Flying With a Heart Condition

If you have a heart condition, you can fly safely as a passenger on an airplane, but you need to be aware of your risks and take necessary precautions.

Heart conditions that can lead to health emergencies when flying include coronary artery disease (CAD), cardiac arrhythmia (irregular heart rate), recent heart surgery, an implanted heart device, heart failure, and pulmonary arterial disease.

Risks

Air travel does not pose major risks to most people with heart disease. But there are some aspects of flying that can be problematic when you have certain heart conditions.

When you have heart disease, air flight can lead to problems due to the confined space, low oxygen concentration, dehydration, air pressure, high altitude, and the potential for increased stress. Keep in mind some of these issues compound their effects on your health.

Immobility

The prolonged lack of physical movement and dehydration on an airplane may increase your risk of blood clots, including deep vein thrombosis (DVT) or pulmonary embolism (PE). One of the biggest risks for people with heart disease who are flying is developing venous thrombosis.

These risks are higher if you have CAD or an implanted heart device, such as an artificial heart valve or a coronary stent. And if you have an arrhythmia, a blood clot in your heart can lead to a stroke.

Low Oxygen and Air Pressure

The partial pressure of oxygen is slightly lower at high altitudes than at ground level. And, while this discrepancy on an airplane is typically inconsequential, the reduced oxygen pressure in airplane cabins can lead to less-than-optimal oxygen concentration in your body if you have heart disease.

This exacerbates the effects of pre-existing heart diseases such as CAD and pulmonary hypertension.

The changes in gas pressure in an airplane cabin can translate to changes in gas volume in the body. For some people, airplane cabin pressure causes air expansion in the lungs. This can lead to serious lung or heart damage if you are recovering from recent heart surgery.

Dehydration

Cabin pressure at high altitude can contribute to water loss and dehydration while flying. This can affect your blood pressure, causing exacerbation of heart disease. This is especially problematic if you have heart failure, CAD, or an arrhythmia.

Stress

If you experience stress due to generalized anxiety about traveling or sudden turbulence on your flight, you could have an exacerbation of your hypertension or CAD.

Pre-Flight Health Evaluation

Before you fly, talk to your healthcare provider about whether you need any pre-flight tests or medication adjustments. If your heart disease is stable and well-controlled, it is considered safe for you to travel on an airplane.

But, if you're very concerned about your health due to recent symptoms, it might be better for you to confirm that it's safe with your healthcare provider first before you book a ticket.

Indications that your heart condition is unstable include:

• Recent heart surgery
• Chest pain or recent heart attack
• Uncontrolled hypertension
• Recent stroke
• An irregular heart rhythm that isn't controlled

If you've had a recent heart attack, a cardiologist may suggest a stress test prior to flying.

Your healthcare provider might also check your oxygen blood saturation. Heart disease with lower than 91% oxygen saturation may be associated with an increased risk of flying.

Unstable heart disease is associated with a higher risk of adverse events due to flying, and you may need to avoid flying, at least temporarily, until your condition is well controlled.

Planning and Prevention

As you plan your flight, make sure that you do so with your heart condition in mind so you can pre-emptively minimize problems.

While it's safe for you to fly with a pacemaker or defibrillator, security equipment might interfere with your device's function. Ask your healthcare provider or check with the manufacturer to see if it's safe for you to go through security.

If you need to carry any liquid medications or supplemental oxygen through security, ask your healthcare provider or pharmacist for a document explaining that you need to carry them on the plane with you.

Carry a copy of your medication list, allergies, your healthcare provider's contact information, and family members' contact information in case you have a health emergency.

As you plan your time in-flight, be sure to take the following steps:

• Request an aisle seat if you tend to need to make frequent trips to the bathroom (a common effect of congestive heart failure) and so you can get up and walk around periodically.
• Pack all your prescriptions within reach so you won't miss any of your scheduled doses, even if there's a delay in your flight or connections.

During Your Flight

If you have been cleared by your healthcare provider to fly, rest assured that you are at very low risk of developing a problem. You can relax and do whatever you like on the flight—snack, read, rest, or enjoy entertainment or games.

Stay hydrated and avoid excessive alcohol and caffeine, which are both dehydrating. And, if possible, get up and walk for a few minutes every two hours on a long flight, or do leg exercises, such as pumping your calves up and down, to prevent DVT.

If you develop any concerning issues while flying, let your flight attendant know right away.

Warning Signs

Complications can manifest with a variety of symptoms. Many of these might not turn out to be dangerous, but getting prompt medical attention can prevent serious consequences.

Symptoms to watch for include:

• Anxiety
• Lightheadedness
• Dyspnea (shortness of breath)
• Angina (chest pain)
• Palpitations (rapid heart rate)
• Tachypnea (rapid breathing)

To prepare for health emergencies, the U.S. Federal Aviation Administration mandates that an emergency medical kit and an automated external defibrillator (AED) be kept on all passenger airplanes that carry 30 passengers or more.

Flight crews receive training in the management of in-flight medical emergencies and there are protocols in place for flight diversions if necessary.

Summary

For most people who have heart disease, it is possible to fly safely as long as precautions are taken The risks of flying for people with heart conditions are related to the confined space, low oxygen and pressure in the cabin, dehydration, immobility, and stress. 

Before flying, ask your healthcare provider if you should have a health evaluation or make changes to your medication. Make sure you know whether your equipment is safe to take through security, keep a copy of your medical information, and make sure you understand the warning signs.