Introduction

Heart disease is the number one cause of death in Malaysia. Every year the statistics of heart patients due to lack of increase in health care such as not practicing exercise, unhealthy food intake and high workloads that cause stress. This can be seen through the MOH statistics where the estimated coronary heart disease are 40 000 new cases per year to 28 million people and the death of an estimated 2.5 times higher than that of cancer in women.

Among the signs of a heart attack are different for each individual. Some people have a numb left hand to the neck part, pain in the middle of the chest, shortness of breath, dizziness, cold sweats, heart palpitations, fatigue, dizziness and fainting.

Major complications faced by cardiac patients after a heart attack are limitations in daily activities, difficulty in returning to work, lack of concentration, tiredness while doing activities, it is difficult to remain calm and the main problem is the relationship of sexuality.

Cardiac Rehabilitation Program (CRP)

Sexual relationship is vital to the life of a married couple. For heart patients whether they had heart bypass surgery or not, anxiety is evident during these sexual activities. The study also showed that the main cause of the problem is the feeling of sexual relations ‘scared’.

Therefore, the recovery process is very important for patients with heart disease to improve the quality of their daily lives. Cardiac rehabilitation process is divided into four phase:

Phase 1 – Sharing of information given by ex CRP participants to new patients about their experiences in the program to improve their quality of life.

Phase 2 – Information and education activities of daily after a heart attack in their daily lives. Topics discussed were related to energy usage, ergonomic in employment, and maximum heart rate according to the phase of the suitability of activities, including sexual intercourse. This session is conducted by Officer Occupational Therapy.

Here is an example of cardiac rehabilitation program conducted for the treatment of returning to work and the management of the daily activities of patients with heart disease.

Phase 3 – Assessment in the workplace is an important component in the durability of patients does daily chores. Discussions with employers are to provide a true picture of the level of ability of patients to perform tasks will be doing before patient back to work. In this phase the patients mostly have recovered and been allowed to conduct activities involving the community.

Commencement Of Sexual Relations

Step 1: Find the maximum heart rate (MHR)

Before patients begin a sexual relationship with a partner, the most important thing to find and note the maximum heart rate (MHR) is the highest that can be pumped by the heart according to age. The importance of knowing MHR is to prevent heart to work more than the limit.

Step 2: Know the appropriate Metabolic Equivalent of Task (MET)

Metabolic Equivalent of Task (MET) is the rate of energy consumption during physical activity refers to the ratio of metabolic rate of 3.5ml O2. Kg-1. Min-1. Suitability sexual activity is closely related to heart rate (HR) and MET a patient. In addition, the position also talked about sexuality and sexual satisfactions affect the number. Through the study by Pollock et al. Heart Disease and Rehabilitation, in 1995, declared a sexual position does not significantly affect blood pressure and HR were either male position at the top or at the bottom.

MET suitable for sexual activity with your partner is 2-3 MET, while sexual activity with unfamiliar couple require 5-6 MET. In addition, most studies show that the average time taken when sexual intercourse is 10-15 minutes and reach orgasm 3 to 5 minutes. HR will also achieve 120bpm up to 130bpm and 150mmHg to 180mmHg systolic BP.

To start a sexual relationship the patient must reach 3-4 MET is equivalent to walking one mile in 20 minutes on a flat road or can climb two flight of stairs with 13 step in 20 seconds. For quite refreshing and exciting sexual relationship with your partner, MET required is 4-5 MET equivalent to playing golf. While sexual relationships with an unfamiliar spouse or other person can increase HR to 200bpm and reached 210mmHg systolic BP. The study also found that 80% of patients died suddenly after sexual intercourse carried out due to the heart of the work exceeds the limit. Only 1% of heart attacks occur after sexual intercourse for spouses who have been married usual.

Step 3: Position Sexuality

Cardiac patients are more encouraged to choose to use sexual positions that they used to do as a couple, however, for patients who had coronary bypass position preferably is not pressing the sternum and at rest. Couples are encouraged to play an active role as a partner for mutual satisfaction.

