UNC Cardiology News

Pillow Talk: When your valentine has had a heart attack

Drs. Cam Patterson and Paula Miller, both UNC Health Care cardiologists, tackle a taboo subject: Is it OK for a couple to resume their sex life after one of them has had a heart attack? And if so, what do they need to be aware of?

Written by Margot Carmichael Lester

We’re all pretty familiar with the lifestyle changes required after a heart attack. Exercise more. Eat better. Manage stress. Take your meds. But there’s another topic that’s just as important, yet rarely discussed: resuming intimacy.

There are plenty of misconceptions about rekindling the spark after a cardiac arrest or other heart-related incident. Nobody wants to do anything to trigger another attack. But at the same time, almost nobody wants to talk about how that might impact a couple’s sexual relationship.

Talking the Talk

That’s understandable on one level. After all, sexual activity isn’t something most of us discuss in polite conservation or mixed company. Plus, it can feel embarrassing when things aren’t going exactly as planned in the bedroom.

But this isn’t just your sex life we’re talking – or not talking – about here. It’s your health. And when it comes to cardiac rehabilitation, your life and health have as strong a bond as you and your partner. That’s why it’s important to put your embarrassment aside and start talking.

“One of the toughest issues to address with patients is talking about sex,” says Dr. Cam Patterson, chief of cardiology at the University of North Carolina Hospitals in Chapel Hill. “People are understandably reluctant to talk about something so private. But it’s really important because there are so many wrong assumptions made.”

Causing Another Attack

The most common is that sex will cause another heart attack. Once the doctor has cleared you, the risk of inducing another attack during sex is low. Of course, partners should both be aware of the symptoms experienced with the first event and agree to stop intercourse if any of these symptoms occurs.

It’s also important to know your metabolic equivalents, or mets. A met is the amount of energy the body uses to during physical activity.

“We use exercise testing to assess tolerance for exercise and sex,” explains Dr. Paula Miller, a cardiologist and director of the Women's Heart Program at the University of North Carolina at Chapel Hill School of Medicine. Sexual intercourse requires 2 to 3 mets during the preorgasmic state and 3 to 4 mets during orgasm. That’s about the same as walking 2 to 4 miles an hour on a level surface. “This gives the patient some confidence when having intercourse.”
Living with Less

In most cases, patients are counseled to avoid sex for a few days or weeks after a heart attack or cardiac surgery. But beyond that, there may be issues with low libido or sexual dysfunction, particularly in men. Some medications can cause problems with sexual performance, but that doesn’t necessarily mean there aren’t alternatives.

“There are medications and other ways to aide in achieving an erection in men,” Miller says. “And spouses can provide reassurance and help in exploring these possibilities.” Being honest with your doctor will enable him or her to work with your treatment plan to address these issues.

Many cardiac rehabilitation programs also include sessions on sex and intimacy to help patients and their partners. Classes usually cover the issues of sex after cardiac arrest, as well as common misperceptions and important facts. Some also offer tips for talking to each other and medical professionals about this delicate topic.

Opening the Lines

No matter how embarrassed you or your partner may be, it’s important to share your concerns, fears and problems related to sexual desire and function with each other and your health care provider. It’s the best way to ensure that you return to the complete relationship you enjoyed previously.

“Returning to a full and fulfilling life is the whole goal of cardiac rehabilitation,” Patterson asserts.  And that includes intimacy.

 

Matters of the Heart: Helping a family member with heart disease

Cam Patterson, M.D., chief of cardiology for UNC Health Care, explains five things you can do to help a friend or family member who has heart disease.

Written by Margot Carmichael Lester

 

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Cam Patterson, M.D.

When someone we love is hurting, it’s only natural to want to help them in every way possible. If a family member is dealing with a cardiac disease, our ability to help can be hindered by a number of factors. But with a little effort, we can overcome these challenges and provide the right kind of support.

“When doctors send our patients home, we often assume that everything we say and suggest and prescribe is going to be followed up on,” admits Dr. Cam Patterson, chief of cardiology at the University of North Carolina Hospitals in Chapel Hill. “But there are all kinds of ways an excellent clinical plan can be derailed.”

