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Cardiovascular Disease and Travel

Cardiovascular disease (CVD) is by far the leading cause of death among international travelers. It accounts for 50% of the deaths among travelers from the United States who are 60 years of age and older. Moreover, CVD is by far the leading cause of in-flight death worldwide, causing 56% of such deaths on U.S. airlines.

It can be argued that many of these deaths may have occurred if travelers 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 - 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 traveling. (Walking, of course, is a great exercise that can be done almost anywhere.)

A weight control program and a healthier diet also improve physical fitness, of course, but for such programs to be effective, they must be started several months before the trip. Carry pertinent health data - ECG tracings and 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. 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. Prudence suggests 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. Traveling with one of them might be wise.

Know the destination and the health risk factors involved. Is it at a high altitude? Hot? Cold? Especially polluted?

Generally, individuals with CVD who can walk briskly about 300 feet or climb a flight of stairs without pain or shortness of breath should have no difficulty flying on commercial airliners (pressurized 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 acclimatization to altitude is important for all travelers, 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 acclimatization 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 acclimatize. While symptoms increased for the first few days, there is no evidence that exercise after acclimatization was of greater risk to the heart than similar exercise performed at sea level.

If you suffer from hypertension, you may have slight increases in blood pressure on ascent to high altitudes, but will generally be able to acclimatize well. In fact, CVD events are so uncommon at higher altitude that some experts speculate that the limitations placed on the heart by hypoxia, in effect, may curtail your ability to exercise to the degree that will precipitate CVD events.

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.

Your body acclimatizes to heat somewhat more slowly and less completely than to altitude. Exposure to heat produces numerous and complex physiological changes in the body, including shunting blood to the skin for evaporative cooling. This increases cardiac output, heart rate, and blood pressure, adding greatly to cardiac workload. Moreover, the demands on cardiac output of heat, exercise and, to some extent, high humidity, are cumulative. Exercise requires that blood also be shunted to muscle. Muscle activity produces additional heat that must be dissipated. Dissipating heat requires additional cardiac effort, and more so in a high humidity environment.

Sensible exercise programs before you travel, preferably in an environment similar to that at the destination, help you acclimatize to heat. Exercise programs help increase the efficiency of skin sweat glands and help the heart to adapt to the increased workload. Acclimatization results in a lower heart rate and a smaller rise in core temperature for a given workload and more efficient evaporative cooling. Generally, women adapt somewhat better to heat and humidity than men.

As with altitude, it is best to minimize exertion for the first few days in a hot environment and to gradually increase the amount of activity. Maximum acclimatization requires one to two weeks. Air conditioning, even for a few hours a day, drinking lots of fluids, and wearing loose-fitting clothing are helpful.

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 travelers with CVD can be significantly altered by travel-related factors like altitude, heat, cold, and jet lag.

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, mortality and morbidity from CVD are the highest in cold-weather months. Cold causes peripheral vasoconstriction and elevation of the systolic blood pressure, increasing the cardiac workload. Cold, altitude and exercise are cumulative in their effects on the heart. 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 elevators. Large ships are well equipped to handle cardiovascular emergencies. They have physicians 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 stabilized, they are immediately transferred to an appropriate facility on shore nearby, or back to the traveler's home. Evacuation from ships can cost $10,000 to $20,000, so do think about carrying travel-related evacuation insurance.

Travelers 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 physicians 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 travelers overlook a good resource for medical advice - calling their physicians 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.

Source: Magellan's Travel



Travel Advice

Flight Delays      

Getting a Good Flight's Sleep

Avoiding Jet Lag 

Cardiovascular Disease and Travel

Insect Protection 

Eight Nifty Cell Phone Travel Tips 

Packing for the Unexpected

Securing Your Luggage 

Seven Days and One Carry-on Bag

The Five Commandments of Packing 

Lost Luggage 

Avoiding Pickpockets 

Hotel Security for the Traveler 

Security Tips for the Female Traveler 

Take Great Vacation Photos






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