Scott Webb (Host): Today, we're discussing whether or not sexual activity increases our risk of having a heart attack, a question many of us of a certain age may have. And joining me for this discussion is Dr. Nikolay Bogush. He's a Fellowship Trained Cardiologist with the Valley Health System.

Welcome to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about heart attacks and sex and whether or not there's a correlation or not. So let's start there. What are the chances of having a heart attack while having sex?

Nikolay Bogush, MD: In general, it's hard to quantify such things because heart attacks can happen to anybody at any time. In general, the way I look at it, is that sex, just like any physical exertion, increases the oxygen demand on your heart. So your heart has to be able to accommodate increased workload.

So really the chance of that you having a heart attack doing sex is that or equal to you when you go out for a walk or if you go for a hike, the chances are the same. So it really comes down to what pre-existing heart conditions you have and how much can you exercise. In general, the rule of thumb is the more you can do physical activity, meaning go out, walk, go up flights of stairs; the better you are able to handle the increased exertion of sex and or any real exertion.

And you should be able to withstand and accommodate that increase of blood flow to your penis or whatever else it goes at the time of intercourse.

Host: Yeah, I see what you mean. Right. So exertion in general, if you're up for going for a walk, then maybe this shouldn't, you know, put any more stress on you than something else like that, going upstairs, whatever it might be. Maybe you can just take us through just some of the basics here. What happens during a heart attack?

Nikolay Bogush, MD: So, in general, during a heart attack, there's multiple different kinds. The most common one we usually worry about is when you have just a sudden rupture of plaque.

So you, inside your blood vessels, think of it as a pipe. You have plaque there, which unfortunately builds up with aging or also with risk factors. If it bursts all of a sudden, because plaque, by its very nature, is not very stable. Think a good analogy would be like when you have a pipe and then you have some rust forming, the rust is not supposed to be there.

But when it gets there, it causes the overall structure of the pipe to be weak. And same thing happens with the plaque and blood vessels. So plaque by itself is very weak. So with time, if it ruptures, it could cause just a sudden decrease in blood flow to your heart, which could cause a heart attack. In general, when it comes to having intercourse or sex, there is an increased amount of stress on your heart because your heart has to be able to pump more blood to your penis to maintain an erection.

And that increased workload is what actually increases the chance of potentially having a plaque rupture, which is very similar to the risk of having a heart attack doing exertion, doing hikes, walks, or et cetera. The other thing I do want to mention is that I think we get asked very commonly is about what about medications like Viagra.

The one thing I do want to kind of preface is that it all depends on what medications you're taking because there's a lot of drug interaction. So, if you are on medication specifically for your heart or if you have a history of having heart attacks specifically, you should definitely consult somebody just to make sure that medications you're taking, don't interact with Viagra and, or anything else you could get over, the counter or from things like Hims and Hers.com, all these things do have interactions and they could potentially be deadly if you don't sit down and do the due diligence to make sure there's no harmful interactions between the medications.

And actually, it also goes into supplements, where there's a lot of supplements available online. You could get, that say, hey, improve your sex life, improve your longevity, whatever else. All these things also have active ingredients in them which could interact with each other. So before taking any of those and trying to mix medications, I think getting somebody to take a look into the actual ingredients of everything you're taking, even if it's a supplement, to make sure that they don't interact in a harmful way to you.

Host: Yeah, that's great advice from an expert, of course, and when in doubt, folks should obviously speak with their providers or specialists. I'm just wondering, you know, you're talking about, gave us the analogy there of the pipe and the rust and all that. What are their sort of common symptoms of heart disease? Like, how do we know if we have heart disease or do we?

Nikolay Bogush, MD: You know, that's a million dollar question just because there's no one specific thing. We have plenty of research that says there's no one specific symptom, which tells you, oh, this is from your heart. In general, your chest, your chest cavity, your chest in general has so many different organs in it, and all the pain could feel very similar.

