Sex and Heart Disease
to their sexuality. Distressing pain and en with heart disease face exceptional chal-lenges other symptoms make it difﬁcult to feel comfort- able, much less sexually aroused. Many men with heart disease are afraid to have sex because they and their partner fear that the increased physical exertion could cause chest pain or even another heart attack. But most men with heart problems can have sex without causing any physical problems. Talking to your doctor about such a delicate subject can be uncomfortable, but you need to ﬁnd out what your limits are. Even if your heart condition is so serious it restricts your ability to have intercourse, you still can be affectionate and intimate with your partner in other ways. For example, you could bring your partner to orgasm using your hand or mouth. Remember that heart disease should never prevent you from having a loving and caring relationship with your partner.
Managing Heart Disease
Once you are released from the hospital after a heart attack, your treatment will focus on long-range preventive care. Your doctor will recommend that you make lifestyle changes such as eating a healthy diet, exercising regularly, losing weight if you are overweight, and quitting smoking if you smoke. In addition, your doctor will want to monitor your condition with regu- larly scheduled checkups and tests, and he or she may prescribe medication to reduce risk factors for heart disease such as high blood pressure or high cholesterol level.
Tests for Heart Disease Physicians use a number of procedures to evaluate a person’s risk for heart problems, the progress a person is making after a heart attack or surgery, and the status of a person’s heart and circulatory system. These procedures include:
• Continuous ECG monitoring of the heart’s electrical activity with a Holter monitor. The monitor, which is worn around the neck or over the shoulder, records an ECG for 24 hours, so the doctor can monitor an arrhythmia (abnor- mal heartbeat) or episodes of silent ischemia (inadequate blood ﬂow to the heart).
• Exercise stress testing is an evaluation of heart rate, blood pressure, electrical activity of the heart, and symptoms of angina and other problems related to
inadequate blood supply to the heart while a person walks or runs on a tread- mill or rides a stationary bicycle. This test can help determine the severity of coronary artery disease and the ability of the heart to respond to a reduced blood supply. The test may be performed before or shortly after the person leaves the hospital to help determine how well he is doing after the heart attack and whether ischemia is continuing. If this test reveals an arrhythmia or ischemia, drug treatment may be recommended. If ischemia persists, a physi- cian may recommend coronary arteriography to determine whether coronary angioplasty (see page 216) or coronary artery bypass surgery (see page 216) is needed to restore blood ﬂow to the heart.
• Radionuclide scanning combined with exercise stress testing may provide a physician with information about the person’s angina. This test involves injecting a radioactive substance that travels through the bloodstream to a tar- get organ and using a special camera to produce an image of that organ. Radionuclide scanning not only conﬁrms the presence of ischemia but also identiﬁes the area and the amount of heart muscle affected.
• Exercise echocardiography is a procedure in which ultrasound images of the heart (echocardiograms) are obtained while a person walks or runs on a tread- mill. The test is harmless and shows heart size, movement of the heart muscle, blood ﬂow through the heart valves, and valve func-
tion. Echocardiography is performed while the per- son is at rest and at the peak of exercise. When ischemia is present, the pumping motion of the wall of the left ventricle appears abnormal.
• Angiography allows blood vessels to be seen on ﬁlm.
A catheter (a thin, ﬂexible tube) is usually inserted into the femoral artery, a large blood vessel in the groin area, and moved up through the aorta (the main artery in the body) and into the coronary arter- ies. A contrast medium (dye) is injected through the catheter into the artery to be examined, and a series of rapid-sequence X rays (similar to a movie) are taken. Narrowing and blood ﬂow inside the arteries are clearly visible, allowing the physician to deter- mine whether the arteries can be treated by bypass surgery or angioplasty. Occasionally angiography is used to detect spasm in coronary arteries that do not have any plaques. Certain medications are given to stimulate a spasm during the procedure to help diag- nose the condition.
• Computed tomography (CT) scanning, a diagnostic procedure in which a computer is used to construct
cross-sectional X-ray images of the heart and coronary arteries, helps to detect calciﬁcation in the artery walls, which is associated with atherosclero- sis. A faster version of CT scanning is used to examine artery walls for struc- tural and functional abnormalities associated with a heart attack.