Recommendations for Cardiac patients for sexual intercourse are 2-3 weeks after an uncomplicated heart attack. 2-3 days after coronary intervention (Example: Undergoing Angiogram or PCI) and 4-6 weeks after operation. (Warning: Sex position after operation must not put pressure on the sternum).

Tips With Current Spouse

• Make sure the bed is comfortable for you and your partner before having sex.
•  Have good ventilation e.g. not too hot and not too cold.
• The lighting was good, not too dark and not light that can interfere with your privacy and your partner.
• Do not encourage to have sex after a meal. Proposed time is more than 1 hour after eating.
• Suggestion time is in the early morning or after waking up because sexual activity requires an enormous amount of energy.
• Stop all sexual activity immediately if you feel chest pain, cold sweats, feeling pressure in the chest and shortness of breath. You are encouraged to take the medication glyceryl trinitrate (GTN) 1 seed and rest for a few minutes until reduced chest pain. If your chest pain persists, take glyceryl trinitrate (GTN) 1 seed for the second time. You need to contact your personal doctor immediately or get a family member or neighbour to send you to the nearest hospital.

Recovery Approach

Cardiac Rehabilitation Program is very important to enhance the functionality and sexual satisfaction. About sexual education is very important in enhancing self-confidence. The role of the Occupational Therapy is very important to develop self-confidence and understanding of the healing process after a heart attack. Interaction and discussion between the Cardiologist, medical officer and Occupational Therapist will be held in improving the quality of life in patients with cardiac involving sexual functionality.

In Malaysia, advisory services and related reference Cardiac Rehabilitation Program that involves suggestion, treatment or counselling daily activities, leisure activities, sexual, drive, stress management and return to work can refer to the Cardiologist, Medical t Officer and Occupational Therapist.

References

Jaarsma, T.(2002). Sexual problems in heart failure patients. European Journal of Cardiovascular Nursing, 1, 61- 67. From the World Wide Web: http://www.elsevier.com/locate/ejcnurse.

Xiaojun, C., Qingying, Z. & Xuerui, T. (2009). Cardiovascular effects of sexual activity. Indian J Med Res, 130, 681-688

Doherty, S., et.al (2010). Cardiac rehabilitation staff views about discussing sexsual issues with coronary heart disease patients: A national survey in Ireland. Eur J Cardiovase Nurs. Form the World Wide Web: http:// www.elsevier.com/locate/ejcnurse

Glenn, N., et.al (2012). Sexual activity and cardiovascular disease: A scientific statement from the American Heart Association. American Heart Association, 2012:125, 1058-1072. From the World Wide Web : http://circ.ahajournals.org

Elaine, E., et.al(2013). Sexual counselling for Individual with Cardiovascular Disease and Their Partners: A consensus Document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CKNAP). American Heart Association, 2013: 128, 2078-2096. From the world wide web : http://circ.ahajournals.org

Steinke, E.E., et.al (2013). Sexual Counselling from individuals with cardiovascular disease and their partners. European Heart Journal, 34, 3217-3235

Fridlund, B.(2009). Healthy sexual life after a cardiac Event: What do we know and what do we do now?. European Journal of Cardiovascular Nursing, 8,459. From the World Wide Web: http://cnu.sagepub.com

Arenhall, E., et.al (2011). The male partners Experiences of the Intimate Relationships after a first myocardial Infarction. European Journal of Cardiovascular Nursing, 10,108. From the World Wide Web: http://cnu.sagepub.com

Abramsohn, E.M., et.al (2013). I’m Not Just a Heart, I’m a whole person here: A qualitative study to improve sexual outcome in women with myocardial Infarction. Journal of the American Heart Association, 2, e000199. . From the World Wide Web: http://jaha.ahajournals.org

Steinke, E.E. (2008), Everything you want to try in Cardiac Rehabilitation: Sexual Satisfaction. In the European society of congress 2008. Munich: Germany