Of "cundumm", "baba"" and "annashetty"
Those were the residency days of seventies and eighties. Our learning days in the wards of KEM hospital. They were the days of recycling materials, very few disposables.
When we saw a ward boy throw away an equipment or a material and we asked him why cant he re-use the same after washing and sterilizing, he used to say "baba e kahyun e cundumm chhe" meaning the staff nurse (baba) said it is condemned and to be thrown away. Besides the words cundumm" and "baba which the ward boys used, another word that amused us was used for anesthetists : "annashetty".
But recently I was reminded of the "cundumm" days when I was hearing Wayne Dyer's tape who mentioned 'you cannot correct anything (or anyone) by condemning it'! When you condemn a person- even mentally- it is as if you have thrown him on the floor, in the dust bin, from where he has no energy left to rise. He is written off- can't be corrected.
So be careful when you condemn someone- even mentally. In your eyes and in your mind, he will never get a chance to correct himself for you will see what you believe, you make your world by your thoughts. Although rare, even a die hard criminal can correct himself, because "when you change the way you look at things, the things you look at change."
And so, what is condemned can't be corrected and what can be or should be corrected shouldn't be condemned.
Because what is "cundumm" cannot be recycled ! The ward boy knew it well.
Love- akshay
Monday, February 20, 2012
Monday, February 13, 2012
Coronary CT angiography
Should all Indians above 40 years of age undergo screening with coronary CT angiography to detect coronary disease ?
Recently, a 56 year old man, a non smoker, who had no prior symptoms, had sudden severe chest pain and collapsed in his house with cardiac arrest. He was a regular tennis player, without hypertension, diabetes or obesity. The only adverse history was that both his parents had coronary heart disease and some cousins too at young age.
Could we have done a test earlier which could have help us predict his heart disease and helped us prevent it? Something like treadmill stress test? Or CT coronary angiography ?
CT coronary angiography is a test in which a liquid (called ‘contrast’ or ‘dye’) is injected into a vein, the subject is asked to hold his/her breath for few seconds, and the heart is scanned under a CT scanner. What comes out as a result are pictures of one’s coronary arteries. One can then see whether his/her coronary arteries have blockages or not.
What is the accuracy of the test- vis a vis the usual invasive coronary angiography ? or vis a vis treadmill stress test?
Well, a negative test is highly reliable. In other words, if your CT coronary angiogram is normal, there is about 98% likelihood that it is truly normal. On the other hand a “positive” test result is not so reliable – which means that if there are blockages, these may be over or under diagnosed and an invasive angiogram MAY be necessary if the physician so feels.
But the advantage of this test is not only that it is convenient, non invasive and can be done in a few minutes on an out-patient basis, but that it also shows the state of coronary artery wall- whether it is thickened due to “plaque” or fat build up on the inner lining. This can tell whether the patient is at a future risk of a heart attack caused by rupture of that “plaque” and clot formation on top of it.
A treadmill stress test does not tell you this and there is the issue of lot of false positives and false negatives in a treadmill test.
So the million dollar question is whether to subject all above 40 years to CT coronary angiography, given the high propensity of the disease in young Indians ? (Almost 4 times our western brothers).
That brings us to the disadvantages of the test. Firstly, it exposes the individual to radiation which is potentially carcinogenic. Secondly it exposes the individual to the “dye” load which can harm kidneys if they are already compromised. Finally the cost (Rs 8000 to 12000) may prohibit usage on a mass scale.
Hence selection of the test for only some high risk individuals is the key. At present, due to its inherent dangers, recent “appropriateness criteria” from bodies such as the American Heart Association mention that the test is definitely ‘inappropriate’ for low or intermediate risk patients but its value is “uncertain” for high risk individuals. *
“Uncertain” means that the authors were equally divided between agreeing and disagreeing with the appropriateness of the test and opine that the test “may be generally acceptable and may be a reasonable approach for the indication”.
So, on the one hand we have a test which can easily tell us whether disease is present or not – a disease which takes away or damages young lives in India. On the other hand we may expose normal people (already exposed to a host of pollutants and radiation) to harmful radiation.
