What Is Heart Disease? Symptoms, Causes, Diagnosis, Treatment, and Prevention

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Can Sex Cause A Heart Attack?

If movies and soap operas are anything to go by, sex can be dangerous for people with heart conditions.

Dangers posed by sexual activity is probably minimal, but heart disease could curtail your sex life.

While research shows that sex can indeed trigger heart attacks in some people, especially men, the odds of literally succumbing to passion are very low. Sexual activity is a contributing factor in less than 1 percent of heart attacks, according to a 1996 study by Harvard Medical School researchers.

Although heart attacks during sex are rare, no one wants to be among the unlucky few who die while getting lucky. So if you have cardiovascular disease (CVD), or even if it runs in your family, it's important to ask your doctor what type of sexual activity is safe. If you've just had a heart attack, for instance, you should wait three to four weeks before having intercourse, according to current guidelines.

And if you have heart failure, your doctor may recommend that you avoid lying on your back during sex, because fluid is more likely to pool in your lungs in that position. Health.Com: Heart health step-by-step

The physical danger posed by sexual activity is probably the least of your problems, however. There are plenty of other ways for heart disease to curtail your sex life. Everything from incision pain following bypass surgery to the emotional stress of living with a heart condition can get in the way of intimacy.

Sexual activity and heart conditions can interact in complicated ways, which can be difficult to tease apart. To make matters worse, heart patients (and their partners) are often uncomfortable discussing their sex lives with their doctors and vice versa.

"I've found that most doctors don't have the time -- or the personality -- to talk about sex with their heart patients," says Dr. Edward Chapunoff, a cardiologist in private practice in Pompano Beach, Florida, and the author of "Answering Your Questions About Heart Disease and Sex."

"They are evasive about it," he said. "They won't bring it up themselves and even if the patient brings it up, a doctor might be hesitant to discuss it."

So what's a heart patient to do? Prepare a list of intimacy questions in advance of your next checkup and don't let your doctor's squirming deter you. In the meantime, here are some answers to three not-so-frequently asked questions about sex and heart disease.

Is my sexual dysfunction related to my heart?

The link between cardiovascular disease and sexual dysfunction is well established, at least in men. Researchers have known for years that erectile dysfunction (ED) is disproportionately common among men with CVD (and even among those with risk factors for CVD, such as diabetes and high blood pressure). While erectile dysfunction can result from a number of factors, including psychological ones, the majority of cases can be traced to vascular problems.

The shared mechanism linking ED and CVD is believed to originate in the endothelium, the thin layer of cells that lines blood vessels. Risk factors such as high cholesterol, high blood pressure, and cigarette smoking prevent cells in the endothelium from releasing nitric oxide. This compromises the ability of blood vessels to dilate, which can lead to both atherosclerosis and erectile dysfunction. Health.Com: 10 best foods for your heart

Atherosclerosis, the hardening and narrowing of the arteries that causes coronary heart disease, can affect the arteries that pump blood into the penis just as readily as those that surround the heart. But endothelial problems can also prevent the so-called smooth muscle in the penis from relaxing properly. In either case, erections become harder to sustain.

For a long time it was thought that ED was strictly a side effect of CVD and atherosclerosis, but experts now believe that ED may actually precede heart problems. A 2005 study in the Journal of the American Medical Association described ED as a "harbinger" of cardiovascular events.

The study, which analyzed more than 4,000 men without symptoms of CVD or ED, found that the men who subsequently experienced ED were nearly 50 percent more likely than those who did not to experience a cardiovascular event within seven years.

"It's important to know that just looking fine doesn't necessarily mean you have a healthy heart," says Chapunoff. "It's important that both the patient and their partner talk to their doctor about any sexual dysfunction, because it could signal a cardiac problem."

In women, the relationship between CVD and sexual dysfunction is less clear. Although sexual dissatisfaction in women has been linked to peripheral arterial disease, the mechanisms of female sexual function are thought to be less intertwined with the cardiovascular system.

Do my heart meds have any sexual side effects?

If your heart doesn't cause you problems in the bedroom, the medicine you take to keep it healthy might. Several medications commonly prescribed to heart patients can have sexual side effects in both men and women, including ED and loss of libido.

