Navigating air travel and cardiovascular concerns: Is the sky the limit?

Abstract

As the population ages and our ability to care for patients with cardiac disease improves, an increasing number of passengers with cardiovascular conditions will be traveling long distances.Many have had cardiac symptoms, recent interventions, devices, or surgery. Air travel is safe for most individuals with stable cardiovascular disease. However, a thorough understanding of the physiologic changes during air travel is essential given the potential impact on cardiovascular health and the risk of complications in passengers with preexisting cardiac conditions. It is important for clinicians to be aware of the current recommendations and precautions that need to be taken before and during air travel for passengers with cardiovascular concerns. | INTRODUCTIONMore than 2.75 billion passengers travel globally by air each year. As the population ages and our ability to care for passengers with cardiac disease improves, an increasing number of people with cardiovascular disease will be utilizing air travel. Among these individuals, some have had pacemakers or automatic defibrillators implanted, recent revascularization, or surgery that might predispose to deep venous thrombosis (DVT). 1-3 Also, the use of air medical transport services provided by private and insurance-affiliated companies has risen significantly over the past 15 years. 4 In the largest observational study of medical emergencies during air travel, which analyzed data of 744 million airline passengers between 2008 and 2010, the medical incidence rate was reported to be 1.6 per 100 000 passengers, with medical deaths occurring in 36 passengers. 3 Cardiac causes represent 8% of the medical emergencies, whereas cardiac arrest was the most common cause of medical death (31/36) and flight diversion. 3,5 Myocardial ischemia is the most common cause of cardiac events during air travel. 6 DVT is another concern for people who fly long distances, with incidence reaching up to 5.4% in high-risk groups flying an average of 12.4 hours. 2 The risk of venous thromboembolism (VTE) is about 3 times higher in passengers on long distance flights than in the general population. 7Air travel is safe for most individuals. Importantly, a thorough understanding of the physiologic changes during air travel is essential for every physician, as special precautions are needed for higher-risk passengers. | PHYSIOLOGICAL CHANGES DURING AIR TRAVELMultiple factors can affect cardiovascular health during air travel, including decreased atmospheric pressure, decreased humidity, gas expansion, prolonged immobility, and increased physical and emotional stress.Most commercial aircraft fly at an elevation somewhere between 22 000 and 44 000 feet above sea level (cruising altitude), with a corresponding decline in partial pressure of inspired oxygen of approximately 4 mm Hg per 1000 feet above sea level. 8 This altitude is associated with an approximate 65% to 85% decrease in atmospheric air pressure and a 60% to 90% decrease in partial pressure of inspired oxygen in comparison with sea lev...

Self‐care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology

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Superficial Temporal Artery True Fusiform Aneurysm With Several Lateral Feeding Vessels

“…Finally, as a flight attendant for the past 25 years, the patient was exposed to repetitive cycles of pressurization and depressurization and acceleration and deceleration during flight take-off and landing. These cycles are associated with transient compensatory increases in blood pressure and resultant tension on the arterial wall, which over time may contribute to aneurysmal degeneration [ 16 , 17 ].…”

Pre-travel Health Advice for Patients With Cardiovascular Disease

“…9 For travellers with more severe CHF, e.g., New York Heart Association (NYHA) classification III or IV, oxygen supplementation is recommended. 10 The use of in-flight oxygen supplementation may be an unpleasant experience for these travellers.…”

“…This becomes crucial during air travel, as the angina threshold is often reduced due to physiologic changes. 10 A comprehensive review by Smith et al outlined the suitability of air travel in patients with CHD. 12 Their recommendations were mainly based on observational studies as well as analyses of in-flight medical emergencies.…”