Although the balance is thus evenly placed, one would like to tilt it in favor of doing the test in high risk individuals especially young Indians who are inherently at a risk higher than western counterparts (to whom the appropriateness criteria properly apply).
So, to answer the question posed at the beginning: “Should all Indians above 40 years of age undergo screening with coronary CT angiography ?”
Well, not all, but only those at high risk of any age may undergo the test..
It may be very useful in a young man of 35 with risk factors, esp a strong family history of premature heart disease, while it may not be useful and cause more harm than benefit in a man of 60 with low risk.
Thus in view of the wide prevalence of severe coronary artery disease in young Indians, coronary CT angiography may be used for “routine screening” of high risk individuals based on the number and severity of risk factors such as diabetes, hypertension, abnormal lipids and family history of premature heart disease (below age 56 in brothers or father and below 65 yrs in mother or sisters). Then, if presence of disease is confirmed by the test, vigorous life style changes and even preventive medications like statins and aspirin may make a difference between life and death for these individuals.
*People are divided into low, intermediate or high risk for heart attack in next ten years based on the presence and severity of ‘risk factors’ in them.
Low risk correlates with a 10-year absolute CHD (coronary heart disease) risk <10%, intermediate risk correlates with a 10-year absolute CHD risk between 10% to 20% and high risk is defined as a 10-year absolute CHD risk of >20%, the presence of diabetes mellitus in a patient 40 years of age, peripheral arterial disease or other coronary risk equivalents (prior angina, heart attack etc) This ‘scoring’ of risk is done by noting risk factors in an individual like hypertension, diabetes, abnormal cholesterol levels, smoking, family history of premature heart disease etc. and logging on to :
http://www.framinghamheartstudy.org/risk/coronary.html
http://hp2010.nhlbihin.net/ATPiii/calculator.asp
Recently, a 56 year old man, a non smoker, who had no prior symptoms, had sudden severe chest pain and collapsed in his house with cardiac arrest. He was a regular tennis player, without hypertension, diabetes or obesity. The only adverse history was that both his parents had coronary heart disease and some cousins too at young age.
Could we have done a test earlier which could have help us predict his heart disease and helped us prevent it? Something like treadmill stress test? Or CT coronary angiography ?
CT coronary angiography is a test in which a liquid (called ‘contrast’ or ‘dye’) is injected into a vein, the subject is asked to hold his/her breath for few seconds, and the heart is scanned under a CT scanner. What comes out as a result are pictures of one’s coronary arteries. One can then see whether his/her coronary arteries have blockages or not.
What is the accuracy of the test- vis a vis the usual invasive coronary angiography ? or vis a vis treadmill stress test?
Well, a negative test is highly reliable. In other words, if your CT coronary angiogram is normal, there is about 98% likelihood that it is truly normal. On the other hand a “positive” test result is not so reliable – which means that if there are blockages, these may be over or under diagnosed and an invasive angiogram MAY be necessary if the physician so feels.
But the advantage of this test is not only that it is convenient, non invasive and can be done in a few minutes on an out-patient basis, but that it also shows the state of coronary artery wall- whether it is thickened due to “plaque” or fat build up on the inner lining. This can tell whether the patient is at a future risk of a heart attack caused by rupture of that “plaque” and clot formation on top of it.
A treadmill stress test does not tell you this and there is the issue of lot of false positives and false negatives in a treadmill test.
So the million dollar question is whether to subject all above 40 years to CT coronary angiography, given the high propensity of the disease in young Indians ? (Almost 4 times our western brothers).
That brings us to the disadvantages of the test. Firstly, it exposes the individual to radiation which is potentially carcinogenic. Secondly it exposes the individual to the “dye” load which can harm kidneys if they are already compromised. Finally the cost (Rs 8000 to 12000) may prohibit usage on a mass scale.
Hence selection of the test for only some high risk individuals is the key. At present, due to its inherent dangers, recent “appropriateness criteria” from bodies such as the American Heart Association mention that the test is definitely ‘inappropriate’ for low or intermediate risk patients but its value is “uncertain” for high risk individuals. *
“Uncertain” means that the authors were equally divided between agreeing and disagreeing with the appropriateness of the test and opine that the test “may be generally acceptable and may be a reasonable approach for the indication”.