Two kinds of cholesterol-lowering drugs, fibrates and statins, have been linked with ED, but it is mainly blood-pressure medications that are believed to contribute to sexual dysfunction. Health.Com: 7 causes of high cholesterol

Beta-blockers, calcium channel blockers, angiotensin-II receptor antagonists, and diuretics are all associated with ED. Although some experts have argued that hypertension itself is responsible for ED, a 2007 study in the International Journal of Impotence Research found that men taking angiotensin-II receptor antagonists were twice as likely to experience ED than men whose hypertension was untreated. Another study of nearly 1,400 men determined that taking hypertension drugs (diuretics, beta-blockers, methyldopa, or clonidine) increased the odds of experiencing ED by 2.5 times.

Blood-pressure medications are also known to cause sexual dysfunction in women, although the phenomenon hasn't been studied as extensively as it has in men. One reason for the disparity may be that the most common symptoms in women -- loss of libido, inadequate lubrication -- are more subtle than ED.

When Liz Saldana, 48, the owner of an online magazine and store in Tampa, Florida, first started taking a beta-blocker, she saw her sex drive shrink significantly.

"I went from being a really vibrant woman to someone who could just live without it," she says. "When my husband initiated anything, my attitude became, 'Oh damn, do we have to do this?'"

She was too embarrassed to bring up the issue with her doctor. "Initially I thought my lack of sex drive pertained to all of the stress I was under, not to my heart medications," says Saldana, who was on the beta-blocker Toprol-XL (metoprolol) before suffering a heart aneurysm in July. "None of my doctors explained that it could be a side effect of what I was on."

It wasn't until she switched insurance companies and got a call from one of the nurses on staff that she finally got to the root of her problem: "She asked a couple of questions that acted as a trigger for me to evaluate my sex drive and realize what was wrong." Health.Com: Why women need to worry about heart attacks

Even though sexual problems are among the most commonly reported side effects from blood-pressure drugs, they have not been well publicized and patients may not realize that their prescriptions are to blame. If you suspect that your heart medications are interfering with your sex life, explain the problem to your doctor and ask about alternative medications. Men may be able to counteract the problem with an ED drug such as Viagra. While they can be potentially fatal when taken with nitrates, ED drugs can be safely combined with many heart medications.

Why can't I get in the mood?

Medications can dampen your sex drive, but psychological factors might also be at play. For one thing, sexual dysfunction is a common psychosomatic side effect of medication (sometimes called a "nocebo effect"). But the emotional strain that accompanies heart disease can also impact your sex life. After a cardiac episode, many patients find that any activity in the bedroom leaves them paralyzed with anxiety. "After a heart attack, not only are you physically weak, but you're scared that something might happen during sex," says Chapunoff.

Saldana is gearing up to have open-heart surgery in the near future. She and her husband of 15 years are sexually active about twice a month, but each time she's terrified that she'll have a heart attack. "I experience a lot of chest pains and when things get heated, I can't have him on top of me," she explains. "I haven't shared my fear with my husband, but I'm afraid to lose control for even a moment because it feels like he's crushing my chest."

And then there's the possible role of depression. Research suggests that heart disease and depression are closely related; depression is roughly three times more prevalent among heart attack survivors than in the general population. But depression is also independently associated with sexual dysfunction (including loss of libido and ED), which suggests that, for heart patients, both their bodies and their minds may be affecting their sex lives.

Sexual dysfunction that appears to be caused by a heart problem may also be a sign of an underlying emotional issue, according to Chapunoff. "Heart disease can become the scapegoat," he says.

"People might say, 'I had a heart attack six months ago, so I can't have sex now,' when really it could be unhappiness that they fail to recognize."

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Heart Attack

heart attack

Our heart is a muscular organ beating 100,000 times a day. Located slightly towards the left of the chest, it pumps 5000 gallons of blood throughout the body in 24 hours. The main function of the heart is to supply oxygen and nutrients to our tissues. It also helps the body get rid of carbon dioxide and other wastes. The consequences can be life threatening if this organ fails to perform its duties. There could be various cardiac issues that lead to heart failure. Myocardial infarction, commonly known as heart attack, can be one of the major culprits behind its failure.

What Is A Heart Attack?

A heart attack is known as myocardial infarction in the medical fraternity. The word 'Myo' means muscle while 'cardial' denotes heart. 'Infarction', on the other hand, refers to death of tissue caused by insufficient blood supply. The death of tissue may lead to a long-lasting damage of cardiac muscles. Heart attack is a condition which usually occurs when the blood supply to the heart is blocked suddenly due to complete blockage of the artery supplying blood to the cardiac muscles. This causes the heart muscle cells to die. The blockage of artery is often caused by plaque formation (deposition and hardening of fatty substances and cholesterol on the walls of arteries) resulting in coronary heart disease (CHD). If left untreated it can be fatal. The severity of damage to the heart tissues caused by a myocardial infarction or heart attack depends on the longevity of the attack. The earlier you receive medical care, the lesser is the damage.

