Guidelines for Flying with Heart Disease

Air Travel Is Generally Safe for Heart Patients, With Appropriate Precautions

Airplane wing
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Having heart disease usually doesn't mean you have to give up you dreams of traveling by air. Most people who have heart disease can continue traveling as they always have, as long as they take a few extra precautions to fly safely. 

Risks of Flying with a Heart Condition

In general, air travel does not pose great risks to most people with heart disease. Cardiac "incidents" occur only in 1 to 2 people per million during air travel.

 

However, some people with cardiac problems need to avoid flying, at least temporarily, because of the increased risk posed by being confined to a relatively high-altitude (and therefore relatively low-oxygen) environment. Airplane cabins are pressurized to the equivalent of approximately 8,000 feet above sea level. While this altitude provides sufficient oxygen for most people with heart disease, those whose cardiac conditions are barely compensated can experience difficulty, including dyspnealightheadedness, or angina.

Overall, the risk of flying is quite small for people who have stable heart conditions. Nonetheless, cardiac emergencies account for a sizable proportion in-flight medical emergencies. To prepare for these situations, the U.S. Federal Aviation Administration mandates that an automated external defibrillator (AED) is on board the majority of passenger airplanes (those with a maximum payload capacity of more than 7,500 pounds).

One of the biggest risks for people with heart disease who are flying is developing a blood clot, or venous thrombosis. Various factors can increase the risk of developing a blood clot while flying. These include dehydration, lower cabin oxygen levels, and sitting for long periods of time. The risk is substantially higher for people who have heart disease.

 

Guidelines for Flying With a Heart Condition

There are no randomized, controlled clinical trials that address the question of flying with heart disease. However, experts generally agree on certain practical guidelines to minimize the risk of flying. 

People With Heart Disease Should Not Fly If:

Notably, experts agree that people with pacemakers or implantable defibrillators can fly safely.

A Preflight Checklist For People With Heart Disease:

  • talk to your doctor to see if any pre-flight testing may be warranted to assure that your heart disease is stable
  • ask your doctor for a document explaining your heart condition, that you can carry with you
  • get to the airport in plenty of time to avoid needing to rush to the gate
  • carry adequate supplies of your medication on board with you
  • carry a copy of your medical history
  • carry phone numbers for your doctor(s) and family members
  • carry contact numbers and website addresses for pacemaker and ICD manufacturers 
  • during the flight, consider wearing compression stockings, avoid alcohol, and drink plenty of fluids to prevent blood clots
  • confirm aisle seating, which will allow you to get up and walk around periodically 
  • check the Center for Disease Control's website for up-to-date immunization and antimalarial recommendations
  • check whether your medical insurance covers medical evacuation, and consider buying medical evacuation insurance if it does not

Sources:

Aerospace Medical Association Medical Guidelines Task Force. Medical Guidelines for Airline Travel, 2nd ed. Aviat Space Environ Med 2003; 74:A1.

Possick SE, Barry M. Evaluation and Management of the Cardiovascular Patient Embarking on Air Travel. Ann Intern Med 2004; 141:148.

Rayman RB. Passenger Safety, Health, and Comfort: a Review. Aviat Space Environ Med 1997; 68:432.

 

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