So, on the one hand we have a test which can easily tell us whether disease is present or not – a disease which takes away or damages young lives in India. On the other hand we may expose normal people (already exposed to a host of pollutants and radiation) to harmful radiation.
Although the balance is thus evenly placed, one would like to tilt it in favor of doing the test in high risk individuals especially young Indians who are inherently at a risk higher than western counterparts (to whom the appropriateness criteria properly apply).
So, to answer the question posed at the beginning: “Should all Indians above 40 years of age undergo screening with coronary CT angiography ?”
Well, not all, but only those at high risk of any age may undergo the test..
It may be very useful in a young man of 35 with risk factors, esp a strong family history of premature heart disease, while it may not be useful and cause more harm than benefit in a man of 60 with low risk.
Thus in view of the wide prevalence of severe coronary artery disease in young Indians, coronary CT angiography may be used for “routine screening” of high risk individuals based on the number and severity of risk factors such as diabetes, hypertension, abnormal lipids and family history of premature heart disease (below age 56 in brothers or father and below 65 yrs in mother or sisters). Then, if presence of disease is confirmed by the test, vigorous life style changes and even preventive medications like statins and aspirin may make a difference between life and death for these individuals.
*People are divided into low, intermediate or high risk for heart attack in next ten years based on the presence and severity of ‘risk factors’ in them.
Low risk correlates with a 10-year absolute CHD (coronary heart disease) risk <10%, intermediate risk correlates with a 10-year absolute CHD risk between 10% to 20% and high risk is defined as a 10-year absolute CHD risk of >20%, the presence of diabetes mellitus in a patient 40 years of age, peripheral arterial disease or other coronary risk equivalents (prior angina, heart attack etc) This ‘scoring’ of risk is done by noting risk factors in an individual like hypertension, diabetes, abnormal cholesterol levels, smoking, family history of premature heart disease etc. and logging on to :
http://www.framinghamheartstudy.org/risk/coronary.html
http://hp2010.nhlbihin.net/ATPiii/calculator.asp
Friday, February 10, 2012
Eating chocolate and drinking red wine
Eating chocolate and drinking red wine
-will it improve your heart health ?
Studies have repeatedly suggested that foods like dark chocolate, red wine, berries etc reduce the risk of heart disease. The common link in all these foods is a group of substances called polyphenols and flavonoids present in them
What are polyphenols and flavonoids?
Polyphenols are natural compounds found in plants that are believed to have beneficial health effects. There are thousands of polyphenols, but one has attracted the most attention to date—resveratrol, which is found mainly in red wine and has been suggested to have potential cardiovascular, anticancer, and antiaging benefits.
Flavonoids are a class of polyphenols. They include the following subclasses:
• Anthocyanidins—In blueberries, red wine, and strawberries.
• Flavan-3-ols—In apples, black tea, blueberries, chocolate, and red wine.
• Flavones—In celery, garlic, green peppers, and herbal tea.
• Flavonols—In blueberries, garlic, kale, onions, spinach, tea, broccoli, red wine, and cherry tomatoes.
• Proanthocyanidins—In apples, black tea, blueberries, chocolate, mixed nuts, peanuts, red wine, strawberries, and walnuts.
• Isoflavones—In soy products and peanuts.
• Flavanones—In citrus fruit and juices and herbal tea
Resveratrol is a poly phenol but not a flavonoid.
Recent studies have found that more the number of flavnoids from the above group of food stuffs, greater the cardiovascular protection. Five flavonoid classes—anthocyanidins, flavan-3-ols, flavones, flavonols, and proanthocyanidins—were individually associated with lower risk of cardiovascular death. In a study in men, total flavonoid intakes were more strongly associated with stroke mortality—showing a 37% reduction—than with ischemic heart disease, which showed a 10% reduction. In women, the strongest inverse association was observed with flavones, particularly for fatal ischemic heart disease
Thus it is not wine alone or chocolate alone that is protective. Rather, better protection could be from a combination of all the foods listed and if one looks at the first five groups in the list above, most of these foods fall under the category of healthy foods already - fruits and vegetables, nuts and seeds, tea and cocoa, garlic and broccoli, blue berries and spinach etc etc.
