CV Day 3

Q1.心臟手術後或是經歷過Acute coronary syndrome的病人，其能不能進行sexual activities?

首先要了解心臟復健的原理
Scottish Intercollegiate Guidelines Network
http://www.sign.ac.uk/guidelines/fulltext/57/index.html

然後定義activities的強度

Compendium  of Physical Activities: an update  of activity codes  and MET  intensities

http://juststand.org/portals/3/literature/compendium-of-physical-activities.pdf

裡頭寫到METS = 1 METS 每小時每公斤體重消耗一千卡

下午 12:51

	METS
Sexual activities	1.5	Active, vigorous effort
Sexual activities	1.3	General, moderate effort
Sexual activities	1.0	Passive, light effort, kissing hug

不過這篇德國的文章有對其中性行為的體位跟強度，及男方或女方做更詳細的分析

[Sex, erectile dysfunction, and the heart: a growing problem].

Görge G, Flüchter S, Kirstein M, Kunz T.

Cardiac and metabolic expenditures during sexual intercourse will vary depending on the type of sexual activity. When oxygen uptake was measured in men, an average metabolic expenditure during stimulation and orgasm of 2.5 metabolic equivalents (METs) was found for woman-on-top coitus, and of 3.3 METs for man-on-top coitus (range 2.0-5.4 METs). However, coital death is rare, encompassing only 0.6% of all sudden death cases. A retrospective case-crossover study has shown that although sexual activity can trigger the onset of myocardial infarction, the relative risk in the 2 h after sexual activity was low (2.5; 95% confidence interval [CI] 1.7-3.7).

但心臟疾病急性爆發後，能不能再度進行，關鍵是在於性行為對mood的影響，而非其運動強度。所以會要求心臟復健能做到5-6METS後才能進行

Sexual dysfunction after a myocardial infarction is a common problem said to occur in 50% to 75% of all patients. Sexual dysfunction often antedates the myocardial event. The advice given by current textbooks is too often based on anecdotal reports that lack scientific accuracy. Studies of the cardiovascular response during sexual intercourse are few, but those that exist consistently show that there are wide individual variations in heart rate, blood pressure, and oxygen consumption. Recent reports have also identified potentially dangerous arrhythmias during intercourse. Patients who reach 5 to 6 metabolic equivalents (METS) on stress-testing without ischemia or arrhythmias can in all likelihood resume their normal sexual activities without any risk. All other cases have to be considered individually according to the current physiologic knowledge.

Tardif GS.Sexual activity after a myocardial infarction.Arch Phys Med Rehabil. 1989 Oct;70(10):763-6.