Cardiovascular Disease and Travel

I’ve been sent this interesting article:

Cardiovascular disease (CVD) is by far the leading cause of death among international travellers and accounts for 50 percent of the deaths among travellers from the United States who are 60 years of age and older.

Many of these deaths may have occurred if travellers had stayed home, but it is also true that travel is stressful, and exposes people to cardiac risk factors that they would not necessarily experience at home e.g. prolonged sitting, hypoxia aboard aircraft and at higher altitudes, hot and cold environments, and sudden spurts of physical activity (carrying heavy luggage for prolonged distances, for example), to name a few.

Preparing To Go

So if you are at all at risk of CVD, it makes sense to invest in a little pre-trip planning. Begin a moderate exercise program several weeks before travel, gradually increasing the intensity as the day of departure approaches, and continue exercising while travelling. Walking, of course, is a great exercise that can be done almost anywhere.

Carry pertinent health data - details about pacemakers, for example - and be familiar with the drugs you are taking (the trade and generic names of the drug, and why you are taking it). This information should be packed in your carry-on luggage. Be sure to know how and where to check your pacemaker, where and when to check your blood for coagulation time, and be able to take your blood pressure, count your pulse rate, and recognize pulse irregularities.

Pace yourself at a level commensurate with your cardiac status. Take rest periods after long flights, being on the go from early morning until late at night is tiring. There are numerous tour companies that cater to individuals who want assistance with luggage, and who want to stay in one hotel for several days at a time.

Altitude

Generally, individuals with CVD who can walk briskly for about 300 feet or climb a flight of stairs without pain or shortness of breath should have no difficulty flying on commercial airliners (pressurised to about 8,000 feet) or participating in activities requiring minimal exertion at this moderate altitude. Well-controlled angina is not considered a problem at this altitude, even in those patients with well-controlled, concomitant pulmonary disease. Gradual acclimatisation to altitude is important for all travellers, and more so for individuals with CVD. This means avoiding strenuous exercise for the first few days, and participating in activities no more strenuous than at home for the whole stay at altitude. Gradual acclimatisation results in virtual restoration of sea-level cardiac performance after five days.

Although common medical wisdom advises individuals with CVD to avoid altitudes above 8,000 feet, studies and observations by experts in high altitude medicine show virtually no increase in the risk of acute cardiac ischemic events or a worsening of hypertension. A study of coronary heart disease at 10,000 feet showed that individuals with CVD have an earlier onset of angina compared to onset at sea level, but there is no impairment in their ability to acclimatise. While symptoms increased for the first few days, there is no evidence that exercise after acclimatisation was of greater risk to the heart than similar exercise performed at sea level.

If you have CVD and wish to participate in vigorous activities at high altitudes - skiing, trekking or climbing, for example - you should consult with your cardiologist and, perhaps, undergo cardiac screening tests to help detect hidden problems and gauge permissible safe altitudes and levels of exertion.

Heat

Your body acclimatises to heat somewhat more slowly and less completely than to altitude. As with altitude, it is best to minimise exertion for the first few days in a hot environment and to gradually increase the amount of activity. Air conditioning, even for a few hours a day, drinking lots of fluids, and wearing loose-fitting clothing are helpful.

Medications

It's wise not to travel for a week or two after starting a major new medication or after significant changes in dosage. This allows adverse effects to surface. Moreover, the effects of many medications commonly taken by travellers with CVD can be significantly altered by travel-related factors like altitude, heat, cold, and jet lag.

Cold

The human body does not adapt physiologically to cold as it does to altitude and heat. Individuals with CVD are at increased risk for cold-related problems. In temperate climates, individuals are at highest mortality and morbidity risk from CVD during in cold-weather months. Coping with cold requires preparedness - limiting the time of exposure to cold, keeping warm and dry, breathing through a scarf when the air is very cold, and being alert for cardiac - related symptoms.

Cruise Ships

Cruises are appropriate vacations for individuals with stable CVD. Passengers can be as active or inactive as they wish. The air is clean at sea, ships are air-conditioned, special diets are available, and most ships have lifts. Large ships are well equipped to handle cardiovascular emergencies. They have doctors on board, nearly all trained in emergency medicine. Ships carry defibrillators and ECGs; they also store cardiovascular-related medications, including heparin and thrombolytic drugs such as TPA and streptokinase. However, cruise ship medical facilities are infirmaries, not hospitals, and cannot supply the important follow-up care. Once patients are stabilised, they are immediately transferred to an appropriate facility on shore nearby, or back to the traveller’s home. Evacuation from ships is expensive so do think about carrying travel-related health insurance.

Pacemakers

Travellers with pacemakers can participate in virtually all travel and sports-related activities. Pacemakers activate the electromagnetic metal detectors at airports, but security guards are familiar with the devices and will perform a manual inspection on request. (Letters from doctors help.) Walking through a detector may cause a harmless skipped heartbeat, but wearers should not stop inside the detector; theoretically, this can result in many skipped beats. Do not enter a detector if the way is blocked on the other side.

In Case Problems Arise

Most travellers overlook a good resource for medical advice - calling their doctors back home. In many situations, telephone advice, even from abroad, negates the need to seek local medical help. Carrying telephone numbers saves time and hassle.

Excerpts from an article in Travelling Healthy: Health Advice for the Global Traveller. Check out the Web site at www.tripprep.com