Does Air Travel Affect the Heart?

According to detailed statistics, more than 3 million people travel by plane each day which means millions and millions of people fly every year.

How do flights affect the heart?

During a flight, aircraft cabins are pressurized. The air pressure in the cabin when flying at cruising altitudes (36,000 – 46,000 feet or 11,000 – 12,000 m) is lower than at sea level. It is equivalent to the outside pressure at 6,000 – 8,000 feet (1,800 – 2,400 m) above sea level. In other words, the atmosphere inside the plane during the flight is comparable to the atmosphere at the top of a 6,000 – 8,000-foot mountain. Since the air pressure is lower, the amount of oxygen in the blood decreases and the gases in the body expand. Usually such effects are well-tolerated by healthy passengers because the body enables certain physiological mechanisms to compensate the reduced oxygen in blood.

But, low cabin pressure is a main risk factor for cardiac patients as it may promote an increase in blood pressure, hypertensive crisis and even the development of a heart attack, although very rare. The decreases in air pressure are perceived by everyone in the cabin, but people with heart problems may face a worsening of their disease. Some people, particularly those with coronary artery disease, angina pectoris, history of myocardial infarction, atherosclerosis or hypertension, may even require supplemental oxygen. Stress being felt by a passenger when travelling by air may also play an important role in the worsening of the passenger’s condition. One of the options to reduce flight-related stress is to have a good check-up before flying, to have adequate rest and enough time for preparation and to reduce the tourist or business activities to more relaxed levels.

How do flights affect blood vessels?

Even the shortest flight causes a restriction of movement. The longer we sit without moving, the more strain is on the vessels of our legs. While sitting, the blood circulation in the lower extremities slows down, blood becomes more viscous, vessels narrow, legs swell and start hurting. And all that happens at the same time as the air pressure drops in the cabin. Such a situation increases the risk of vascular thrombosis (formation of blood clots in the vessels). This condition is particularly dangerous because blood clots may travel to the lungs or heart causing a blockage.

Here are some tips to avoid negative effects of long flights on the vessels of the body:

- Do not cross one leg over the other - it causes the vessels in your legs to be squeezed and suffer even more;
- Try to drink enough water to keep your blood hydrated. Avoid alcohol and drinks containing caffeine – coffee, tea and energy drinks;
- Do not keep your legs bent for more than 1 hour. Do not sit with your legs tucked up underneath you – it significantly disturbs blood circulation and increases the strain on the vessels;
- Sit with your legs extended for as long as possible. Move and stretch your legs regularly;
- Every 30 minutes, get up from your sit and go for a walk around the cabin. Some airlines recommend pulling each knee up to the chest and keeping it there for 15 seconds and repeat up to 10 times;
- When booking a ticket, ask for an aisle seat not a window seat. If you have an aisle seat, you’ll have a chance to stretch your legs whenever you need to, you’ll be able to get up and move without disturbing people sitting near you;
- If you have any heart problem, it is worth seeing your cardiologist before the flight so as to understand whether it’s reasonable to take a blood thinning agent with you.

Adaptation after the flight

When you arrive at your destination, your body might have to adapt to a new climate, new time zone, etc. All these disturb the usual biorhythms to which your body is accustomed at home. During the adaptation period, your heart, blood vessels and your whole body will experience increased strain and you might have to cope with jet lag. You may encounter increased blood pressure, dizziness, headache, feelings of shortness of breath, absent-mindedness, unexplained irritability or sleep disturbance. That is the reason why you should spend the first 2 or 3 days adapting– sleep as much as you need, eat well, walk and get enough fresh air.

Air traveling with pacemakers, implanted metal devices, implantable defibrillators & coronary stents

According to The American Heart Association, travelling by air should pose no danger to patients with pacemakers, implanted metal devices, implantable defibrillators or coronary stents. However, in rare cases, implantable cardioverter defibrillators have induced unnecessary shocks lasting for many hours during high-altitude flights.

The Merck Manual Home Edition recommends patients with implanted pacemakers, defibrillators or stents should have a card or a letter from a doctor with them that documents the presence, location, kind and electronic characteristics of the device implanted. When such person passes through electronic security, the implanted metal device might trigger an alarm. Usually the devices used in electronic security do not affect implantable defibrillators; however, travelers with defibrillators are advised not to stay in walk-through metal detectors for more than 15 seconds. Handheld detectors are also considered safe for patients with implanted devices, but still it’s better to avoid prolonged contact (longer than 5 seconds) with such detectors.

If you have any worries about your device when flying or going through security checkpoints, you should discuss this with your physician. When in an airport, you should tell the airport security agents about your implanted device and show them your card ahead of time – be prepared for a private screening. If your physician has indicated that you should not be subject to a metal detector inspection because it may affect the functionality of your device, then you should ask the security officer to perform a pat-down inspection instead.

So is it safe for cardiac patients to fly?

Statistically, air travel does not pose a great danger to most cardiac patients - heart problems occur only in 1-2 people per million. However, there is a group of patients who should avoid flying, at least for some time.

These are those who:

- have had a myocardial infarction (heart attack) within the past 14 days;
- have had angioplasty and coronary stent placement within the past 14 days;
- have had coronary artery bypass grafting within the past 21 days (or longer if there have been any pulmonary complications);
- have poorly controlled heart failure (edemas), unstable angina, or uncontrolled arrhythmias (ventricular or supraventricular arrhythmia).

Obviously a cardiac patient should not be far from home until sure that his condition is stable.

- Always have adequate supplies of the medicines prescribed for your heart;There are general recommendations for heart patients:

- Bring with you a copy of your medical history, recent electrocardiogram and the phone numbers of family members and your cardiologist;
- See your doctor and get a pre-flight testing, if required, to be sure that your cardiac condition is stable;
- If you need supplemental oxygen, notify the airline representatives beforehand;

- Be aware of any symptoms (like shortness of breath, etc.) that could indicate your condition is changing from a stable to an unstable state.

-