External CounterPulsation

If you are a Heart Patient and want to Air Travel

With journey by air becoming rather common in world, a question that is pretty often asked by the patients to their doctors arises with its importance; “how safe is the air travel for me?”

A billion passengers aboard the international and domestic flights each year, however, the overall percentage of in-flight sever cardiac problems is low. Yet, a few heart patients need to keep away from air travel. Because, the amplified risk by being restrained to a high altitude, even if the aircraft is pressurized at 7000ft above sea-level- 760mm Hg, there is still lack of oxygen as the pressurisation isn’t at mean-sea-level. Acute exposure to moderate altitude results in decreasedPaO2*, thus, amplified risk of high altitude hypoxia* leading to mental confusion and disorientation; pulmonary hypertension which lead to dizziness, shortness of breath, fainting, and other symptoms, all of which are accelerated by exertion. (Pulmonary hypertension can be a severe disease with a markedly decreased exercise tolerance and heart failure.) Many passengers experience the fear of plane crash accidents, leading to mental stress.

Pre-flight determination must include a careful study of medical history and examination. Vital signs should include resting oxygen saturation*, pulse rate and blood pressure. A resting Electrocardiogram* should be obtained and a copy should be given to the patient who can carry it along with in person. If recommended echocardiography*, stress test and angiography* may be done. Patients should enquire about the recent pacemaker’s evaluation and stress testing. All the tests for new symptoms or a concerned check for device malfunction must be carried out before the travel if possible. Routine check of pacemakers and ICDs-Implantable Cardiac Defibrillators must be performed on time. But, do not delay travel.

Airport security gates might detect pacemakers or ICDs but not stents, so the patients having any of these three devices must carry a document that identifies the type of device and verifies stent placement. Routine in-flight oxygen isn’t necessary for travellers suffering from cardiovascular disease; however, some passengers who require supplemental oxygen at sea-level will require it during the air journey. In that case oxygen should be requested well in advance.

Researchers have stated some guidelines for heart patients who are bound to or wish to travel by air; they are mentioned below.

A must do pre-flight checklist:

- Have a talk with your doctor to see if any pre-flight testing may be necessary to ensure that the cardiac disease is stable.
- Like an airplane, the human body too has a service ceiling. Use supplemental oxygen to avoid exceeding your service ceiling. Carry an ample supply of medicines; make sure they are labelled well and keep in hand luggage.
- Carry a copy of your medical history and a copy of your baseline electrocardiogram [ECG] if you have irregular heart beat or have a pacemaker.
- Carry various numbers and website addresses of pacemaker and ICD manufacturers and local representatives of the destination you are flying to.
- Passengers over 50 years old or those below 50 with one or more risk features for deep venous thrombosis (such as large varicose veins, obesity, congestive heart failure, pregnancy, recent major surgery, use of hormone replacement therapy, or oral contraceptives) should wear below-the-knee compression stockings (20 Hg-30 Hg) when travelling by aircraft for more than eight hours or 5000 km.
- Avoid alcohol and keep yourself well hydrated to avoid blood clots.
- Confirm aisle seating if at risk for deep venous thrombosis so you can go in or move out of your seat easily, also you can walk around and stretch your legs without disturbing other passengers.
- Consider purchase of medical evacuation if your health insurance does not cover medical evacuation.