Martha Gulati, MD, MS, FACC, FAHA

We get a lot of questions about this clinically, and I always say that it is depicted in movies as the classic Hollywood heart attack of a gentleman having intercourse with someone who is much younger than them, or their mistress, and they die from sudden cardiac arrest. From a patient perspective, patients often worry about this. I think that we, as physicians, don’t [generally] communicate sexual activity. We might bring up other things going on in their lives, but I think doctors avoid talking about sexual activity and I think patients are uncomfortable.

These data come from the community-based Oregon SUDS (Sudden Unexpected Death Study). There are differences in Oregon vs. other U.S. states, but, in general, it should reflect … the [overall] U.S. The annual incidence of sudden cardiac arrest linked to sexual activity was estimated to be 0.28 per 100,000 adults, which is low. That’s one thing we can tell our patients: Sudden cardiac arrest linked to sexual activity is infrequent; even though it’s depicted in the movies, it’s less likely to happen to you.

Another interesting finding was that it is more likely to occur during sex in men and African Americans.

As physicians, we should always assess patients to determine whether they’re safe for sexual activity — just like any activity. A lot of the people who had sudden cardiac arrest in this study were people with prior coronary disease.

Even with the most [vigorous] intercourse, and not to minimize people’s sexual prowess, the estimated metabolic equivalent (MET) is [generally] 2-4, sometimes 5 at the upper end. In terms of what that represents, if you walk at 2 miles per hour on a level surface, that’s around 2 METs. We typically estimate 5 METs for activities of daily living. If a patient is doing daily activities without any chest pain, then they are probably safe for sexual activity. If the patient can’t do that, then it is important to talk to the physician and for physicians to be asking these questions so there is a clear idea of what their activity at home is like. Where we do see sudden cardiac arrest or death is when people are doing something new to them. Were they exerting themselves to a level that they haven’t done before? How frequently do they have sex? These are some of the conversations to have.

The other interesting finding was that only about one-third of sudden cardiac arrest cases got CPR when a partner was there watching. There was another paper released yesterday [at AHA 2017] about sudden cardiac arrest and women, specifically, with men receiving more bystander CPR than women. Time is heart muscle; the quicker you start, even if you’re calling 9-1-1, the next thing while you’re waiting for EMS to come is to begin CPR. We need to be better educators in our community. We’ve got to teach our patients to be empowered because they can save lives.