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