It’s a common misconception that engaging in sexual intimacy can trigger heart attack and, possibly, sudden cardiac arrest. Local anecdotes are frequently cited about how a popular mayor in the 1960s died in that situation.

A new study presented during the recent scientific sessions of the American Heart Association (AHA) in Anaheim, California, has reassuring findings that the odds of dying of sudden cardiac arrest while having sex are extremely low, less than 1 percent, including people with heart disease. The study was published on the same day in the Journal of the American College of Cardiology (JACC).

The researchers, headed by Sumeet Chugh, M.D., associate director of Cedars-Sinai Heart Institute in Los Angeles, analyzed the records of 4,557 sudden cardiac arrest deaths in Portland, Oregon, from 2002 to 2015. Of these deaths, only 32 men and two women died likely of sudden cardiac arrest during or within one hour of sexual intimacy.

Although the population of patients studied are different and could not be compared with each other, this frequency of sudden cardiac arrest during sex is less than the number of people dying suddenly during strenuous exercise or other physical activities.

Arrhythmia

Sudden cardiac arrest during sexual intercourse is likely due to a fatal arrhythmia or irregular heartbeat called ventricular fibrillation. There is some surge of adrenaline during sex which might make a predisposed heart vulnerable to this type of fatal arrhythmia, characterized by a chaotic beating of the heart ending in sudden arrest. It is possible that these cases of sudden cardiac arrests are immediately preceded by a heart attack, triggering the killer heartbeat.

There is a so-called “stair-climbing test,” which is a rough evaluation of one’s fitness to engage in sexual activity. We usually ask our patients if they could go up two flights of stairs without experiencing chest pains or prolonged shortness of breath. If they do, they can safely engage in regular sexual activity (not acrobatic sex, though).

This was actually a recommendation issued by the AHA during its scientific sessions in 2012. This advice is applicable to everyone, either with heart disease or not. The guidelines on fitness for sexual activity were issued, realizing the concern that such topic is one of the least discussed issues with heart-attack survivors.

Dr. Glenn Levine, a professor of medicine at Baylor College of Medicine in Houston and lead author of the AHA report, explaining the recommendations, said that AHA had to issue the guidelines to correct misconceptions on the cardiovascular risk of sexual activity.

He explained that many heart patients have no qualms about climbing stairs, even rushing up and down several flights, but they worry about safety in engaging in sexual activity.

Therapeutic

Although it’s true that one who has had a heart attack has a higher risk of a second heart attack, having sex has not been shown by scientific evidence a a major culprit.

Following a heart attack, some patients and their spouses wrongly believe that it’s better to abstain from sex. This is now known to be totally baseless. In fact, some consider regular sexual activity with one’s spouse or regular partner to even be “therapeutic” and good for the heart.

There are old isolated reports of a higher risk of a heart attack and sudden cardiac arrest due to extramarital sex, especially with an unfamiliar partner in an unfamiliar venue. Unfortunately, the number of cases included in the reports are too few to make a definitive conclusion.

But it’s logical to assume that the adrenaline rush may be higher with extramarital sex due to the fear of being caught, plus the fact that the sexual intimacy usually takes place in some unfamiliar locations.

Following a heart attack, patients are usually referred to undergo cardiac rehabilitation, which includes a set of exercises, while being monitored for heart symptoms and irregular heartbeat. This guides the attending physician to assess the readiness of the heart attack survivor to undergo specific activities, including sexual intimacy.

The physician should not neglect this important aspect of giving the “green light” to their heart attack patient to resume sex. I discussed in this column a blunder I committed involving one of my heart attack patients by not discussing the issue. More than a year after the heart attack of the husband, the couple had not resumed sexual intimacy.

Guidelines on sexual intimacy are something doctors should discuss with all heart patients in a very objective manner. This is one sore and awkward gap that we need to fill in managing patients following a heart attack, and those with other heart problems.