I am writing a novel and need a couple of questions answered concerning heart disease.
1. The character in my book is a 40-year-old male. Could you name a condition he would have that would realistically cause his cardiologist to warn him against sexual activity, lest he have a heart attack? In my story the patient’s condition was diagnosed 15 years earlier, which would have made him 25 years old when he found out. What other activities would having this condition limit?
2. Also, if he did indeed heed the doctor’s warning but had a heart attack anyway, what would his limitations then be (i.e. sex, any other daily activities, diet? In a real life case, would a cardiologist warn him against any kind of sexual arousal, even kissing, etc.?
These are important questions that relate to life style and quality of life. Sexual activity is a form of exercise and for most patients with coronary artery disease exercise is desirable.
There are many causes of chest pain and it is unusual for a person to develop angina and coronary disease in the 20’s. If so there is usually a familial problem such as a very elevated cholesterol. Cigarette smoking would also not help.
It is not wise for a patient to keep exercising when angina pain occurs and most will stop before damage to the heart is done. Most heart attacks happen not because a patient continues to exercise but because of a ruptured plaque in a coronary artery (hence the term coronary thrombosis). Angina is influenced by physical and emotional activity.
If a patient has chest pain with modest exercise while taking medications most will go for an angioplasty procedure (see the pages which show deployment of a stent to reopen a coronary artery) or bypass surgery to relieve the pain. After a heart attack again a patient’s quality of life is important, and they are usually enrolled in an exercise classe, asked to modify their risk factors (See Dr. Grover’s article on risk factors) and are encouraged to reenter the main stream of life. Most people can do this. If the attack is severe and extensive damage is done the patient may have very little energy to do any form of physical exercise other than breathing. Fortunately this is rare!
Finally, note that coronary artery disease is usually associated with other vascular disease that can cripple a patient’s ability to perform sexually, cause strokes and even prevent a walk down the block!