A patient with heart attack would most likely be treated in the emergency room. Initial measures include: • Being hooked to a heart monitor, so the health care team can look at how the heart is beating. • The patient would be given oxygen so that the heart doesn’t have to work as hard. • An intravenous line will be placed into one of the patient’s veins so medicines and fluids can pass through. • Nitroglycerine and morphine would be supplied to help reduce chest pain. Abnormal heartbeats are the leading cause of death in the first few hours of a heart attack. These abnormal heartbeats or arrhythmias may be treated with medications or cardioversion. EMERGENCY TREATMENTS Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. Usually a small, metal mesh tube called a stent is placed at the same time which helps prevent the artery from closing up again. Drugs may be given to break up the clot, a procedure known as thrombolytic therapy. Some patients may also have heart bypass surgery to open narrowed or blocked blood vessels that supply blood to the heart using the procedure known as open heart surgery. AFTER HEART ATTACK Some other drugs are given after a heart attack and these include: • Blood thinners such as aspirin, warfarin etc to prevent the blood from clotting. • Beta-blockers and other anti-hypertensive drugs such as ACE inhibitors to help protect the heart. • Statins or other drugs to improve cholesterol levels One may need to take some of these medicines for life and the patient would always have to consult the doctor before stopping or changing the drugs. After the heart attack the patient may feel sad and may feel anxious or worry about being careful in every activity. These feelings are normal but tend to go away after 2 or 3 weeks. The patient can be guided however to slowly increase exercise levels and follow a healthy lifestyle. EXPECTATIONS After a heart attack, the chances of having another one are higher and how well one does depends on the damage to the heart muscle, heart valves and where the damage is located. If your heart can no longer pump blood out to your body as well as it used to, you may have heart failure. Abnormal heart rhythms can occur, and they can be life threatening. Usually a person who has had a heart attack can slowly go back to normal activities, including sexual activity. LIVING A HEALTHY LIFESTYLE To prevent another attack: • Keep your blood pressure, blood sugar, and cholesterol under control. • Don’t smoke • Eat a heart-healthy diet rich in fruits, vegetables, and whole grains, and low in animal fat. • Get plenty of exercise, at least 30 minutes a day, at least 5 days a week after talking to your doctor first • Get checked and treated for depression • Limit alcohol intake. • Stay healthy by maintaining a good body mass index of between 18.5 and 24.9 SEX AFTER HEART ATTACK It is important to remember that sex is a workout. So doctors typically tell patients to abstain from sex after heart disease until they can withstand the cardiac workout. The concern for some doctors is somebody who has no physical activity and with sexual activity is more physically active than any other time. Patients who can handle stairs or walk six minutes on the treadmill should be ok. Once they pass the stress test, they can have sex, play tennis or have a light jog around the building. Not surprisingly, some patients and their partners are afraid that sex would trigger a heart attack. The reality however is that most patients however can have a normal sexual life. Although one cannot jump into sex the day after a heart attack or surgery, most people can resume sexual activity three to six weeks afterward as long as they are free of chest pain or other complications. Sex also gives heart patients a good incentive to change their lifestyles. What is good for the heart is good for the penis. Healthy lifestyle such as exercising, maintaining an ideal body weight, not smoking is good for the heart as well as good for the male organ. ERECTILE DYSFUNCTION Although heart disease is a risk factor for erectile dysfunction (ED), erectile dysfunction can be an early warning sign of cardiovascular disease. The reason: the tiny arteries that go into the penis are about half the diameter of the ones that go into the heart, so they clog up first. Generally, there is about three years between symptoms of erectile dysfunction and symptoms of heart disease. Every man with ED should be considered a man with potential heart disease. People with heart disease are also likely to have other risk factors of ED such as hypertension, diabetes, smoking and obesity. MEDICATIONS Beta-blockers used for irregular heartbeats after open heart surgery and to lower blood pressure, are the biggest culprit that can interfere with sex after heart disease. They lower blood pressure – and the ‘haemodynamic fill of the penis’. It is like low pressure in a hose which makes the hose limb. Doctors also can try to adjust the drug’s dosage over time, which can also help, or switch patients to a different medication. An erectile dysfunction drug may help, but some men may not be able to take ED drugs because of other medications. Viagra and other ED drugs do not mix well with nitroglycerine, which many heart patients take to relieve angina or chest pain. The combination can send blood pressure plummeting to unsafe levels and cause dizziness, fainting, heart attack or stroke. Anybody who’s had a heart attack or heart surgery should definitely be cleared through their doctor before they think of using any of the medications for sexual activity. WARNING SIGNS TO STOP If you have chest pain, extreme shortness of breath, or an irregular heartbeat during sex, stop and test. If the problem persists, get to hospital immediately. With any kind of physical activity, there is increase in breathing and heartbeat rate. If it is more than the usual type of shortness of breath or more than a moderate increase in heart rate, that would be a sign to stop and seek medical attention.