by Carolyn Thomas ♥ @HeartSisters
Five months after my heart attack, I boarded a plane from the West Coast bound for Rochester, Minnesota. Considering that I’d suffered two terrifying cardiac events on another long flight just five months earlier made this trip just a wee bit scary for me.
Only the reality that I was headed to the world-famous Mayo Clinic helped to propel me onboard. I told myself that if anything happened to me and my heart during this flight, the board-certified cardiologists at the Mayo Women’s Heart Clinic would know exactly what to do for me. If I survived the flight, that is . . . . .
Like many freshly-diagnosed heart attack survivors, my fear of having a heart attack on a plane was very strong. (Note: many survivors experience a very strong fear of having another heart attack just walking down the street).
So being strapped into a metal box 35,000 feet up in the sky, hour after endless hour, inhaling stale air, in a pressurized germ-infested environment, with reduced circulating oxygen levels in my blood, risking the onset of hypobaric hypoxia, and with no guarantee at all that my seatmate would be a board-certified cardiologist seemed just plain crazy.
But apparently there is good news about heart patients and flying from the British Cardiovascular Society.
Most people with heart disease who are not critically ill can safely fly on commercial aircraft, according to a U.K. report.(1) Lead author Dr. David Smith (Royal Devon and Exeter NHS Foundation Trust) told Heartwire:
” The overwhelming conclusion is that the cabin environment poses very little threat. It’s not the flying that’s the problem for heart patients, but the stability or instability of someone’s underlying condition that indicates the probability of a spontaneous cardiac event occurring while they are in the air.”
The passengers who might feel some minor physical effects of low blood oxygen (hypoxia) include those already at risk of:
- myocardial infarction (heart attack)
- heart failure
- abnormal heart rhythms
But according to Dr. Smith, the blood oxygen levels induced by flying “appear to have little or no adverse circulatory effects, certainly not for short- and medium-haul flights.”
However, some heart patients at high risk are advised to “defer travel” until their condition is stable, including those:
- having an ejection fraction <40%
- showing signs and symptoms of poorly controlled heart failure
- with unstable angina or uncontrolled arrhythmias
- awaiting further investigation, revascularization, or device therapy
And here’s how soon after a cardiac procedure you are generally safe to fly:
- After uncomplicated elective (non-emergency) cardiac catheterization (angioplasty, with or without stent implants), patients can fly after a few days.
- If patients suffer from stable angina with infrequent attacks, they should be able to fly. It is safe to use nitroglycerin spray in a pressurized aircraft cabin.
- Patients with pacemakers implanted can fly after a few days, unless they have suffered a pneumothorax, in which case they should wait until two weeks after it has fully healed.
- Those with ICDs (Implantable Cardioverter Defibrillators) can fly after a few days, with the added recommendation that they should not fly after the ICD has delivered a shock until the condition is considered stable again.
- Those who have experienced a heart attack (myocardial infarction) can fly after 10-14 days. If you are older than 65 or if you’ve had another heart attack in the past, you’re statistically more likely to have one again. The U.K. Civil Aviation Authority recommends that if you have no symptoms or other heart conditions and no further cardiac treatment is planned, you’re considered to be at low-medium risk to fly. But if further cardiac treatment is planned, you’re considered to be at higher risk of another heart attack – best not to fly at this time.
- Those who have had heart valve repair or replacement surgery or coronary artery bypass grafts (open heart surgery) can usually fly after 4-6 weeks (longer if they have had pulmonary complications).
Generally speaking, if you can walk briskly for 100 metres on the flat without being breathless or in pain, you can fly.
But even when your physician has officially given you the green light to fly again, remember that severe fatigue can continue to be a serious issue for heart patients long after the other physical effects of cardiac procedures have healed.
Anticipating this fatigue may influence your decision, for example, to request an airport wheelchair or a ride to connecting gates on the airline golf cart, and to limit the weight and size of your carry-on bag. Please plan ahead and arrive at the airport significantly early for any flight to minimize rushing or stress.
The anxiety surrounding air travel can be debilitating even for non-heart patients. If fear of flying has ever been a serious issue even before your own cardiac event, it may indeed feel worse now. If you really must fly, ask your own doctor about managing this anxiety before your flight.
