​As a matter of fact, the wife of one of my heart-attack patients asked me if it was safe for her husband to have sex.  They were so worried that sex would be fatal that they had refrained from all intimacy for several months since the heart attack.  How incredibly sad that something so intimate and binding in a stable marriage relationship was avoided due to an unsubstantiated fear that it could result in death. 

Is there any evidence to support this fear and anxiety?

Despite what Hollywood would lead us to believe, having a literal heart attack during or immediately following sex is an incredibly rare event.  During sex, for both men and women, it is common for the heart rate and blood pressure to rise.  However, sexual activity is equivalent to only mild to moderate physical activity in the range of 3-5 METS which is similar to a brisk walk or climbing two flights of stairs[1].

Thus, if you can walk briskly or climb two flights of stairs without any troubles your heart should hold up just fine during sex.  Indeed, studies have shown that even in patients who have already had a heart attack that there was no increased risk of a heart problem during sex as long as they were otherwise physically active[2].

There have been several published studies evaluating people who actually died from a cardiac arrest while having sex.  What they found from these studies is the following[3][4][5]:

• ​Most were older men having sex with younger women
• 75% of the cardiac arrests were from extramarital affairs
• Sex was in a new location
• Sex generally followed excessive eating or alcohol consumption

So what are my recommendations when my cardiac patients ask me if it is OK for their hearts to have sex?

As long as you are not having any heart symptoms or your heart condition is under control under the care of your doctor, you are physically activity, and sex occurs within a safe monogamous relationship then it is actually very healthy for the heart.

Those people who are suffering from heart symptoms or who are not physically active should discuss with their physician whether it would be safe or not to have sex.