Infectious Disease Book

Travel Medicine

  • Cardiac-Related Air Travel Restrictions

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Cardiac-Related Air Travel Restrictions

Aka: Cardiac-Related Air Travel Restrictions, Cardiovascular Status Evaluation Before Air Travel, Preflight Cardiovascular Assessment, Air Travel Restrictions Following Myocardial Infarction
  1. See Also
    1. See Air Travel Restrictions
    2. In-Flight Medical Emergency
    3. Respiratory-Related Air Travel Restrictions
  2. Contraindications: General Air Travel Restrictions
    1. Recent Myocardial Infarction (see below)
    2. Unstable Angina
    3. New cardiovascular or respiratory symptoms
      1. Full evaluation before travel
    4. Recent cardiovascular medication changes without appropriate follow-up
      1. Must be clinically stable beyond duration of medication half-life
  3. Management: General Air Travel Restrictions
    1. Congestive Heart Failure
      1. No air travel for 2 weeks after decompensation
      2. Exception: Oxygen and <10,000 ft (3048m)
    2. Chronic Stable Angina
      1. Stable for 8000 feet cabin pressure if able to walk to 328 ft or 100 m or climb 12 steps
      2. Evaluate for Supplemental Oxygen needs if patient is short of breath after walking 50 meters
        1. See Hypoxia Altitude Simulation Test
    3. Implanted metallic devices (e.g. Pacemakers, implanted Defibrillators, loop recorders)
      1. Avoid air travel for 2 days following device placement
      2. Pat-Down screening is recommended over walk-through metal detectors
        1. However, some devices are considered safe wih airport screening devices
  4. Management: Air Travel Restrictions Following Myocardial Infarction
    1. Low Risk Myocardial Infarction: Defer air travel for 3-10 days after ACS
      1. Age <65 years
      2. First coronary event
      3. Successful reperfusion (PTCA)
      4. Ejection fraction >45%
      5. No Myocardial Infarction related complications
      6. No planned cardiovascular evaluation or intervention
    2. Moderate Risk Myocardial Infarction: Defer air travel for 10 days after ACS
      1. Ejection Fraction >40%
      2. Coronary Artery Bypass Graft or uncomplicated open-chest procedure
      3. No symptoms of Congestive Heart Failure
      4. No findings of inducible ischemia or Arrhythmia
      5. No planned cardiovascular evaluation or intervention
    3. High Risk Myocardial Infarction: Defer air travel until condition stabilizes
      1. Ejection Fraction <40% with symptomatic Congestive Heart Failure
      2. Pending cardiovascular evaluation or intervention
  5. Prevention
    1. Air travel is safe in stable cardiovascular disease
    2. Make use of airport transport services (e.g. powered cart), Wheelchairs and baggage trolleys
    3. Bring adequate supply of medications (with extra doses in case of delays)
    4. Stay compliant with all medications including antihypertensives
    5. Carry a copy of most recent Electrocardiogram results
    6. Prevent Venous Thromboembolism
      1. Use below the knee Compression Stockings
      2. Walk inside the cabin
      3. Avoid Alcohol and stay well hydrated
  6. References
    1. Possick (2004) Ann Intern Med 141:148-54 [PubMed]
    2. Powell-Dunford (2021) Am Fam Physician 104(4): 403-10 [PubMed]

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