Ask Dr. K: Heart attacks during sex are highly unlikely

I can understand why. Physical exertion causes the heart to work harder, and if you’ve had a heart attack, your heart has been injured. My patients often worry about having another heart attack, or about dying during intercourse. These concerns are understandable. But according to my Harvard Medical School colleague, cardiologist Thomas Lee, they are unfounded.

Less than 1 percent of all heart attacks occur during sexual activity. The risk is as low for men who have suffered a heart attack as it is for those without heart disease.

The risk of dying during intercourse is even lower. But interestingly, according to the American Heart Association, extramarital sexual activity increases this risk. That may be because extramarital sex is more likely to happen with a younger partner in an unfamiliar setting, and anxiety about having extramarital sex may add to the surge of adrenaline that makes the heart work harder.

If you’ve had angioplasty or bypass surgery, your doctor will tell you how long to wait before resuming sexual activity. In general, if you have had angioplasty, wait until the puncture site has healed. After open coronary artery bypass surgery, wait about six to eight weeks, until your breastbone has healed. Dr. Lee notes that if you’ve had minimally invasive or robotic bypass surgery, most doctors will advise you to resume sexual activity once you feel ready. That’s because minimally invasive surgery does not involve cutting the breastbone.

As always, let your symptoms (or lack thereof) be your guide. For example, if you don’t have symptoms of heart disease — breathlessness or palpitations, for example — you are likely at low risk of having a heart attack during sex. The same is true if you can pass a stress test without experiencing chest pain. Relative to any vigorous exercise — jogging, biking, swimming — the amount of exertion during sex (and, hence, the need for your heart to work harder) is pretty small.

On the other hand, do not have sex if you experience symptoms of heart disease at any time. Your heart attack was caused by disease of the arteries of your heart. Having symptoms of heart disease after you’ve had a heart attack can mean, unfortunately, that the disease in your arteries is still threatening your heart. You need to bring this to the attention of your doctor! Delay sexual activity until your condition is stable.

More important, everyone recovering normally from a heart attack actually needs regular exercise. It is a part of every cardiac rehabilitation program. Regular exercise under medical supervision strengthens the heart. Don’t be afraid of exercising after a heart attack: It’s good for you. And when your doctor has cleared you to do it, sex is good for you, too.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.