Long flights can mean crossing time zones, sleep deprivation and jet lag. Probably the most important effect of changes in sleep patterns for passengers with cardiovascular disease is the potential disruption in taking daily medications. It can be difficult to stick to a normal meds routine when that routine is altered, especially if we’re confused about what time it really is. The U.K. report warns that it’s especially important for passengers with stable heart failure, angina or arrhythmia to maintain the regularity of their medications.
If you’re planning an out-of-country flight in the near future, remember that most major insurance companies will not provide travel medical insurance earlier than 90 days after a cardiac event, or even after a change in your medical treatment. In some cases, just a doctor’s appointment in the past 90 days at which your medication dosage is changed (either increased OR decreased) can mean your condition can be considered “unstable” and thus grounds for denial when you file a travel medical insurance claim.
Each airline has its own policy for allowing flying passengers after a cardiac event – and as you’ll see from the Oregon heart patient’s experience with Alaska Airlines (described below), some of these policies appear to defy accepted medical guidelines. So call both your insurance broker and the airline before you book a flight to double-check all details relevant to your own travel and clinical circumstances.
For heart patients who sport implanted medical devices, it may be comforting to know that the amount of metal used in most implanted heart devices like pacemakers, heart valves or ICDs is very small, according to cardiologists at St. Jude Medical. It is usually not enough to set off airport security metal detectors; if it does, simply show security personnel your patient identification card. Passing through a metal detector should not hurt your device. However, do not linger near the security system arches or poles.
Dr. Clemens Jilek and his team of researchers from the German Heart Center in Munich recently did a study on 388 heart patients, published in the journal Annals of Internal Medicine. They concluded that metal detector security screening appears safe for those with pacemakers or ICDs implanted.
What about those new full body scans at airport security gates and people with implanted pacemakers or ICDs? According to cardiologist Dr. Richard Fogoros, there are few if any controlled clinical studies or even written information about the safety of these full body scanners for heart patients:
“I called the technical support departments of two major pacemaker manufacturers. I was told that they regard the full body scanner as completely safe for those with implanted pacemakers and ICDs, and this is what they tell patients and doctors when they call for advice (which apparently they do frequently, since there is no written advice anywhere). I was told that:
- 1) their engineers have determined it is extraordinarily unlikely that these scanners are capable of negatively affecting implantable medical devices
- 2) many thousands of people with pacemakers and ICDs have used total body scanners over the past several years, and there has been no allegation of any problems.
“So, both engineering theory and a large volume of real-world experience indicates they are safe, according to them.
“There is no reason to believe that a full body scanner will effect a pacemaker or ICD, and medical device companies are willing to say that verbally (but not in writing).
“If you want to wait until some authority is willing to make a definitive written statement about this, you can opt for a pat-down instead when you go through airport security. Since this issue is in the hands of bureaucrats, however, don’t hold your breath waiting for a resolution.”
A serious health problem you may have also heard linked with air travel, particularly long flights, is deep vein thrombosis (DVT) and venous thromboembolism.
Although a long-haul flight doubles the risk of DVT, it is actually similar to that incurred during car, bus, or train travel for a similar period, the U.K. researchers state. And the absolute risk of DVT for a fit and healthy person is one in 6,000 for a flight of more than four hours, they note, pointing out that pilots are at no greater risk than the general population, a statistic that is not particularly comforting.
Now I have to worry not only about myself, but about my pilots. Why not take the advice of my heart sister Jaynie, who always harps at us to wear compression knee-high stockings while flying?
There are some recommended common sense flight precautions for those at risk of DVT:
- consume plenty of fluids
- exclude caffeine and alcohol
- wear compression stockings
- take a dose of low-molecular-weight heparin (a blood thinner)
- wear a MedicAlert bracelet or dogtag necklace at all times
- talk to your doctor to confirm that your cardiac disease is stable
- carry adequate supplies of all prescribed medicine
- carry a copy of your medical history
- carry emergency phone numbers for your doctor(s), family members and destination contacts
Having memorized these precautions, you might want to also consider the alarming case of one Oregon heart patient who describes her “very interesting flight” to Rochester, Minnesota to see cardiologist Dr. Sharonne Hayes at the Mayo Women’s Heart Clinic. Here is the transcript of her complaint against Alaska Airlines filed with the FAA:
“I mentioned to the E/C flight attendant that I carry nitroglycerin for chest pain in my pocket should I request assistance, and that it was only cautionary in nature because I was traveling alone.
