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Senior Citizens & Sex
Men with Chronic Heart Failure can have Active Sex
Lives: Mayo Clinic Journal
Middle aged men have peak heart rate during
intercourse that’s lower than heart rates during normal daily activities
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Oct. 4, 2007 – A literature review published in the
October issue of Mayo Clinic Proceedings finds that with proper
screening and treatment, many patients with chronic heart failure –
primarily older Americans - can safely engage in sexual activity. This
provides strong support to the position of the American Heart
Association.
Although medication can help extend the lives of
men with chronic heart failure, several factors associated with this
disease can interfere with a person’s ability to engage in and enjoy
sexual activities.
Fatigue, depression, medication side effects and
the fear of damaging the heart can cause people with chronic heart
failure to lose interest in sex or wonder whether this activity is safe
for them, note the Mayo researchers.
The American Heart Association has previously
stated, “Most people with heart failure can continue sexual relations
once symptoms are under control.”
Co-authors Stacy Mandras, M.D., Patricia Uber,
Pharm. D., and Mandeep Mehra, M.D., conducted systematic independent
literature searches using the MEDLINE database and examined a broad
range of medical research that focused on chronic heart failure, sexual
activity and sexual dysfunction. This literature included data from
patient surveys and clinical trials.
Findings
Many people with chronic heart failure worry that
having sex will place too great a strain on the heart and the
researchers set out to determine if this concern is warranted..
To address this issue, Drs. Mandras and Mehra
analyzed studies that showed the impact of sexual activity on heart
rate, blood pressure and respiratory rates, which typically increase
during sexual activity and other forms of exertion.
One study the authors reviewed measured these
changes in middle-aged men with and without coronary artery disease.
This study found that the peak heart rate during intercourse was lower
than heart rates measured during the patients’ normal daily activities.
The study participants’ peak oxygen consumption
levels during intercourse were moderate — comparable to their oxygen
consumption levels during moderate activities such as walking on level
ground at 3 to 4 miles per hour, climbing stairs slowly or doing general
housework such as vacuuming.
The authors also addressed how to counsel and treat
chronic heart failure patients who are coping with erectile dysfunction,
difficulty achieving or maintaining an erection. Researchers estimate
that erectile dysfunction affects 60 percent to 70 percent of people who
have chronic heart failure.
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Sex and Heart Failure – American Heart Association
"Can someone still have sex after
heart failure is diagnosed?"
Try not to feel embarrassed about raising this
question with your physician or other healthcare providers. They've
heard it before.
Most people with heart failure can continue sexual
relations once symptoms are under control. They may feel more
comfortable and confident when following certain guidelines suggested
for heart patients:
● Choose a time when you're rested, relaxed and
free from the stressful feelings brought on by the day's schedules and
responsibilities.
● Avoid having sex right after eating a heavy
meal.
● Select a familiar, peaceful setting that's free
from interruptions.
● If you start to feel uncomfortable or tired
during intercourse, stop and rest for a short time.
There's no reason why heart patients can't resume
usual sexual activity as soon as they feel ready to do so. However, if
your condition is severe and you can't tolerate exercise, you may need
to find less demanding ways to express love and affection. You could
spend time hugging, kissing and touching instead.
People with heart failure should remind themselves
that it's OK if they're not ready to have sex right away. Feelings like
stress, anxiety and depression are natural after a serious health
diagnosis and often cause a loss of interest. Patients will need to work
with their partners to demonstrate their love in other ways.
>>
More about Chronic Heart Failure at American Heart Association
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The authors observe that multiple factors may be
involved. In addition to decreased exercise capacity, patients with
chronic heart failure have blood vessel and circulation abnormalities
that can reduce blood flow into the penis and interfere with the ability
to maintain an erection. And erectile dysfunction can be caused or
worsened by many of the medications that are commonly prescribed to
treat chronic heart failure.
Currently, the preferred treatment for erectile
dysfunction includes sildenafil (Viagra), vardenafil (Levitra) and
tadalafil (Cialis).
However, numerous experts have raised concerns
about the use of these drugs in patients with chronic heart failure who
also take nitrates (or other medications that relax and widen blood
vessels). This drug combination has been shown to be dangerous, because
it can increase the risk for a life-threatening drop in blood pressure.
To further explore this potential risk, the authors
reviewed results from a variety of studies in which male patients with
congestive heart failure took sildenafil. The authors observed that more
data are needed to determine the safety of the newer drugs, vardenafil
and tadalafil, for these patients.
“Taken together, these studies show that erectile
dysfunction in patients with mild to moderate chronic heart failure can
be safely and effectively treated with sildenafil, provided that
patients are appropriately screened before therapy,” say the authors.
For those patients who cannot take erectile
dysfunction medications, the authors counsel that an exercise training
regimen may be an appropriate substitute therapy to enhance sexual
function and quality of life. The authors stress that clinicians should
focus on the sexual activity history of chronic heart failure patients
and not ignore it, since addressing this element can substantially
improve their quality of life.
Editor’s Notes:
Background about chronic heart failure
American Heart Association says nearly 5 million
Americans are living with heart failure, and 550,000 new cases are
diagnosed each year.
Chronic heart failure often develops after other
cardiac problems have damaged or weakened the heart, leaving it too weak
or too stiff to fill and pump efficiently. Many underlying heart
conditions can lead to heart failure. It can develop quickly after
damage caused by a heart attack, or it can develop gradually after years
of high blood pressure or coronary artery disease.
Mayo Clinic Proceedings, a peer-review journal,
publishes original articles, reviews and editorials dealing with
clinical and laboratory medicine, clinical research, basic science
research and clinical epidemiology. Mayo Clinic Proceedings is published
monthly by Mayo Foundation for Medical Education and Research as part of
its commitment to the medical education of physicians. The journal has
been published for more than 80 years and has a circulation of 130,000
nationally and internationally. Articles are available online at
www.mayoclinicproceedings.com.
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