| |
Cardiovascular Disease and TravelCardiovascular
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? Altitude
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. Heat
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. 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 travelers
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, 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. Pacemakers
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
|
|