“The Head Flight Attendant ordered me off the flight because she ‘assumed’ that I was unhealthy. She required me to provide a doctors’ note clearing me to fly. She informed me that the FAA allows flight crew to decide who is fit to fly or not, and they can remove whomever they feel is unfit to fly.
“Alaska Airlines customer services representative and flight attendant refused to speak with my cardiologist who was wakened at 6:30 a.m. on a Sunday morning because I did not have the “requested” doctor’s note.
“I explained that the flight crew had no data to support their assumption that I was unfit to fly, nor did they request the other passengers to produce doctors’ notes.
“Alaska Airlines discriminated against me based on the fact that I carry nitro in my pocket. They created a very stressful environment and threatened to impair my ability to seek medical care at the Mayo Clinic. They humiliated me in front of a plane full of passengers.
“An air carrier may not discriminate against an otherwise qualified individual on the following grounds: 1) the individual has a physical or mental impairment that substantially limits one or more major life activities. 2) the individual has a record of such an impairment. 3) the individual is regarded as having such an impairment.”
(1) Smith D, Toff W, Joy M, et al. “Fitness to fly for passengers with cardiovascular disease. The report of a working group of the British Cardiovascular Society“. Heart 2010
UPDATE 2020: “Since the COVID-19 virus is already out there, should I avoid plane travel just to be safe?”
“Planes tend to be low humidity, but the air’s actually pretty clean. It gets recirculated through these HEPA [high-efficiency particulate air] filters that really are very good at clearing stuff out,” said Dr. Vicki Hertzberg, a biostatistician at Emory University, who co-led a study on flights and disease transmission with scientists at Boeing. “Also, they suck in about 50% clean air with every recirculation. So in some aspects, the air on a plane is cleaner than what’s going on in your new office buildings.”
UPDATE 2001: Despite Dr. Hertzberg’s optimistic predictions along with her Boeing friends (who arguably have good economic reasons to release optimistic data), the CDC still reports daily COVID-19 Exposure Alerts, listing flights, dates and seat numbers surrounding passengers who are confirmed COVID-19 cases. Heart patients are already at significantly higher risk for contracting the coronavirus than the general flying public is.
NOTE FROM CAROLYN: I wrote more about my fateful five-hour flight in Chapter One of my book, A Woman’s Guide to Living with Heart Disease . You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the code HTWN to save 30% off the list price).
19 thoughts on “How soon are heart patients safely fit to fly?”
I just some how have fallen outside of of the safety zones for flying. I was told from the point of my AMI that my heart was to weak to withstand G-force meaning flying will forever be out of range. Since then I’ve developed Supraventricular tachycardia (SVT-fast or irregular heartbeat) with episodes of SCD that won me an A-ICD (implanted defibrillator). The worse part of all is I don’t feel my SVTs, and my SCD has me going down in slow motion. I’m not allowed to move to far from where I am.
Lastly I have a stent and an A-ICD, I have set off security alarms and it does hurt. They say that we shouldn’t but my stent has set of the alarm. We were given color coded cards to carry with us when the devices were implanted. My stent is at the top of the list. In the 12 years since my AMI I’ve two long road trips. Both were 12 hour bus trips to New York. The first with the cardiac therapist and staff at the heart hospital, super safe trip. The second was with family for a weekend trip, they had to stop every three hours to slow swelling of feet and legs.
This was so interesting to learn about my condìtion. And I will use the knowledge to teach others.
I am with CABG 2 months ago, I have breathing problem, can I traveling by air?
Hello Majid, only your cardiologist can answer you. The U.K. report suggests 6 weeks minimum before CABG patients fly, but longer if you have pulmonary problems. Ask your doctor – and good luck to you.
The NHS choices website also gives information apparently after discussion with the CAA.
This suggests that you can safely fly 10 days after chest surgery or CABG. Clearly there is enormous variation in the advice given
by different bodies.
With breathing complications like Majid describes, that 10-day suggestion may not be appropriate, which is why the best answer is to consult with her own physician.
Very comprehensive article. Thanks for this useful list of flying-related tips and facts. Now if you could just help us make the airlines run on time to get rid of those long delays . . .
