How many movies have you seen that include a part where a guy is dead in bed after a sex romp because his heart gave out? It’s such a common movie motif that you’d think dying of a heart attack during sex is epidemic. But how often does life really imitate art?

Sex should be one of the most pleasurable experiences in life, but it can’t be if you’re worried that it will cause a heart attack—a common concern among people with a history of cardiovascular disease (and their partners). But the latest update from the American Heart Association is comforting. In one study, out of 5,559 cases of sudden death, only 34 occurred during sexual intercourse. That’s a tiny 0.6%. Still, it doesn’t mean that you can’t have a heart attack from sex—and it’s clear, if you keep your ear to the ground on this topic, that people still do worry about it. So I called up Henry G. Stratmann, MD, former clinical professor of medicine at Saint Louis University and coauthor of Sex and Your Heart Health, to chat about it.


Sure, Dr. Stratmann told me, it’s true that sexual intercourse increases your heart rate, makes you breathless and raises your blood pressure—whether you’re a man or a woman. But these increases are usually moderate at most and generally don’t last that long, which means they are not seriously taxing your heart, he said. If you’re not in the best shape and have significant blockages in your arteries, you are naturally forcing your heart to work harder, and this is where you could run into problems with angina (chest pain) or in the rare, worst case scenario, a heart attack.

Remember those 34 people out of 5,559 who died during sex most likely because they had a heart attack? Besides the fact that the overwhelming majority were men, they had a couple of interesting things in common that you can take as a heads-up to keep their fate from becoming yours…

75% of them were having extramarital sex—in most cases with a younger partner in an unfamiliar setting, such as a hotel room or their lover’s home. This is the common scenario seen in the movies…and heart attacks probably occur in this setting in real life because men who are having illicit sex or simply sex with a much younger woman may be exerting themselves more than they ordinarily would during sex.

Most of them had consumed excessive amounts of food or alcohol before their heart attacks. Because the heart goes to work pumping blood to your digestive organs after you eat, it is that much more preoccupied when you overeat, having less energy to spare to simultaneously keep up with your sexcapades. As for alcohol excess, a major party-time binge can put you at risk for atrial fibrillation (a kind of irregular heartbeat), again potentially making your heart unable to keep up with your lovemaking.


Ultimately, Dr. Stratmann said, it’s true that if you’ve already had a heart attack, you may be at slightly higher risk of having another one from sexual exertion than if you’d never had a heart attack. But you can make this additional small risk even smaller if you keep in mind these guidelines…

Right after an uncomplicated heart attack, refrain from sex for at least one week and until you don’t have chest pain or other heart symptoms while doing activities that require mild-to-moderate exertion, says Dr. Stratmann. But, to really play it safe, wait until your doctor gives you a full health assessment that may include a stress test and tells you it’s OK to have sex.

If your heart attack was recent, join a heart attack rehabilitation program and keep up with it. Heart attack rehab usually includes gentle exercises, such as walking or cycling, which are designed to gradually raise your heart rate without threatening your heart. This kind of activity can be good for protecting your heart for sexual activity as well, Dr. Stratmann said, noting that regular exercise is an excellent way to improve health and potentially reduce the overall risk of having another heart attack. In fact, he said, sex itself can actually be good exercise for your heart.

If your heart attack wasn’t recent, you may have been refraining from sex for a long time—maybe even years—out of fear. Discuss your concerns with your doctor, who will probably order a stress test or ask you to take some other physical challenge that can reassure you. If you can adequately get through a formal stress test, or even just perform an everyday activity like climbing a certain number of steps without trouble, your doctor will probably tell you that you can have sex safely.

Keep the lines of communication open with your doctor. Studies have shown that many patients are too embarrassed to talk to their doctors about having sex after a heart attack. Worse, many doctors neglect to bring it up. “It’s an important conversation,” Dr. Stratmann said. Don’t be timid about asking for guidance that is specific to your individual health status and needs. You can also read this practical article about sex after heart attack from the American Heart Association. And watch this video interview with Suzanne Steinbaum, DO, attending cardiologist and director of Women and Heart Disease at Lenox Hill Hospital in New York City.


I pressed Dr. Stratmann on one final issue—what about really exciting sex? It doesn’t have to be extramarital. Since this is the kind of sex that seems to kill mature men with weak hearts most often, are heart attack survivors doomed to only run-of-the-mill sex for the rest of their lives?

“No,” said Dr. Stratmann. “From a medical standpoint, sex is just another form of physical activity.” If you are cleared to do other activities that get you huffing and puffing and full of enthusiasm, then you also can have sex however you like it. The choice is yours, but the healthier and fitter you strive to be, whatever your previous health status, the better the sex.