From the Guidelines
Patients should wait at least 1-2 weeks after an uncomplicated myocardial infarction (MI) before resuming sexual activity, as long as they are asymptomatic and can perform mild to moderate physical activity without symptoms. This recommendation is based on the most recent guidelines, which suggest that sexual activity is reasonable 1 or 2 weeks after uncomplicated MI, when the patient is without cardiac symptoms during mild to moderate physical activity 1.
Key Considerations
- The timing of return to physical activity, including sexual activity, depends on the presenting condition and previous functional status.
- Patients who experienced a complicated MI, have ongoing symptoms, or cannot climb two flights of stairs without angina or significant shortness of breath should wait longer and consult their cardiologist for personalized guidance.
- Sexual activity represents a moderate level of physical exertion, equivalent to climbing two flights of stairs or walking briskly, requiring about 3-5 METs (metabolic equivalents) 1.
Resuming Sexual Activity
When resuming sexual activity, patients should:
- Start gradually
- Choose positions that require less exertion
- Stop if experiencing chest pain, significant shortness of breath, or unusual fatigue
- Consider taking nitroglycerin prophylactically before sexual activity if they have angina, although this is not routinely recommended The cardiovascular risk during sexual activity is relatively low in properly rehabilitated patients, with the absolute risk of triggering another MI being approximately 10 in 1 million per hour for a healthy individual 1.
Additional Guidance
- Cardiac rehabilitation, including early ambulation and prescriptive exercise training, is recommended for all eligible patients after MI, as it reduces the risk of death in survivors of MI 1.
- Patients with complicated MIs should resume sex more gradually, depending on their tolerance to exercise and activity 1.
- Cardiac surgery patients can generally resume sexual activity 6 to 8 weeks after CABG or non-coronary open heart surgery with a well-healed sternotomy incision 1.
From the FDA Drug Label
Treatment with intravenous metoprolol tartrate injection can be initiated as soon as the patient’s clinical condition allows ... Alternatively, treatment can begin within 3 to 10 days of the acute event The patient can start taking metoprolol within 3 to 10 days after an MI, or as soon as their clinical condition allows. 2
From the Research
Timing of Return to Normal Activities after Myocardial Infarction
- The optimal time for returning to normal activities, including work, after a myocardial infarction (MI) is a topic of interest, with studies suggesting varying timelines based on patient risk stratification and individual health status 3.
- A study published in The American Journal of Cardiology in 2006 found that return to full normal activities, including work, at 2 weeks after acute myocardial infarction appears to be safe in patients who are stratified to a low-risk group 3.
- Comprehensive cardiac rehabilitation, which includes components such as clinical evaluation, optimization of pharmacotherapy, physical training, and psychological rehabilitation, should be initiated as early as possible after the acute phase of myocardial infarction and continued for the required time, properly staged, and individualized depending on the clinical status of the patients 4.
Factors Influencing Return to Normal Activities
- The decision on when to return to normal activities should consider the patient's left ventricular ejection fraction, results from a symptom-limited exercise stress test, and the presence of angina or other complications 3.
- Patients with left ventricular ejection fraction <40% may require additional considerations, such as electrophysiologic studies to assess the risk of inducible ventricular tachycardia 3.
- The use of medications such as beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and statins, as well as lifestyle modifications, plays a crucial role in the management of patients after myocardial infarction and may influence the timing of return to normal activities 5, 6.
Individualized Approach
- An individualized approach to cardiac rehabilitation and return to normal activities is essential, taking into account the patient's clinical status, risk factors, and response to treatment 4, 3.
- The involvement of a multidisciplinary team, including physicians, physiotherapists, nurses, psychologists, dieticians, and social workers, is crucial in providing comprehensive care and guiding the patient's return to normal activities 4.