Another caveat one must remember is that many of the studies showing beneficial effects have used products enriched with flavonoids. For example in the studies, it is not the chocolate you buy in the shops that showed benefits. Normal chocolate is too full of fat and calories and doesn't contain high levels of flavonoids. One cannot thus recommend that people buy ordinary chocolates to get their flavonoids. Chocolate companies are starting to bring out flavonoid-enriched cocoa powders and chocolate bars and that may be the way to go with the healthy-chocolate message.
Also, the amount of polyphenols and flavonoids will vary with the growing conditions, the amount of sunlight and water, and the country of origin
Thus, it may appear that the best things to eat and drink are chocolate and red wine, only because this is what has been most studied and most popular. But one can say that there is also significant evidence of benefits with teas, fruits, nuts, seeds, garlic, kale, broccoli and others listed above. Hence a healthy mixture of these healthy foods is recommended. Thus if you always eat an apple every day, try berries or other type of fruits instead. Try new vegetables—kale or broccoli—and introduce more nuts into your diet. Little changes in the diet can achieve a wide variety of these compounds.
Finally, although the most convincing evidence with flavonoids is on vascular benefits, there is also some suggestion of positive effects on the brain and cancer.
Everyone has to eat. Why not eat things that are said to be good for you?!
-will it improve your heart health ?
Studies have repeatedly suggested that foods like dark chocolate, red wine, berries etc reduce the risk of heart disease. The common link in all these foods is a group of substances called polyphenols and flavonoids present in them
What are polyphenols and flavonoids?
Polyphenols are natural compounds found in plants that are believed to have beneficial health effects. There are thousands of polyphenols, but one has attracted the most attention to date—resveratrol, which is found mainly in red wine and has been suggested to have potential cardiovascular, anticancer, and antiaging benefits.
Flavonoids are a class of polyphenols. They include the following subclasses:
• Anthocyanidins—In blueberries, red wine, and strawberries.
• Flavan-3-ols—In apples, black tea, blueberries, chocolate, and red wine.
• Flavones—In celery, garlic, green peppers, and herbal tea.
• Flavonols—In blueberries, garlic, kale, onions, spinach, tea, broccoli, red wine, and cherry tomatoes.
• Proanthocyanidins—In apples, black tea, blueberries, chocolate, mixed nuts, peanuts, red wine, strawberries, and walnuts.
• Isoflavones—In soy products and peanuts.
• Flavanones—In citrus fruit and juices and herbal tea
Resveratrol is a poly phenol but not a flavonoid.
Recent studies have found that more the number of flavnoids from the above group of food stuffs, greater the cardiovascular protection. Five flavonoid classes—anthocyanidins, flavan-3-ols, flavones, flavonols, and proanthocyanidins—were individually associated with lower risk of cardiovascular death. In a study in men, total flavonoid intakes were more strongly associated with stroke mortality—showing a 37% reduction—than with ischemic heart disease, which showed a 10% reduction. In women, the strongest inverse association was observed with flavones, particularly for fatal ischemic heart disease
Thus it is not wine alone or chocolate alone that is protective. Rather, better protection could be from a combination of all the foods listed and if one looks at the first five groups in the list above, most of these foods fall under the category of healthy foods already - fruits and vegetables, nuts and seeds, tea and cocoa, garlic and broccoli, blue berries and spinach etc etc.
Another caveat one must remember is that many of the studies showing beneficial effects have used products enriched with flavonoids. For example in the studies, it is not the chocolate you buy in the shops that showed benefits. Normal chocolate is too full of fat and calories and doesn't contain high levels of flavonoids. One cannot thus recommend that people buy ordinary chocolates to get their flavonoids. Chocolate companies are starting to bring out flavonoid-enriched cocoa powders and chocolate bars and that may be the way to go with the healthy-chocolate message.
