Traveling With Heart Disease
Whether the destination is Thailand, China, or the Galapagos Islands, today’s travelers are flocking to more adventurous and exotic locales, often for longer periods of time. But how does travel affect your heart if you have heart disease? Depending on your health condition, there are several factors to consider when planning your next trip.
Before you leave, the first and most important step for all heart patients is to have a complete physical exam and get an accurate assessment of your current physical health. “The biggest risk a heart patient can take is going on a trip unprepared—not knowing what your cardiac status is,” says Winnie Ooi, MD, DMD, MPH, director of the travel clinic at Lahey Clinic in Burlington, MA.
Most people with stable heart disease that is monitored and controlled should have no problem traveling; however, travel is not recommended for people with uncontrolled ]]>angina]]>, abnormal heart ]]>arrhythmia]]>, or uncontrolled ]]>congestive heart failure (CHF)]]>. If you have had a ]]>heart attack]]> within the past four weeks, or open heart surgery within the past two to six weeks, air travel is not recommended.
Different types of heart disease require different precautions. For example, people with CHF should avoid high altitude destinations, while people with valvular heart problems may experience changes in their prothrombin (clotting) time when taking ]]>malaria]]> pills. Check with your doctor about precautions that are important to your own health condition.
You should also consider getting vaccinated for ]]>influenza]]> and pneumococcus. Dr. Ooi notes, “Adults are vastly undervaccinated, particularly for influenza and pneumococcus. I usually recommend a flu shot for my patients, since flu exists in all parts of the world. Pneumococcal vaccines will depend more on age and underlying health conditions.”
Finally, it is highly recommended that you purchase emergency evacuation insurance, particularly if you are traveling to a remote area.
Once you’ve had your physical and notified your doctor of your travel plans, it is a good idea to document the following medical information and keep it with you at all times:
- Keep a list of all the drugs you are taking. Use generic names and indicate dosages, as drug formulations vary from country to country.
- Have a copy of a baseline ]]>electrocardiogram]]>.
- Have the name and contact information of your physician.
- Also include a brief letter from your doctor (on letterhead, signed and dated) that describes your condition, the need for any supplies or medications, and information on any implanted pacemakers or cardiac defibrillators you may have.
Pack and carry more than enough of each of your medications to cover the length of your trip, as medication may be difficult to refill once you reach your destination. Check with your doctor or pharmacist to be sure that any medications prescribed specifically for your trip (eg, malaria pills) do not interfere with your heart medications. Keep all medications in their original containers. Pack all of your medical information and medications in your carry-on luggage to avoid losing them in misplaced luggage.
In the Air
Air travel in a pressurized cabin exerts certain influences on the body that are important for heart patients. Prepare by doing the following:
- Stay hydrated: Be sure to drink plenty of non-alcoholic fluids during your flight to insure hydration in the dehydrating plane atmosphere. Avoid beverages that contain alcohol or caffeine.
- Move around: Heart patients may be especially prone to blood clots due to diuretic use or slower blood circulation. Be sure to get up, stretch, and move around the cabin at least once every hour to avoid blood clots and the danger of deep vein thrombosis.
- Make advance arrangements for oxygen: If you will need oxygen during your flight, check for airline availability, policies, and cost well in advance, as some airlines do not provide oxygen. If your airline does not, your doctor will need to provide a prescription and fill out an airline medical form that should be submitted at least three business days before your departure.
- Pacemaker/defibrillator function: People with an implanted defibrillator or pacemaker should check with their cardiologist to determine if airline security magnets will interfere with its function.
A rule passed by the Federal Aviation Administration requires that all US airlines carry defibrillators as well as upgraded emergency medical kits. Check with your airline to to be sure they have defibrillators in place.
On the Ground
When you arrive at your destination, be sure to pace yourself and avoid highly strenuous activities and unnecessary stress. Certain activities, such as scuba diving, are extremely risky for heart patients and are not recommended.
If you take diuretics, stay hydrated, and try to monitor your salt intake when eating out. If you are taking blood thinners (such as Coumadin [warfarin]), do not eat excessive amounts of green leafy vegetables; they contain high levels of ]]>vitamin K]]>, which helps the blood to clot, and may interfere with the effectiveness of your medication. You should also be careful to follow the CDC recommendations regarding safe drinking water and foods to eat or avoid in the locations to which you’ll be traveling.
Most of all, try to relax, and enjoy your trip!
Prevention Travel Information
Centers for Disease Control
International Association for Medical Assistance to Travelers
Heart and Stroke Foundation of Canada
Travel Medicine Program, Public Health Agency of Canada
American Heart Association applauds FAA rule requiring life-saving devices on airplanes. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3055 . Accessed November 17, 2003
Bettes TN, McKenas DK. Medical advice for commercial air travelers. Am Fam Physician. 1999;60(3):801-808, 810.
Bratton RL. Advising patients about international travel: what they can do to protect their health and safety. Postgrad Med. 1999;106(1):57-64. Postgraduate Medicine website. Available at: http://www.postgradmed.com/issues/1999/07_99/bratton.htm . Accessed November 17, 2003.
Last reviewed January 2009 by ]]>Igor Puzanov, MD ]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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