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A 50 yr old man has a cardiac arrest during sexual intercourse. He is promptly resuscitated and recovers uneventfully from an acute anterior wall myocardial infarction. At discharge from the hospital , he and his wife inquire about the safety of future sexual intercourse. Which of the following is the most appropriate advice>
A Psychiatric consultation is necessary
B. Sexual intercourse should be performed while wearing an ambulatory ECG monitoe
C. Sexual intercourse will be safe when exercise tolerance improves
D. They should wait 3 months before having sexual intercourse
E. They should have sexual intercourse as soon as possible to overcome the fear of another event
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| frank100
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E. they should toghether approach the problem by creating a sex situation associated to the underlying disease, but this can be only discovered by them both. all cardiologists say that sexual intecourse should be resumed as soom as posible.
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| AAAAA
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"If you're recovering from a heart attack, you should wait at least two weeks before engaging in intercourse — and then attempt it after only after passing a cardiac stress test, cardiovascular evaluation, and echocardiogram. In the mean time, you can maintain intimacy by cuddling and kissing." American Cardiology Conference Guidelines on sex after myocardial infarction.
C
(Personal Notes: Most patients would not tell you they have a MI while having sex. But a few did and I tried to avoid giving them Viagra, use a pump or ring to enhance their endurance. Also in most cases, I advice the wife to be on top and reduce the stress on my patients' heart. One couple resumed sex after a mild heart attack and used up six penile rings in three months. I normally advice them take it easy and do not resume sex at least two weeks or there are so many substiutions to involve intimacy besides sex)
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| GDS2008
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Has anyone seen the movie "Something's gotta give". The ER doc (Keanu Reeves) asks the patient (Jack Nicholson) who presents with an MI that he could resume sexual activity only after his exercise tolerance improves.  I am not saying that that is the answer, but I beleive D. It is recommended to wait for at least 3-4 weeks before resuming sexual activity (Ref: American Heart Association and American College of Cardiology guidelines). Based on this, I will go for D.as my answer.
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| AAAAA
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Sexual intercourse is rated as mild-to-moderate exercise (the equivalent of briskly walking half a mile or climbing a few flights of stairs). If you can tolerate exercise, then you are probably physically ready for sex. Most guidelines recommend that heart attack patients resume usual sexual activity as soon as they feel ready for it. If, however, you have three or more of the major risk factors for a heart attack (age, high blood pressure, obesity, diabetes, smoking, high cholesterol and a sedentary lifestyle) it may be a good idea to refrain from sexual intercourse until you have had a chance to discuss the matter with your physician.
So it depends more than just one answer.
E is correct if the world is perfect
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| AAAAA
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Most guidelines recommend that heart attack patients resume usual sexual activity as soon as they feel ready for it.
The answer E is incorrect if you look at the reason why they want to resume sex !
The guideline is correct to resume sex but not for the fear of another event ! (that's is the wrong reason !!")
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| AAAAA
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GDS2008 wrote:Has anyone seen the movie "Something's gotta give". The ER doc (Keanu Reeves) asks the patient (Jack Nicholson) who presents with an MI that he could resume sexual activity only after his exercise tolerance improves. I am not saying that that is the answer, but I beleive D. It is recommended to wait for at least 3-4 weeks before resuming sexual activity (Ref: American Heart Association and American College of Cardiology guidelines). Based on this, I will go for D.as my answer.
Technically, three months is fine, but in real life, three months is tooooooooooooooo long NOT to have sex. I have many patients resumed sex after 11 -14 days after the woman had C-section and torn the incision off. When I saw a patient torn open the incision within 10-12 days after C-section, I knew the couples had vigorous high-energy sex !!
But in some other cases, some couples admitted "lite and easy-going sex", but still torn the incision off, they still torn the incision off.
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| Perhaps
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I am probably the only one who believed in Keanu Reeves and chose C.
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| AAAAA
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frank100 wrote:
E. they should toghether approach the problem by creating a sex situation associated to the underlying disease, but this can be only discovered by them both. all cardiologists say that sexual intecourse should be resumed as soom as posible.
But did the cardiologist say they should resume sex so they would not have fear of another evernt. No.
They should resume sex "as soon as possible' if they can tolerate (i.e. improve exercise tolerance and should wait for at least 3-6 weeks and this is individualized)
As I said, many patients resumed sex after 10-14 days on a "lite" sex schedule !
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| frank100
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but option E, is not saying to resume sex the same night of discharge...if Mr johnson is not feeling sexy this night he won´t do hard work this night...
persuade them to start masturbating, then touching, then...but stop everything as if it was a guideline is not fair. and I repeat option E never said to resume #$%/ in the hospital or so...
perhaps I´m wrong, but It is fair game to encourage a patient to keep on going wiith hir or her previous live in order to prevent comorbidities such as depresion, which is very common in patient like the one we are talking about...
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| frank100
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I´ve seen patients improve their excersise tolerance 4 months after the event...
in those cases, C is a nono.
I have seen 3 or 4 situations like that in my rotations but the answer is the same. start as soon as posible...but take some considerations
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| GDS2008
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I completley agree that 3 months is a long time to wait and certainly none of us would like to wait for that long if put in that situation. So what should be the correct answer here??
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