Heart Attack Symptoms

The classic symptom of a myocardial infarction is chest pain or discomfort. But there are other signals too. Here is a low-down on the crucial ones.

Upper body pain

If you have pain, discomfort or pressure in your chest, that branches out to your arms (especially left arm), jaw, throat and shoulder blades, chances are that you are getting a myocardial infarction.

Breaking out in cold sweats

Don't ignore if you suddenly break out in a cold sweat, especially when you are going through the other symptoms of a heart attack.

Sudden dizziness

Starting from empty stomach to dehydration, a lot of things could trigger dizziness or light-headedness. But if your feeling of unsteadiness is associated with chest discomfort, it could well be the sign of a heart attack. Evidences suggest that women are more likely to feel this way during a myocardial infarction.

Irregular heartbeat

A racy heart could be the result of many factors including excessive caffeine intake and poor sleep among others. But if you feel that your heart is beating faster than normal for more than just a few seconds, seek medical intervention immediately.

Stubborn cough and cold

Normally, cold and flu symptoms aren't considered to be an alarm bell for a heart attack. But if you are in the high-risk group for the condition (have a family history, obese, or are suffering from diabetes), then this can be a warning sign for sure. If you experience flu-like symptoms that don't go, get your mucus tested. A pink mucus could indicate your heart isn't functioning to its maximum potential. That's why blood is leaking back in the lungs.

What Causes Heart Attack?

The muscles of your heart constantly need oxygen-rich blood which is ensured by your coronary arteries. This blood supply gets blocked when your arteries become narrow due to the build-up of plaque. It is formed by fat, calcium, proteins, and inflammatory cells. The outer layer of the plaque deposit is hard while the inner layer is soft. The outer shell breaks in case the plaque is hard. This is known as rupture, a condition that leads to the formation of blood clots around the plaque. If a blood clot blocks your artery, then blood supply to your heart is cut which, in turn, depletes the cardiac muscles of oxygen. This causes the muscle to die, resulting in permanent damage. The intensity of damage depends on the time gap between treatment and the attack. After a heart attack the cardiac muscles start repairing themselves. On an average, it takes them about 2 months to heal.

Apart from this, there could be another condition that can lead to a heart attack: Spasm in your coronary artery (ischemia). This can also restrict blood supply to the heart and can occur even if you don't have any coronary artery disease. However, this is a rare occurrence.

Heart Attack Risks

There could be many risk factors behind a heart attack. Here, we guide you on the most prominent ones:

Age: This plays an instrumental role in increasing your risk of a heart attack. Evidences suggest that men over 45 and women above 55 are more likely to experience heart attack.

Gender: Men are 2-3 times more likely to have a heart attack than women. The female hormone, oestrogen, works as a shield in case of women.

Genetic predisposition: If you have a first-degree relative (a parent, brother or sister) with a history of heart disease – such as angina, heart attack or stroke – you are twice as likely to develop similar problems, compared to the general population.

High blood pressure: Uncontrolled blood pressure levels over a long period of time can damage your blood supplying arteries making you vulnerable to heart attack.

High levels of bad cholesterol and triglyceride: Bad cholesterol or LDL has a narrowing effect on your arteries. Moreover, a blood fat known as triglyceride, can also increase your chances of getting a heart attack. Both these factors are largely related to your diet. So, eating mindfully is crucial to reduce your risk of heart attack.

Obesity: Excessive body weight is likely to increase your LDL, triglyceride levels while increasing your chance of developing diabetes. All these are potential risk factors behind heart attack. Staying physically active and eating mindfully are the cornerstones of maintaining ideal body weight.

Diabetes: This condition is marked by high blood sugar levels, another condition that can make you vulnerable to heart attack.

Stress: It is known to elevate your blood pressure levels which, as already mentioned, is a major risk factor behind myocardial infarction.

Smoking: It tightens your arteries and raises your blood pressure levels. All these increase your heart attack risk.

