Sexual intercourse is recognized as a rare precipitator of sudden cardiac death (SCD), with one forensic study of autopsies after natural death estimating that 0.2% were associated with sexual activity. The prevailing perception is that this is a problem largely afflicting middle-aged males. However a new study, published in a research letter in JAMA Cardiology, suggests that the phenomenon, though still rare, may affect younger people and women more than has been appreciated.
Researchers from St George's University of London reviewed more than 6800 cases of SCD referred to the center for cardiac pathology at St George's between January 1994 and August 2020. All cases had already had a detailed autopsy, including toxicological screening, to exclude non-cardiac causes. Clinical information was obtained from referring coroners. Expert cardiac pathologists undertook macroscopic and histological evaluation of each heart.
Of the total 6847 SCD cases, 17 (0.2%) had involved death occurring during or within 1 hour after sexual intercourse. The mean age at death was 38 (with a standard deviation of 18 years), and 11 of the 17 (65%) were men. The number of women (6/17, 35%) was substantially higher than in previous studies, which the team attribute to the relatively young age of the cohort, whereas other studies have included older men who would be expected to have a higher prevalence of coronary artery disease.
Sudden Arrhythmic Death Syndrome most common cause
The most common autopsy finding had been a structurally normal heart, in nine individuals (53%), suggestive of sudden arrhythmic death syndrome. Other causes were aortic dissection in two individuals (12%) and one death each (6%) attributed to arrhythmogenic cardiomyopathy, hypertrophic cardiomyopathy, ischaemic heart disease, idiopathic fibrosis, idiopathic left ventricular hypertrophy (LVH) and mitral valve prolapse.
Only one patient had reported previous cardiac symptoms, although four had a history suggestive of cardiac disease: one man in his 30s with diagnosed mitral prolapse; one person in their 20s with diagnosed hypertension who was found to have aortic dissection at post-mortem; a patient with a history of tachycardia associated with electrolyte imbalance, and a teenager with LVH who was found to have hypertrophic cardiomyopathy at autopsy.
The team acknowledge that limitations of the study were that they examined only SCD cases, and therefore results excluded other causes of death, and they assessed only people who had died, so survivors of sudden cardiac arrests were not included.
The preponderance of cases of sudden arrhythmic death syndrome reflects the young age of the cohort and suggests that "primary electrical disease may be associated with a rare incidence of sudden death during sexual intercourse", the researchers said.
But although younger people with known cardiac conditions, such as cardiomyopathies and channelopathies, may be concerned about their risk for sudden death during sexual intercourse because of the accompanying catecholaminergic surge, they believe their findings provide some reassurance that sexual activity is relatively safe in such patients, especially in those younger than 50 years.
Hope to avoid future tragedies
The study was part-funded by the charity Cardiac Risk in the Young (CRY), which aims to prevent young SCDs through awareness, screening and research, as well as supporting affected families. Dr Steven Cox, CEO of CRY, told Medscape UK: "We are delighted to have funded this interesting and insightful research which feeds into our overall objectives of helping to save young lives.
"Through funding research into the causes of young sudden cardiac death, we are able to better understand how tragedies can be prevented. It’s therefore important to recognize that this research looked at almost 7,000 sudden cardiac deaths, which have now been investigated and studied by the CRY research team.
"Once a young person is identified with a potentially life threatening cardiac condition they will be given specialist lifestyle advice about how to avoid the risks of suffering a cardiac arrest. Sometimes these limitations, especially if they are advised to avoid competitive sports, can have a real impact on their quality of life. However, this research into the circumstances when there has been young sudden cardiac death provides some very strong reassurance for young people that they are safe when engaging in sexual activity.
"Every week in the UK, at least 12 young (aged 35 and under) people die from a previously undiagnosed heart condition. In 80% of cases there will have been no warning signs, which is why proactive screening of asymptomatic people is so vital. Once identified, the vast majority of these conditions can be successfully treated (via surgery, medication or lifestyle modifications) allowing individuals to continue enjoying a normal life and resuming normal activities."
SOURCE: Medscape