Resuming Sexual Activity After Myocardial Infarction

Risk Stratification and Timing

• The European Society of Cardiology recommends that patients with uncomplicated myocardial infarction can safely resume sexual activity at 1-2 weeks post-event when they can perform mild to moderate physical activity without cardiac symptoms 1, 2, 3
• The American College of Cardiology suggests that stable patients without complications can resume sexual activity with their usual partner within 1 week to 10 days, as a Class I recommendation 4, 5
• Patients with complicated myocardial infarction should resume sexual activity more gradually over several weeks to months, depending on exercise tolerance 1, 6

Functional Capacity Assessment

• Sexual activity is reasonable when patients can achieve 3-5 METs without symptoms, equivalent to walking 3-4 mph or climbing 2 flights of stairs briskly 2, 3, 7
• If a patient can exercise at 5 METs without angina, excessive dyspnea, ischemic ST-segment changes, cyanosis, hypotension, or arrhythmia, sexual activity is safe 2, 3

Critical Safety Instructions

• Patients must report warning signs during sexual activity, such as chest pain lasting >15 minutes, shortness of breath, rapid or irregular heart rate, dizziness, insomnia, or fatigue, immediately 1, 2, 3, 8
• Nitroglycerin can be taken prophylactically before sex or during coital angina, but patients using PDE5 inhibitors must never use nitrates for coital angina and should call emergency services immediately 1, 2, 3, 8

Role of Cardiac Rehabilitation

• Regular exercise reduces the risk of sexual activity-triggered myocardial infarction, and exercise training during cardiac rehabilitation increases maximum exercise capacity and decreases peak coital heart rate 2, 3
• The European Society of Cardiology recommends regular physical exercise as a reasonable strategy for patients with stable cardiovascular disease planning to engage in sexual activity 1, 2, 3, 8

Patient Counseling Essentials

• Most patients prefer general information about sexuality effects while hospitalized, and more specific information can be provided after discharge 1, 8
• Reassure patients that the relative risk of cardiac events with sexual activity is low, and the actual risk of sexual activity-triggered cardiovascular events is very low in properly risk-stratified patients 2, 3, 7