To keep that from happening, Patterson suggests that family members do the following:

  1. Understand the illness. The most common obstacle is not having enough information on the condition. Start by consulting with the cardiologist about your role in rehabilitation and recovery. It’s also a good idea to talk to your loved one about how much she or he is willing to share with you, and by gauging how well she or he understands the condition.
  2. Manage medications and follow-up appointment. With new routines and medications, patients can get frustrated. This is where family members can be a huge help. Make sure you understand the purpose, dosage and side-effects of each medication, and that you are aware of all appointments for doctor visits and cardiac rehab sessions.
  3. Participate in lifestyle changes. Most cardiac patients have to make significant changes in exercise and diet. Success rates skyrocket when a family member or friend participates. For instance, the American Heart Association reports that people are 76 percent more likely to stay on their walking program if someone else is counting on them.
  4. Watch for emotional responses. It’s not uncommon for cardiac patients to become depressed or go into denial. If your loved one becomes angry or withdrawn, or if you notice other major changes in his or her personality, talk about it together. And if you’re really concerned talk to the cardiologist, nurses or any primary care provider. Even clergy members can help.
  5. Get active. Activity levels will be limited for most patients, but it’s important for family members to help them get on with their lives. Reintroduce your parent or spouse to what they do on a day to day basis, like going back to church or working on a hobby – the things that make life fulfilling.

And there’s something you can do for yourself, too. Since heart disease has a genetic component, it’s important for children and siblings to know their heart health status by making an appointment with a physician. For spouses, it’s important to make sure you have your own support system – family, friends, clergy, support groups, etc. – to help you manage the emotions you may encounter in caring for a loved one. You can’t help if you’re not healthy yourself!

“It’s important to realize that your family’s going to have to make adjustments because of this severe illness, but you can’t let it get in the way of being a family,” Patterson says.

Patients with serious conditions like heart disease often feel alone or don’t want to be burdens on their families. Following these steps can help you support your loved one on the road back to a full and meaningful life.

UNC Heart Center Lipid Clinic Training Program: CANCELLED

The UNC Heart Center Lipid Clinic Training Program has been CANCELLED. The event was scheduled to be held November 6-7, 2008 at the Hilton Garden Inn, 7007 Fayetteville Road, Durham, NC.

The UNC Heart Center Lipid Clinic Training Program has been CANCELLED. The event was scheduled to be held November 6-7, 2008 at the Hilton Garden Inn, 7007 Fayetteville Road, Durham, NC.

UNC researchers receive a grant to study the link between cancer and venous thrombosis

Nigel Key, MD and Nigel Mackman, PhD, have received a five-year, $1,986,650 grant to study the mechanisms of venous thromboembolism in cancer.

Drs. Key and Mackman received their grant from the National Heart, Lung, and Blood Institute. Dr. Key, Harold Roberts Distinguished Professor of Medicine, and Dr. Mackman, John C. Parker Distinguished Professor of Medicine, will serve as joint principal investigators on the grant.

Venous thromboembolism (VTE) is a leading cause of disability and death in cancer patients. The incidence of VTE in these patients is further increased by the administration of anti-cancer drugs. However, the mechanisms of VTE in cancer patients are largely unknown.

The overall goal of this proposal is to determine whether an association exists between levels of a procoagulant molecule called tissue factor in the circulation and venous thrombosis in patients with pancreatic or colon cancer, and in tumor-bearing mice. The general hypothesis is that cancer and chemotherapy drugs increase the release of tissue factor-positive microparticles (small membrane vesicles released from activated or apoptotic cells) into the circulation which increases the risk of thrombosis. The study will determine if levels of tissue factor-positive microparticles can be used as a biomarker of a pre-thrombotic state in patients with pancreatic or colon cancer. This will be a multi-center prospective observational study utilizing patient blood samples from the University of North Carolina at Chapel Hill, East Carolina University and Rex Hospital. In addition, mouse models will be used to directly examine the role of tissue factor-positive microparticles in venous thrombosis.

UNC Heart Center Lipid Clinic Training Program

This training course focuses on evidence based lipid management and supports the healthcare professional to better understand and implement processes which support continuity of care, adherence and patient education.

 

November 6-7, 2008
Hilton Garden Inn, 7007 Fayetteville Road, Durham, NC

The University of North Carolina at Chapel Hill School of Medicine offers a Lipid Clinic Training Program through the UNC Heart Center Lipid Clinic.  This training course focuses on evidence based lipid management and supports the healthcare professional to better understand and implement processes which support continuity of care, adherence and patient education. 

We invite cardiologists and other physicians involved with cardiovascular disease management, as well as their healthcare team to attend this course.  Such teams are often MD-directed with the inclusion of a pharmacist, nurse, nurse practitioner, physician assistant and/or dietitian. 

For more information and a brochure, please visit the following website link:
http://www.med.unc.edu/cme/events/lipid-management