WORLD HEART DAY
Safe journeying
DR. RAJAESH RAJANI
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Here are tips to ensure that travellers with cardiac trouble have a hassle-free trip.
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Most people with stable heart disease that is monitored and controlled should have no problem travelling. However, travel is not recommended for people with uncontrolled angina, abnormal heart arrhythmia, or uncontrolled congestive heart failure (CHF
).
In general, air travel does not pose great risks to most heart patients. Cardiac “incidents” occur only in one or two patients per million during air travel. However, some patients need to avoid flying, at least temporarily, because of the increased risk posed by being confined to a high-altitude (and therefore low-oxygen) compartment. (Airplane cabins are pressurised to the equivalent of around 10,000 feet above sea level.)
What to carry
Once you’ve had your physical and notified your doctor, document the following medical information and keep it with you at all times: List of all drugs you take: Use generic names, and indicate dosages, as drug formulations vary from country to country; Copy of a baseline electrocardiogram; Name and contact details of your doctor; 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; 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. Keep all medications in their original containers. Pack all of your medical information and medication in your carry-on luggage to avoid losing them.
On-board oxygen (which is separate from the emergency system) should be requested well in advance to ensure an adequate supply if there is frequent angina or reduced oxygen levels in the patient at ground level. Cabin staff are trained for emergencies and all airlines carry first aid and medical emergency kits. Most major airline flights now have a “smart” in-flight defibrillator.
On board precautions
Travellers with one or more risk factors for Deep Vein Thrombosis like obesity, varicose veins, oral contraceptives should observe the following precautions.
Move your legs. Don’t sit with your legs bent for hours on end. Stretch your legs from time to time, and move your feet at the ankles. Stand up to stretch the legs now and then. This stops blood stagnating in the deep veins of the calf. Go for a walk up and down the aisle.
Avoid dehydration. Drink plenty of fluid. Water is ideal. Avoid excessive alcohol, which tends to cause dehydration.
Wear compression stockings. Graduated compression stockings reduce the risk of DVT and also help to prevent ankle swelling. Below Knee stockings are the most comfortable kind, and seem just as effective as full length stockings. These stockings come in a range of sizes, and your legs will need to be measured to get the right fitting. People who have trouble with the arteries of their legs should seek medical advice before using compression stockings.
Taking an aspirin tablet (either a 75mg “junior aspirin” or a normal 300mg aspirin tablet) a few hours before a long journey may provide a small amount of extra protection against DVT.
Patients with pacemakers and implantable cardiac defibrillators should be rerouted for security clearance with hand-held metal detectors and hand searches. The hand-held device should be held over the ICD for no more than a few seconds
Other travel
Road travel is reasonably safe for cardiac patients. Avoid the stress of driving yourself. Persons with recent heart attacks should avoid driving themselves for at least 3-4 weeks. Driving is possible six weeks following a bypass surgery and within a week of an angioplasty. One should follow all the precautions to prevent deep vein thrombosis by taking frequent halts and stretching the legs whenever possible.
Travel by rail is quite safe. The standard precautions to avoid venous thrombosis should be followed. Acutely ill patients should desist from any form of long journeys unless that travel is for the purpose of treatment.
The writer is a Consultant Cardiologist based in Mumbai.
Patients should not fly if:
they have had a heart attack (myocardial infarction) in the past two weeks
they have had coronary artery stent placement within the past one week
they have had coronary artery bypass surgery within the past two weeks (longer if they have had complications)
they have unstable angina, poorly controlled heart failure, or uncontrolled arrhythmias
Get help
Seek medical attention if these symptoms occur during travel.
Irregular pulse or one unusually fast (greater than 100 beats per minute) or very slow (lower than 50 beats per minute)
Shortness of breath
Light-headedness
Unusual fatigue
Unusual swelling of the legs and/or feet
Chest pain or discomfort
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