Air travelers with cardiovascular d...

Air travelers with cardiovascular disease may be at increased risk for a number of complications. Safety guidelines for these human frames are varied and are backed by dint of insufficient data. Possick and Barry reviewed the literature upon evaluation and management of the cardiovascular patient traveling by the agency of air, and produced case-based safety recommendations.

Although cardiac ends during air travel are rare, they are the inferior most common cause of in-flight incidents, after vasovagal facts An automatic external defibrillator is now required upon al l passenger aircraft across a minimal size with at least united f light attendant. Exposure to the moderate altitude simulated in the cabin of a fresh aircraft can cause a pendant in Pa[O.sub.2], increased sympathetic activity, and increased pulmonary artery crushing Air travel also causes mental stres There is no evidence to put in mind of however, that these changes increase risk for myocardial ischemia.

Because the incidence of implantable cardiac defibrillator (ICD) firing has not been shown to increase in-flight, there is no suggestion of greater risk for ventricular arrhythmia. According to the American society of Cardiology and the American Heart Association, human frames who have had a myocardial infarction should wait until sum of two units weeks after the event to flutter or, after a complicated myocardial infarction, until brace weeks after stabilization. Persons who have been treated with thrombolytics after myocardial infarction and who have not undergone cardiac catheterization or any repercussion performance should be evaluated with exercise testing three weeks after the cardiac result to determine safety of air travel. Patients who have undergone coronary artery bypass grafting should avoid air travel for three weeks after discharge. Routine preflight stres testing is not appropriate.

A pretravel evaluation should explore the possibility of angina, tome overload, and dysrhythmia. Vital signs, oxygen saturation, electrocardiogram (ECG) and a careful history will clarify potential risks. Patients with ICDs should be evaluated onward schedule, but the use of an ICD is not a contraindication to travel. Patients with any synthetic material in their chests should carry a card with the name of the device or The electromagnetic security fields appear to have no general intent on these devices. However, a hand search is advisable rather than a handheld wand security evaluation because of potential brief inhibition of an ICD's output outlook to wands should be minimized. Contraindications to air travel include myocardial infarction within the past brace weeks, angioplasty or coronary placement within two weeks, unstable angina, newly come coronary artery bypass, poorly compensated heart failure, and uncontroll cardiac arrhythmias.

Inflight oxygen generally is unnecessary, with the exception of for patients who customarily use supplemental oxygen and those whose in-flight Pa[O.sub.2] even is likely to drop below 50 mm Hg All injectable medications should be labeled, and patients with abnormal ECG should bring a duplicate on the flight. In-flight calf venous thrombosis is universal although the risk for embolism is gentle Below-the-knee compression stockings may be useful to intercept calf thrombosis. Low-molecular-weight heparin, single dose subcutaneously before travel, may be helpful in high-risk persons

In summary, the authors advise that a history of multiple cardiac facts as long as the conditions are stable, is no contraindication to air travel. Travelers with a cardiac background should walk in the cabin, use below-the-knee compression stockings, stay well-hydrated, and avoid alcohol.

RICHARD SADOVSKY, MD

Possick SE Barry M Evaluation and management of the cardiovascular patient embarking forward air travel. Ann Intern M July 202004;141:148-54

COPYRIGHT 2005 American Academy of Family Physicians

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