Also, the amount of polyphenols and flavonoids will vary with the growing conditions, the amount of sunlight and water, and the country of origin
Thus, it may appear that the best things to eat and drink are chocolate and red wine, only because this is what has been most studied and most popular. But one can say that there is also significant evidence of benefits with teas, fruits, nuts, seeds, garlic, kale, broccoli and others listed above. Hence a healthy mixture of these healthy foods is recommended. Thus if you always eat an apple every day, try berries or other type of fruits instead. Try new vegetables—kale or broccoli—and introduce more nuts into your diet. Little changes in the diet can achieve a wide variety of these compounds.
Finally, although the most convincing evidence with flavonoids is on vascular benefits, there is also some suggestion of positive effects on the brain and cancer.
Everyone has to eat. Why not eat things that are said to be good for you?!
Tuesday, February 7, 2012
Sex and the Heart- Frequently asked questions
Sex and the Heart : Some FAQ’s
Recently, the American Heart Association (AHA) released a scientific statement to address this issue, which was published in the journal Circulation January 19, 2012.
One of the main purposes of the statement was to make physicians and healthcare providers aware that this is a real issue that is not appropriately addressed with the patient and partner and which truly should be. The recommendations have been compiled by experts from various fields, including cardiology, exercise physiology, sexual counseling, and urology.
Below are frequent questions that arise in the minds of patients with regards to sex and heart disease and the answers based on the now available recommendations:
Q.How great is the risk of heart attack during or after a sex act ?
The risk of heart attack is only extremely modestly increased during sexual activity and represents only a miniscule amount of a person's overall risk.
Sexual activity is the cause of <1% of all heart attacks. In an autopsy report of 5559 instances of sudden death, 34 (0.6%) reportedly occurred during sexual intercourse. Two other autopsy studies reported similarly low rates (0.6%– 1.7%) of sudden death related to sexual activity. Of the subjects who died during coitus, 82% to 93% were men, and the majority (75%) was having extramarital sexual activity, in most cases with a younger partner in an unfamiliar setting and/or after excessive food and alcohol consumption
Q. Is it safe for a heart patient to resume sexual activity ? How does one know it is safe?
Patients with any kind of cardiac disease, wishing to initiate or resume sexual activity must be evaluated with a thorough medical history and physical examination. Sexual activity is reasonable for patients with cardiac disease who, on clinical evaluation, are determined to be at low risk of cardiovascular complications, like patients who do not have symptoms on usual activities such as walking at moderate speed or climbing 2 flights of stairs. For patients who are not at low cardiovascular risk or have unknown cardiovascular risk, exercise stress testing is advisable to assess exercise capacity and development of symptoms, ischemia, or rhythm disturbances on exercise
Q. How does one judge the safety of sexual activity based on exercise testing?
If you can can exercise on the treadmill test up to a certain level (in medical terms more than 3 to 5 METS) without experiencing anginal chest discomfort, excessive breathlessness, ECG changes, fall of blood pressure or rhythm abnormalities, you can safely resume sexual activity.
Q What can a patient with heart disease do to further reduce his/her risk of a heart attack during or after sexual activity ?
Besides taking proper cardiac medications and adopting a prudent lifestyle including diet, cardiac rehabilitation and regular physical activity can reduce the risk of cardiovascular complications in people with heart disease. Sedentary individuals have a relative risk of sex related heart attack of 3.0, whereas physically active individuals have a relative risk of only 1.2. In other words when a sedentary individual indulges in sexual activity, his risk of a heart attack is 3 times more as compared to the risk of having a heart attack when he is at rest, whereas when a physically fit or trained person does so, his risk is only 1.2 times more.
Q. I had a heart attack 3 weeks ago and doctors have said I am stable and allowed to walk in my compound at moderate pace. Is it safe for me to resume sex?
Sexual activity is reasonable 1 or more weeks after an uncomplicated heart attack if you are without cardiac symptoms during mild to moderate physical activity.
