
Hidden Epidemic: Heart Disease in America
Take One Step: A PBS Health Campaign

Watching: Take One Step for a Healthy Heart with Larry King

Chapter 3 - Sex, Heart Attacks & Stress [5:11]

Is sex after a heart attack dangerous? Are sexual problems an early sign of heart disease? Is stress always bad for the heart?

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Transcript: Chapter 3 - Sex, Heart Attacks & Stress


LARRY KING: Sallie Foley, can you return to life as usual after a heart attack sexually?

SALLIE FOLEY: It's a good question, because some people can and some can't. They have to check with their physician.

DR. MICHAEL ROIZEN: Wait a second; we should ask him, right? [laughter] What do you think about that, Larry?

LARRY KING: Uh... [laughter] I have two boys: one is seven, one is six. It was done without Viagra. I rest my case.

SALLIE FOLEY: And not everyone is quite that fortunate. So the first thing that people think about after a heart attack or any kind of heart disease is not about their sex life, it's whether or not they're going to live. Later, as a quality of life issue, people are concerned about whether or not they can return to sexual activity with a partner. And many people avoid it unnecessarily. The problem is getting people to talk to their physicians about it.

LARRY KING: If I can speak from first-hand nature; I may be the only person here who had a heart attack. The big fear is there's a fear of it. There's a fear of what am I going to do? What if I might die? What is the strain on my heart? So you're afraid.

DR. STEVEN NISSEN: There's fear not just amongst the patient but their partner as well. The partner fears that they'll--

LARRY KING: I don't want him to die on me.

DR. STEVEN NISSEN: Exactly. And there's several things that we need to do. One is we've got to talk about this. And the other is physicians have to ask patients about it. So when I see a patient back after a heart attack, I ask, "Have you resumed sexual activity or not?" And if they haven't, I ask them why not. And you come up with some interesting comments like "I'm afraid I'm going to die if I do." The reality is if you can walk up a couple flights of stairs, you can begin having sex again.

LARRY KING: Dr. Roizen, what's the link between stress and heart disease? What do we know?

DR. MICHAEL ROIZEN: Stress, and especially chronic stress, is a great ager of our arteries, meaning causes heart disease. But so does acute stress. The example is after 9/11 defibrillators fired three times more in the next month after 9/11 as they did the month before, not only in New York but also in Alabama and Kansas. So we take these major stressful life events and they really affect us greatly.

LARRY KING: Dr. Johnson, is all stress equally deadly?

DR. PAULA JOHNSON: No. There are some things that are good. For example, being up here today on TV, you get kind of a dose of it, it gets you going and you perform. But the kind of stress that Dr. Roizen just talked about in terms of the chronic stress, that's the bad kind of stress, and stress that is persistent.

And I think we also make a mistake of how do we measure stress. So I think that we kind of have a working definition. But things like the stress of poverty, the stress that it's a day to day wearing and tearing, those are the types of things that we know can actually be connected with the development of blockages in the arteries.

DR. MARIANNE LEGATO: I think that there are some comments about stress that are important to remember, that a feeling of control over your life is healthy. Undergoing some kind of emotional pain, which you feel is endless and that you can't solve is not healthy.

DR. STEVEN NISSEN: It's important that we not over-state this though. You know, we've got these big risk factors of cholesterol and diabetes and smoking and blood pressure, and those are the big drivers. And stress tends to make things worse. But we would do really well if we would attack those major risk factors aggressively, as you did in your own life. But we want to do it not after people have had a heart attack but before.

DR. MICHEAL ROIZEN: And that's really the key point, is that everyone knows the conditions. So it's smoking, it's a high LDL, a low HDL. It's not getting any physical activity. It's not having a friend or passion for something you're doing. It's having high blood pressure. If you have one of those and are listening to this show, you should do something about it today, not wait until you have a heart attack.

LARRY KING: Dr. Foley, is sex stress?

SALLIE FOLEY: It's good stress, but it can be if the couple are having difficulties, it could be a negative stress. An early warning sign that is often missed is problem with sexual dysfunction. People don't realize that their sexual health is actually part of their overall health. So sometimes someone will have erectile difficulties and they'll feel embarrassed or ashamed and they'll ignore it, not realizing that it often is a precursor of heart disease.

DR. STEVEN NISSEN: You know, this issue of erectile dysfunction, though; it's something we need to say that's very important. Sometimes the first symptom that a man has disease in their blood vessels is difficulty having an erection. And so that really should-- people should seek medical attention. The same things that cause the blocking up of the arteries in the heart are blocking up the arteries to the penis, and erectile difficulty can in fact be a sign of heart disease and people need to know that.

DR. PAULA JOHNSON: The other area that's very important for women and is very much related to stress is depression, and depression after a heart attack is a significant problem for everybody. For women, though, it seems to really put them at even increased risk for a second heart attack. And it can be thought about as yet another type of stress.

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