by Dr. D. P. Atukorale

Misinformation about sex and heart disease abounds among Sri Lankan heart patients. These myths do nothing but create needless fears which slow the patients recovery.

Although some Sri Lankan physicians and surgeons find sexual matters difficult to discuss with their patients. this area is a major concern for most heart patients Physicians should try to overcome their reticence and offer information in an objective and non-threatening fashion that will allay fears and anxiety. Resumption of sexual activity may be very important during the stressful readjustment period after a heart attack and after by-pass surgery.

Most patients are capable of physical exertion required (5 METS at orgasm) which is about the equivalent of climbing a flight of stairs briskly (Nemecetal, Am, Heart J. 1976;92:274-277) on the other hand, angina during the intercourse is a possibility and can be devastating to a heart patient. Therefore it may be advisable for some patients to use a nitroglycerin (GTN) tablet 15-20 minutes prior to sexual activity, particularly before the first attempt after discharge from the hospital.

It is generally safe for an uncomplicated heart attack or by-pass surgery patient to have sex with his or her partner four to six weeks after leaving hospital. It is dangerous for heart attack and by-pass patients to have extra-marital sex as large quantities of catecholamines secreted by the adrenals can cause dangerous arrhythmias (palpitations) which can rarely cause ventricular fibrillation (cardiac arrest). It is the duty of the cardiologists who are doing cardiac rehabilitation, to discuss about their marital problems as part of cardiac-reh abilitation.