Diagnosis Of Heart Attack

A heart attack is usually suspected by typical clinical symptoms and is confirmed by carrying out the following tests:

ECG: Electrocardiogram or ECG is a diagnostic test which measures electrical signals that travel through the heart, causing it to pump blood through its chambers. These impulses are recorded in the form of a graph showing waves in a distinct pattern. Depending on the shape of these waves, doctors can evaluate any abnormal condition of the heart.

Blood test: Bloodwork is needed to detect the presence of cardiac enzymes which are raised during a heart attack. With the help of these readings, your doctor is able to identify the size and time of the attack. Some blood tests also measure the levels of certain heart cell proteins that are released when damage occurs due to the lack of blood supply.

Echocardiography: This is an imaging test performed during and after a heart attack. It tells your doctor whether or not your heart is pumping well. This test also reveals if any part of your heart is injured during the attack.

Angiogram: This is an imaging test to detect blockage in the arteries. It is rarely used to diagnose a heart attack. In this test, a liquid dye is injected into your heart arteries with the help of a tube known as catheter.

Cardiac CT or MRI: These imaging tests reveal the extent of damage to your cardiac muscles.

Treatments Of Heart Attack

A heart attack requires emergency assessment and treatment. It is important that you are treated quickly to minimise damage to your heart. The line of treatment, which varies depending on the severity of the condition, includes medicines, surgical intervention and other procedures.

MEDICINES

Your doctor prescribes drugs to prevent clot formation, relieve pain, regularise your heart rhythm, broaden blood vessels, regulate blood pressure levels, so on and so forth. While your doctor may suggest many medicines, we guide you about the most common ones:

Aspirin: This emergency medicine reduces blood clotting, ensuring blood flow through the narrow artery.

Thrombolytics: These drugs also help in busting clots that cut off blood supply to your heart. Thrombolytics, administered on time, increase your chance of survival.

Antiplatelet agents: They not only keep new clots at bay but also prevent existing clots from getting bigger.

Pain relievers: Morphine is commonly used for reducing chest pain.

Beta blockers: They ensure better functioning of the heart by relaxing your heart muscles , regulating heartbeat and blood pressure levels. Beta blockers can also be instrumental in preventing future heart attacks.

ACE inhibitors: These medicines function as blood pressure lowering agents while reducing your heart's stress level.

Statins: They keep your blood cholesterol levels under control.

SURGERY AND OTHER PROCEDURES

Along with drug therapy, you may need any of the following procedures:

Angioplasty: This involves performing a coronary angiography, locating the blocked artery and opening the block with a balloon and finally implanting a stent at the site of the block, to keep the artery open and your blood flowing freely.

Bypass surgery: In this procedure, the surgeon sews your veins or arteries in a location away from the blocked or narrowed artery. A bypass surgery allows your blood to reach your heart after bypassing the narrowed area. It can be performed at the time of a myocardial infarction or a few days later.

Diet For Heart Attack

The cornerstone of a heart attack treatment is preventing a relapse and other future complications like stroke. Your food habit influences, to a large extent, how different organs of your body function and your heart isn't an exception. Having healthy meals can be instrumental in reducing your chance of getting another heart attack. Fill up your plate with foods that are low in saturated foods. Some examples could be:

Fruits and vegetables

Lean meats

Poultry

Nuts, beans, and legumes

Fish

Whole grains

Plant-based oils, such as olive oil

Low-fat dairy products

While it is important to include healthy foods in your meals, there is another golden rule that you need to follow. Cut out certain foods that are harmful for your heart. They are:

Foods high in salt

Refined sugar and carbs

Processed food

Lean Meat

Foods high in saturated fats

Prevention Of Heart Attack

Modifying your lifestyle and taking up a few healthy habits can go a long way in preventing or reducing your risk of a heart attack. Here are a few small steps that will help for sure:

Eat a healthy, balanced diet (avoid excess fat/ oil/ meat; include more of green veggies, fruits, nuts, fish).

Avoid smoking and excessive alcohol intake.

Keep your blood pressure, blood sugar levels and cholesterol within normal limits.

Exercise regularly. This is extremely necessary to maintain a healthy body weight. Obesity is a major risk factor behind heart attack.

Manage stress by practising meditation, breathing techniques and yoga exercises.

Yearly health check-ups with a physician.

The content has been verified by Dr. Nilesh Gautam, Senior Interventional Cardiologist, Head of Department of Preventive Cardiology and Rehabilitation at the Asian Heart Institute, Mumbai.

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