Travelling With A Heart Condition By Dr Ade Alakija Q-Life Advisory Services.

Heart disease whether congenital, hereditary or acquired can be life threatening and all necessary precautions to avoid worsening the condition should be taken. Heart related problems account for a high percentage of all in-flight medical emergencies and the risk of complications on board can be reduced by following a few simple steps.

Air travel is not recommended within less than 2 weeks following a heart attack without complications. Flying is allowed only when you are stable. If a person has undergone an angioplasty where a stent(wire mesh) is placed in heart arteries, then a waiting period of one week is recommended before travel. Pacemaker users and those that have implanted cardiac defibrillators (ICD) though not at great risk (walking through a detector) should go through individual security clearance with hand held metal detectors or hand searches only. (The hand held device should, if used be held over the ICD for a few seconds only)

The following steps should be taken in preparation for the travel:

•  Have your flight plans and all necessary details in writing (seperate from your phone organizer) eg hotel address and booking code, important phone numbers etc. Get contact numbers and website addresses for pacemaker and ICD manufacturers and local representatives in the destination country.
• Get information on the area you are visiting. It is your responsibility to make sure you travel for your business or leisure trip unhindered. 
• You must be stable on your medication before travel. Carry an ample supply of all medications, make sure they are labelled and placed in a carry-on bag.
• Have your blood pressure and weight taken regularly.
• Have your full cardiac workout including ECG’s, stress test, blood taken for cholesterol, lipid and sugar. Carry a copy your normal (ECG) if you have irregular heartbeat or a pacemaker.
• Exercise and diet will play a key role in your overall health.
• Improve your lifestyle, avoid smoking, reduce weight if overweight. 
• For those travellers who are being treated for heart disease, try to read up more on your condition and take precautionary measures. Drugs like mefloquine, halofantrine amongst others should be avoided. Consult your Cardiologist, Family Physician or Travel consultant. 
• Those that have had open heart surgery or have pacemakers installed or procedures like angioplasty done on them, special care should be taken. Depending on your condition, you may need a travel companion with you, arrange for oxygen in the plane, your drugs must be within easy reach (on your person or in hand luggage with your doctors emergency numbers) and adequate. (enough for your trip and 2 weeks beyond.) 
• Have a reference doctor and hospital at your destination. 
• Avoid long haul trips (trips greater than 6 to 8hrs). If possible, break your journey. 
• Keep your hotel informed of your condition if potentially life threatening.   
• Know your distress signs.
• Do not change medication before and during travel if possible. If you must, do it two to 3 weeks before travel to make sure you are stable. 
• Keep your watch on home time and take medication based on home time for short trips if possible(less than 1 week) across time zones. For long stay, gradually adjust to the new time zone. 
• Make sure your vaccines are up to date especially meningococcal, influenza, vaccines needed for your destination and all childhood vaccines.
• Take antimalarials with you in case you have an attack of ‘fever’.  
• Make sure your life and health insurance are up to date and take special travel insurance if necessary.  
• Prolonged periods of immobility can lead to venous stasis and increase the risk of developing deep vein thrombosis (DVT). When on board the plane, try to avoid alcohol. This can worsen dehydration in the already dry cabin air and increase your risk of DVT. Drink plenty of water and fruit juices. Avoid stimulants like caffeine until you have had a full nights sleep at your destination. 
• Exercise regulary on long flights to help your blood circulation.(Airlines have usefull information in their on board magazines). Choose an isle seat where feasible to encourage mobilisation and stretch your legs without disturbing other passengers.   
• Sleep and miss movies if you must. 
• Cardiac patients are at risk for DVT. (Your doctor should let you know if you are at risk) take the necessary precautions. The risk aplies to any form of travel where you are routed to one place for hours. Exercise at least every hour on long jouneys, good measured fitting hosiery (in flight stockings and socks) will encourage circulation. Wear loose clothing.  
• It is always good to be aware of the current outbreaks of disease, violence, natural disasters or civil unrest at your destination. Also, like in the UAE (Dubai & Co) and some other countries, certain prescription drugs & over the counter drugs are not allowed into the country.
• Seek urgent medical attention if you develop swollen painful legs especially if one is more so than the other and if you also have breathing difficulties.
• AES (Anti-embolism stockings) should be worn which discourages oedema and promotes venous return therefore reducing the risk of DVT. Please consult your doctor or travel medicine consultant. Class 1 AES stockings which provide a compression of 14-17mmHg at the ankle are usually adequate for most travellers. AES should not be used on travellers with certain conditions like peripheral vascular disease, limb deformity that prevents correct fit peripheral neuropathy.
• There are travellers at Low Risk, Moderate risk (e.g. Obese travellers, previous history of DVT, clinically evident cardiac disease etc) and High risk (e.g. Traveller has undergone surgery under general anaesthesia lasting more than 30 mins in the previous 4 weeks, has thrombophilia and those who have cancer untreated or currently on medication).
• Please consult your doctor or travel consultant before travel. Address any new symptoms with your doctor before travelling.
• Visit www.istm.org for a travel clinic near you.
• There are some reputable insurance companies offering comprehensive travel insurance. Please use them. Remember to always have a fully loaded mobile phone that can roam in your destination country.