Certain patients, such as those with severe heart disease who have symptoms while at rest, should put off sex until their condition has stabilized. But if you can walk briskly or climb two flights of stairs without experiencing chest pain, abnormal heart rhythms, or shortness of breath, you're almost certainly ready to start having sex again, the guidelines say.
The authors stress, however, that all heart patients should check with their doctor before resuming their sex life. Just as important, the guidelines encourage patients -- and their partners -- to discuss any feelings of sex-related anxiety or depression with a health professional.
"Both patients and the patient's spouse or partner often have anxieties about resuming sexual activity after the patient has been diagnosed with heart disease or has undergone a heart procedure," says Glenn N. Levine, M.D., the lead author of the guidelines and a professor of medicine at Baylor College of Medicine, in Houston. "Sometimes it is actually the partner who is more anxious than the patient."
The guidelines, which appear in the journal Circulation and have been endorsed by a host of physicians' groups, are the first ever from the AHA to focus on heart disease and sex -- a subject that gets far too little attention, the authors say. Most cardiologists fail to raise the topic with their patients, and they are even less likely to ask about anxiety or depression, Levine says.
Stephen Kopecky, M.D., a cardiologist at the Mayo Clinic, in Rochester, Minnesota, says many patients who have a heart attack or undergo bypass surgery become depressed, which can reduce libido and affect sexual function. To make matters worse, he says, avoiding sex can in turn worsen depression.
"That's why it's so important for us to talk to patients about this, and tell them this is not the end of [their] sex life," says Kopecky, who has studied sexual activity in heart patients but did not participate in writing the new guidelines.
Heart problems during sex are very rare. Less than 1% of all heart attacks are triggered by sexual activity, Levine and his coauthors note, and the odds are even lower for people who exercise regularly. A sedentary person's risk of having a heart attack roughly triples during sex, while an active person's risk rises by just 20%.
But in either case the absolute risk is extremely small, especially since intercourse typically lasts for minutes, rather than hours. The chances that a heart-attack survivor will experience another heart attack or die in any given hour is roughly 1 in 100,000, for instance; during sex those odds increase to no more than about 1 in 33,000.
Still, the guidelines recommend that heart-attack survivors wait at least a week after their attack to resume having sex. Patients who have had bypass surgery or other major heart surgery should wait at least six to eight weeks, the authors say, although sex is generally safe several days after minimally invasive surgery to clear blocked blood vessels.