Sexual intercourse and angina pectoris

Thirty men and five women aged 36-70 years with angina were questioned about their sexual activity. Twenty-nine (83%) had intercourse more than once a week and six (17%) abstained. In 19 (65%) angina occurred during intercourse, and four also complained of palpitation. Fourteen patients underwent 24-hour ECG (electrocardiogram) tape-recordings before and after beta-blockade, and indicated the time of intercourse in diary cards. Tape analysis before beta-blockade revealed an average maximal 24-hour heart rate of 124.0 +/- 7.2 beats/min, and 122.2 +/- 7.1 beats/min during intercourse. Two patients complaining of palpitation during intercourse developed supraventricular tachycardia (SVT) and two sinus tachycardia. Beta-blockade abolished the SVT and reduced the average maximal 24-hour heart rate to 82.1 +/- 6.0 beats/min (P less than 0.001), and 82.0 +/- 2.8 beats/min during intercourse (P less than 0.001). After 6 months, the 19 patients previously symptomatic were pain-free during intercourse, though six also required prophylactic sublingual nitrates. Four of the six who previously abstained were able to have a normal sex relationship. Twenty-four hour tape ECG recordings have shown that the heart rate during intercourse is similar to that during normal daily life. There is no reason why most patients with angina cannot have a normal sex life, and physicians should ask and advise routinely.