received information about the safety of resuming sexual activity showed a lesser degree of apprehension in the post-MI period.…”

Intercourse Avoidance among Women with Coronary Artery Disease

“…The American Heart Association scientific statement regarding sexual activity among patients with CAD has well addressed safety and timing of return to sexual activity after cardiac events [7]. Literature has shown that patients with CAD can enjoy a sexually active life [1]. The risk of experiencing any severe complication during sexual activity in these patients is far less than that expected by patients and their partners.…”