The sex act is a combination of physical exertion and mental relaxation. Sex play can be broadly divided into three phases. Foreplay constitutes the first phase, where there is no physical exercise involved and where the mental exercise is of the pleasurable type and less likely to cause strain on the heart. The last phase which constitutes the orgasm, however, is accompanied by an amount of mental excitement and exertion that can increase blood pressure and heart rate. A great majority of heart patients can lead a normal sex life without any undue embarrassment to cardiovascular system. In fact, extra suppression of urge for sex is likely to bring about more built-up mental tension and with no advantage to the heart.

After two to three months of the attack, most patients recover fully and they can certainly return to their normal sex life. The patient should follow his own urges and desires. There is no need to force oneself into it. A few patients with enlarged hearts or irregular hearts may experience chest pain, palpitations / or uncomfortable breathlessness during intercourse. They are advised to go slow and modify their conjugation in a way that the male remains a passive partner. With slight understanding on the part of the couple, this can be achieved without great difficulty. This advice may hurt a man’s ego.

However, it will be very comforting for a man to realize that his wife can be one of the happiest persons on earth if she gets an affectionate, caring and loving husband, a pleasant home and healthy children. This is her world of happiness. The actual physical act of sex is usually of only secondary pleasure to a female partner.

The incidence of cardiac strain is more when the sex act is performed in extra-marital sphere. This is quite natural and perhaps deeply related to a sense of guilt, fear, disharmony etc. Patients who experience anginal pain or breathlessness during the sex act are advised one of the following steps for prevention :

1. Sucking a nitroglycerine pill about five minutes before commencement.
   
   
   
2. Application of nitroglycerine skin ointment over the chest or arm about fifteen to thirty minutes earlier.
   
   
   
3. To crush and suck a capsule of nifedepine( adalat) in the same way as a nitroglycerine pill.
   
   
   
4. Regular use of one of the beta-blocker drugs taken after dinner may help in some patients.