Q. Which type of heart patients should not resume sexual activity ?
Sexual activity is safe for the majority of heart disease patients and that doctors—as well as patients and their partners—should endeavor to bring up the subject of sex in discussions. The only patients who should refrain from sex are those with acute or unstable heart disease or severe symptoms; they should be assessed and stabilized with appropriate treatment before engaging in sexual activity. Also patients with heart disease who experience heart symptoms precipitated by sexual activity should defer sexual activity until their condition is stabilized and optimally managed
Q. My friend has been put on cardiac drugs for treatment of his heart condition, which the doctors say is severe. He has difficulty in sexual activity. Should he stop the cardiac drugs?
No. Drugs used to protect the heart should not be stopped altogether. If a patient being treated with a cardiovascular drug complains of sexual dysfunction, it could also be due to other reasons like : 1.underlying arterial or cardiac disease itself, 2.the nocebo effect (which is due to a patient’s knowledge that a drug has been associated with erectile dysfunction) or 3. anxiety or depression. So these conditions should be sought and treated first before stopping or altering any drug. Drugs like thiazides, spironolactone and beta blockers are known to cause sexual dysfunction and a doctor may substitute them by drugs like frusemide, eplerenon and nebivolol respectively.
Q Can this above mentioned friend of mine be put on drugs like Sildenafil or Tadalafil to improve his sex life?
The answer is yes, with some STRICT provisions. 1. If his usual medications include any form of nitrates, then giving Sildenafil like drugs is extremely dangerous and could be fatal due to the severe and sudden blood pressure lowering effect when Sildenafil like drugs are given in a patient who is already on nitrates. Hence he should be off nitrates (even a spray) at least for 24 hours before starting Sildenafil. 2. If his cardiac medications include an alpha blocker, its dose should be lowered lest it should cause severe lowering of BP. 3. Conversely, if a person is on regular usage of Sildenafil or Tadalafil, and now requires a nitrate drug due to his heart disease, Sildenafil or Tadalafil should be stopped for 24 or 48 hours respectively before a nitrate can be started.
Q. When can a patient who has undergone balloon angioplasty, resume sex?
Sexual activity is reasonable for patients who have undergone angioplasty and may be resumed several days after the procedure if the artery puncture site (usually the groin or the wrist) are without complications.
Q. When can a person resume sex after bypass surgery ?
Sex can be resumed 6 to 8 weeks after standard coronary artery bypass graft surgery, provided the sternal wound is well healed.
Q. I have been told I have ‘compensated’ or ‘stable’ heart failure. Can I indulge in sex ?
Yes, sexual activity is reasonable for patients with compensated and/or mild heart failure but not advised for patients with decompensated or advanced heart failure until their condition is stabilized and optimally managed.
Recently, the American Heart Association (AHA) released a scientific statement to address this issue, which was published in the journal Circulation January 19, 2012.
One of the main purposes of the statement was to make physicians and healthcare providers aware that this is a real issue that is not appropriately addressed with the patient and partner and which truly should be. The recommendations have been compiled by experts from various fields, including cardiology, exercise physiology, sexual counseling, and urology.
Below are frequent questions that arise in the minds of patients with regards to sex and heart disease and the answers based on the now available recommendations:
Q.How great is the risk of heart attack during or after a sex act ?
The risk of heart attack is only extremely modestly increased during sexual activity and represents only a miniscule amount of a person's overall risk.
Sexual activity is the cause of <1% of all heart attacks. In an autopsy report of 5559 instances of sudden death, 34 (0.6%) reportedly occurred during sexual intercourse. Two other autopsy studies reported similarly low rates (0.6%– 1.7%) of sudden death related to sexual activity. Of the subjects who died during coitus, 82% to 93% were men, and the majority (75%) was having extramarital sexual activity, in most cases with a younger partner in an unfamiliar setting and/or after excessive food and alcohol consumption
Q. Is it safe for a heart patient to resume sexual activity ? How does one know it is safe?
Patients with any kind of cardiac disease, wishing to initiate or resume sexual activity must be evaluated with a thorough medical history and physical examination. Sexual activity is reasonable for patients with cardiac disease who, on clinical evaluation, are determined to be at low risk of cardiovascular complications, like patients who do not have symptoms on usual activities such as walking at moderate speed or climbing 2 flights of stairs. For patients who are not at low cardiovascular risk or have unknown cardiovascular risk, exercise stress testing is advisable to assess exercise capacity and development of symptoms, ischemia, or rhythm disturbances on exercise
Q. How does one judge the safety of sexual activity based on exercise testing?
If you can can exercise on the treadmill test up to a certain level (in medical terms more than 3 to 5 METS) without experiencing anginal chest discomfort, excessive breathlessness, ECG changes, fall of blood pressure or rhythm abnormalities, you can safely resume sexual activity.