Yeah, I’ll get right on that . . . 😉
Hi, I enjoyed this post. As a person who has congenital heart disease I have often faced “complications” at airports, with one particular gentleman asking what the “HUGE” scar was.. Well how rude.
I am from England and I have had lots of operations, ablations, implants, etc. But travelled a lot as I do not let it get in the way. I just would like to say that I have always brought insurance to cover myself (and family), especially for my heart, and although it costs a lot sometimes, it’s worth every penny.
Do not let it stop you travelling but always listen to your doctor too, if they say no, then go with that; save your money and go another time (she says through grumbled teeth, wanting to see her friends in America).
That IS rude! (what’s the huge scar from? Preferred answer: How about “None of your frickety-frackin’ business!” ?!?) Travel insurance is such an important issue for heart patients as some policies will NOT cover pre-existing conditions or even incidents that follow a recent doctor’s appointment or meds change! Always read the fine print. Good luck with getting to America to see your friends!
Rude question answer, “I had my heart removed so insensitive questions like yours won’t hurt it.”
But then, I am a brat! 🙂
Elizabeth Youmans RN, BSN
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My husband had a heart attack and cardiac arrest last week, not sure how much of the large muscle will return but hopeful, and he’s walking and breathing good. We also go abroad. Now feel worried as lots of people who have had heart attacks go, but have not seen any post re cardiac arrest. Whether this makes a difference, also been told as a cardiac arrest person it’s very difficult to get insurance, can you shed any light?
Hi Brian – The good news is that walking and breathing seem fine so far! I just went back and re-read the U.K. report mentioned in my post. You are right – nothing specifically about cardiac arrest; they seem to include that condition within heart attack criteria. Your cardiologist involved will have far more info and be able to advise both of you on the safety of international flights based on unique details of the case.
Getting out-of-country travel medical insurance – regardless of cardiac arrest or any other cardiac diagnosis – is fraught with fine print designed to deny medical claims based on how “unstable” the patient’s condition is (but even a doctor’s appointment during the past 90 days at which any treatment decision is adjusted – like decreasing the dosage of a previously prescribed drug because the patient is doing better! – can suggest to the insurance company that the condition is now “unstable”). Talk to a trusted insurance broker for more info. Best of luck to you…
This is a very good post and one you should run every year at the start of vacation time. I said that I had been given paper work somewhere regarding travel and not to for this first year. It was clearly written in this post. When I went on my trip, they were running tests on me because of my edema. It dropped my EF (ejection fraction) down to 40% and they still haven’t been able to find out why. I also have congestive heart failure, when I talk about taking a trip I mean going outside of my state.
I went on a 12 hours-one way, and 12 hours-back home trip. I know that they had told me not to take trips without first talking it over with the doctor; this was one of those times in which I looked for someone to agree with me as opposed to following orders.
But it wasn’t an uneventful trip. I began to feel the discomfort shortly after heading back. They wanted to know if I wanted them to get emergency help, and I told them I could make it home. It was a week before I began to feel better.
I won’t make that mistake again, this is a very good posting for all of us, it reminds us of things we try to forget.
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Very useful overview for those of us wondering about how soon is “too soon to fly”. Thanks for sharing this.
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After I had heart surgery 4 years ago, I worried constantly about having another incident. But my most recently job had me traveling 50 – 75% of the time including many flights or long drives in the car. What my cardiologist was able to reassure me is that my continuing to control my diet, exercise and blood pressure should keep me healthy. Thanks for the article and the common sense flight precautions.
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hallo there, thanks for this info on flying.I don’t have heart disease but the last time I flew, at Easter week the woman sitting next to me on the plane suffered a heart attack about 30 min out of Gatwick. The airline staff were very good, and they managed to keep her calm and the plane landed safely within a very short time and she was immed evacuated. I don’t know what happened to her after that but I can see how terrifying it might be if U are a heart patient and U are trapped in a plane. It was certainly terrifying for the rest of us to witness. Thx for your very good work here on this website. Useful and well-done.
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Very excellent advice of highest quality on flying following a heart incident. My wife must fly to our daughter’s wedding in two months and already she is worried very much since her own heart incident so I’m showing to her this article. Thank you.
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