Whether it's your chest, whether it's your skin, whether it's your pectoral muscle, whether it's your ribs, your lungs, your heart or your esophagus, which goes right through where you are right behind your heart. All these things cause chest pain.

And really what we start to worry about is when people have symptoms with exertion, is that like a rule? No, it's not a definitive. It's more so the most common thing we usually worry about is when these things happen with exertion, but they could also, chest pain could happen at rest and be from the heart as well.

So really there's two ways of getting a heart attack. One is when you have sole build of a plaque, which usually people's first symptoms usually with exertion. So being able to keep track of how much you're doing physically in an objective way, for example, measuring how much does it take me to walk a mile?

And if you know a year ago it took you 10 minutes to walk a mile, now it takes you 15 minutes, something's changed. I think things like that changes in your exercise tolerance is a good way to kind of measure to see how healthy is your heart and how it's able to handle exertion.

The second type of plaque could happen when you just have acute rupture. When you have, again, I mentioned you have this plaque inside your blood vessel. which could be relatively small. It could be like 10%. Then all of a sudden, because of stress, just because of events, sometimes we can't even predict whether it's inflammatory events, whether there's genetics, it could rupture.

And that could cause a heart attack out of nowhere. And it just could cause chest pain. Now, I don't want you to think that any chest pain is a heart related pain. It doesn't have to be, but you do have chest pain, I think definitely going out to see medical help is appropriate, especially if you have risk factors.

And also, if you're just getting older, and if you're male, I mean, all these are risk factors, that should be taken into account. I think in general in our society, we are doing better because the amount of heart attacks we're seeing in emergency rooms is decreasing. I think part of that is because people are just becoming more attuned to their bodies and attuned also to when they have their chest pain or discomfort, they feel more comfortable bringing it up with their doctors and actually saying, Hey, I have this.

And then we just do a better job of screening and actually looking at each individual person to see, well, what risk factors do you have and what can we do to lower your risk of heart disease? Because even now, if you look at the overall mortality rate in America, or really anywhere in the world, the most common cause of death is still cardiovascular disease.

So whatever we could do to try to lower any individual's risk of heart disease, I think that's should give them a chance to live as long as they possibly can.

Host: For sure. And you mentioned males there. If someone is a male, and I am, and I'm in my mid 50s, so you perked up my ears a little bit. Are men at greater risk for heart attacks than women, or is it roughly 50 50?

Nikolay Bogush, MD: So unfortunately men are at higher risk. One of the things we always tell patients that we were always taught in cardiology is that men tend to get heart disease way earlier than women. Average age for a man to get heart disease is probably their mid 50s while for a woman it's in their 60s. So women, there is a genetically protective component, which is, it's partly due to hormones, but partly due to, in general, the genetics of a woman, how they handle stress. So men are at higher, risk.

But, unfortunately for women, women are likely to be misdiagnosed because women's symptoms are more atypical. So women could present with things like nausea or vomiting instead of chest pain, which sometimes leads to delayed diagnosis and which could lead to worse outcomes.

So I guess to answer the question, men are more likely to have heart disease and have it occur at a younger age, but women are more likely to be missed just because they have more unusual or atypical symptoms.

Host: Yeah, I've heard that. It's generally more subtle, right?

Nikolay Bogush, MD: Yeah, it can be. The problem with the, in general, chest pain is very common. Now, trying to figure out what, is this chest pain concerning or not? That's really when you got to talk to an expert because there's no one symptom or one sign that tells you this is heart or not, which we come back to.

In general, I see a lot of patients will come in with chest pain and don't have heart disease. But I still applaud them for coming in because you don't know until you go in and you ask and you do certain testing to make sure your cholesterol is fine. You have no signs of blockages, what's your excess tolerances.

So all these things really come back that yes, a lot of chest pain is not from the heart, but you don't want to be the one person who misses it because that could really affect your quality of life and longevity. Because in general it's always better to be preventing heart disease and treating them after the fact, because unfortunately just like your brain, your heart is not able to regenerate at all.