Q What can a patient with heart disease do to further reduce his/her risk of a heart attack during or after sexual activity ?
Besides taking proper cardiac medications and adopting a prudent lifestyle including diet, cardiac rehabilitation and regular physical activity can reduce the risk of cardiovascular complications in people with heart disease. Sedentary individuals have a relative risk of sex related heart attack of 3.0, whereas physically active individuals have a relative risk of only 1.2. In other words when a sedentary individual indulges in sexual activity, his risk of a heart attack is 3 times more as compared to the risk of having a heart attack when he is at rest, whereas when a physically fit or trained person does so, his risk is only 1.2 times more.
Q. I had a heart attack 3 weeks ago and doctors have said I am stable and allowed to walk in my compound at moderate pace. Is it safe for me to resume sex?
Sexual activity is reasonable 1 or more weeks after an uncomplicated heart attack if you are without cardiac symptoms during mild to moderate physical activity.
Q. Which type of heart patients should not resume sexual activity ?
Sexual activity is safe for the majority of heart disease patients and that doctors—as well as patients and their partners—should endeavor to bring up the subject of sex in discussions. The only patients who should refrain from sex are those with acute or unstable heart disease or severe symptoms; they should be assessed and stabilized with appropriate treatment before engaging in sexual activity. Also patients with heart disease who experience heart symptoms precipitated by sexual activity should defer sexual activity until their condition is stabilized and optimally managed
Q. My friend has been put on cardiac drugs for treatment of his heart condition, which the doctors say is severe. He has difficulty in sexual activity. Should he stop the cardiac drugs?
No. Drugs used to protect the heart should not be stopped altogether. If a patient being treated with a cardiovascular drug complains of sexual dysfunction, it could also be due to other reasons like : 1.underlying arterial or cardiac disease itself, 2.the nocebo effect (which is due to a patient’s knowledge that a drug has been associated with erectile dysfunction) or 3. anxiety or depression. So these conditions should be sought and treated first before stopping or altering any drug. Drugs like thiazides, spironolactone and beta blockers are known to cause sexual dysfunction and a doctor may substitute them by drugs like frusemide, eplerenon and nebivolol respectively.
Q Can this above mentioned friend of mine be put on drugs like Sildenafil or Tadalafil to improve his sex life?
The answer is yes, with some STRICT provisions. 1. If his usual medications include any form of nitrates, then giving Sildenafil like drugs is extremely dangerous and could be fatal due to the severe and sudden blood pressure lowering effect when Sildenafil like drugs are given in a patient who is already on nitrates. Hence he should be off nitrates (even a spray) at least for 24 hours before starting Sildenafil. 2. If his cardiac medications include an alpha blocker, its dose should be lowered lest it should cause severe lowering of BP. 3. Conversely, if a person is on regular usage of Sildenafil or Tadalafil, and now requires a nitrate drug due to his heart disease, Sildenafil or Tadalafil should be stopped for 24 or 48 hours respectively before a nitrate can be started.
Q. When can a patient who has undergone balloon angioplasty, resume sex?
Sexual activity is reasonable for patients who have undergone angioplasty and may be resumed several days after the procedure if the artery puncture site (usually the groin or the wrist) are without complications.
Q. When can a person resume sex after bypass surgery ?
Sex can be resumed 6 to 8 weeks after standard coronary artery bypass graft surgery, provided the sternal wound is well healed.
Q. I have been told I have ‘compensated’ or ‘stable’ heart failure. Can I indulge in sex ?
Yes, sexual activity is reasonable for patients with compensated and/or mild heart failure but not advised for patients with decompensated or advanced heart failure until their condition is stabilized and optimally managed.
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