So once there's injury and the heart cells die, there's no coming back. So that's why I think in general when if you have chest pain and you're not sure because you haven't went to medical school and you don't want to use Google MD as your primary diagnostic tool. I think coming in, just talking and getting interested in screening to say, Hey, this is what's going on. Is this normal or not? And even if this keeps happening or changing, come in again. There's no harm in coming in and just being seen to make sure everything's okay. Because again, even if you, if a hundred people come in, if you save five people from getting a heart attack, that's amazing. And second of all, the people that do come in, maybe they don't have the symptoms of heart disease, but they could be at higher risk.

They're just not sure about it. And now, more than ever, we have a lot of testing, we have even just a lot of information, a lot of family history information that could be derived and kind of tell what's your risk in general, and would you benefit from having preventative medicine, preventative treatment rather than waiting for you to get a heart attack or stroke in the first place?

Host: Right. Yeah and I know the old saying time is heart, time is brain, so when it comes to stroke, right, time is of the essence. Getting to the emergency department, same thing with heart, time is heart as you say. These things won't regenerate themselves. So preventing them, preventing strokes, preventing heart attacks is key and it's been really educational today, Doctor. Just want to wrap up and ask you if, you know if someone's been diagnosed with heart disease, what sort of behavior and lifestyle modifications can we do to stay as healthy as possible to avoid the big one, if you will?

Nikolay Bogush, MD: I mean, there's a lot of things you could do. I mean, and really what it comes down to it, activity is the number one thing. There's a lot of things we cannot control in our lives, like genetics, we can't control what we were born with, our gender we cannot control, and also our age. Age is a huge risk factor, but we can't control it because tomorrow we will be one day older.

But things we can do is really with exercise. In general, everybody gets sick at some point, but our ability to exercise is a way to kind of measure our cardiovascular reserve, if you will. The more we're able to walk, the more we're able to do, really, the more we're able to get our heart rate up, right?

Walking by itself could be considered exercise, but not, necessarily. If you're walking at a very leisurely pace, it's not really exercise because your heart rate doesn't get high enough. But if you're able to walk more and actually take an effort to take the stairs, go, up an incline specifically to get your heart rate up, that would be protective.

And the second thing is really just trying to eat as best as you can. I am a very big proponent of making changes which are sustainable. I don't expect people to eat every single meal of just broccoli and carrots. But if you could try to incorporate in one meal a day, we're having mostly vegetables versus like having rice, carbs or protein; that's a start. And making these small changes over the course of your lifetime could make way bigger impact than doing like a diet for three months, eating well for three months, but then just saying, I can't do it anymore.

Host: Yeah. One of those fad diets or something like that. Well, as I said, this has been a really educational today. You know, we always just want to help folks and encourage them that any signs, symptoms, concerns speak with their own providers, be referred if they need to be. So thank you so much for your time and you stay well.

Nikolay Bogush, MD: And the only other thing I would definitely want to kind of reiterate is that if you're not sure, just always ask. Don't feel, oh, am I wasting people's time and energy? The answer is no because heart disease could happen to anybody and even to very young people and older people. So if you just have a question, just go in and ask and don't feel silly about it that you're young and otherwise healthy.

If you're not sure, I think that's what we're here for. It's just to make sure you're doing okay and making sure we set you on the right track to hopefully live as long as you can and have the best quality of life possible.

Host: Yeah, that's perfect. Well, thanks again. I really appreciate it.

Nikolay Bogush, MD: All right. Thank you.

Host: For more information about cardiology services at Valley, please visit valleyhealth.com/heart or call 1-800-VALLEY1. That's 1-800-825-5391 to schedule an appointment.

And if you found this podcast helpful, please share on your socials and check out our entire podcast library for topics of interest to you. And thanks for listening to Conversations Like No Other presented by Valley Health System in Ridgewood, New Jersey. For more information on today's topic or to be connected with today's guest, please call 201-291-6090 or email valleypodcast@valleyhealth.com. I'm Scott Webb. Stay well.