Guidelines for Flying With Heart Disease

Air travel is generally safe for heart patients, with appropriate precautions

If you have heart disease, you can fly safely as a passenger on an airplane, but you need to be aware of your risks and take necessary precautions. Heart conditions that can lead to health emergencies when flying include coronary artery disease (CAD), cardiac arrhythmia (irregular heart rate), recent heart surgery, an implanted heart device, heart failure, and pulmonary arterial disease.

Airplane wing
Rofique Hussain / EyeEm / Getty Images

When planning air travel, anxiety about the prevention and treatment of a heart attack on a plane or worrying about questions such as "can flying cause heart attacks" may give you the jitters. You can shrink your concern about things like fear of having a heart attack after flying by planning ahead.

Risks

Air travel does not pose major risks to most people with heart disease. But there are some aspects of flying that can be problematic when you have certain heart conditions.

When you have heart disease, air flight can lead to problems due to the confined space, low oxygen concentration, dehydration, air pressure, high altitude, and the potential for increased stress. Keep in mind some of these issues compound each other's effects on your health.

Confined Space

The prolonged lack of physical movement and dehydration on an airplane may increase your risk of blood clots, including deep vein thrombosis (DVT), pulmonary embolism (PE), or an arterial blood clot in the heart (heart attack) or brain (stroke). These risks are higher if you have CAD or an implanted heart device, such as an artificial heart valve or a coronary stent. And if you have an arrhythmia, a blood clot in your heart can lead to a stroke.

One of the biggest risks for people with heart disease who are flying is developing an arterial blood clot or venous thrombosis.

Low Oxygen

The partial pressure of oxygen is slightly lower at high altitudes than at ground level. And, while this discrepancy on an airplane is typically inconsequential, the reduced oxygen pressure in airplane cabins can lead to less-than-optimal oxygen concentration in your body if you have heart disease. This exacerbates the effects of pre-existing heart diseases such as CAD and pulmonary hypertension.

Dehydration

Dehydration due to cabin pressure at high altitude can affect your blood pressure, causing exacerbation of heart disease. This is especially problematic if you have heart failure, CAD, or an arrhythmia.

Air Pressure

The changes in gas pressure in an airplane cabin can translate to changes in gas volume in the body. For some people, airplane cabin pressure causes air expansion in the lungs. This can lead to serious lung or heart damage if you are recovering from recent heart surgery.

Stress

If you experience stress due to generalized anxiety about traveling or sudden turbulence on your flight, you could have an exacerbation of your hypertension or CAD.

Pre-Flight Health Evaluation

Before you fly, talk to your doctor about whether you need any pre-flight tests or medication adjustments. If your heart disease is stable and well-controlled, it is considered safe for you to travel on an airplane.

But, if you're very concerned about your health due to recent symptoms, it might be better for you to confirm that it's safe with your doctor first before you book a ticket that you may have to cancel.

Indications that your heart condition is unstable include:

  • Heart surgery within three months
  • Chest pain or a heart attack within three months
  • A stroke within six months
  • Uncontrolled hypertension
  • Very low blood pressure
  • An irregular heart rhythm that isn't controlled

If you've had a recent heart attack, a cardiologist may suggest stress test prior to flying.

Your doctor might also check your oxygen blood level with an arterial blood gas (ABG) blood test. Heart disease with lower than 91% oxygenation may be associated with an increased risk of flying.

Unstable heart disease is associated with a higher risk of adverse events due to flying, and you may need to avoid flying, at least temporarily, until your condition is well controlled.

People with pacemakers or implantable defibrillators can fly safely.

Planning and Prevention

As you plan your flight, you need to make sure that you do so with your heart condition in mind so you can pre-emptively minimize problems.

While it's safe for you to fly with a pacemaker or defibrillator, security equipment might interfere with your device function. Ask your doctor or check with the manufacturer to see if it's safe for you to go through security.

If you need to carry any liquid medications or supplemental oxygen through security, ask your doctor or pharmacist for a document explaining that you need to carry it on the plane with you. Carry a copy of your medication list, allergies, your doctors' contact information, and family members' contact information in case you have a health emergency.

To avoid unnecessary anxiety, get to the airport in plenty of time to avoid stressful rushing.

As you plan your time in-flight, be sure to take the following steps:

  • Request an aisle seat if you tend to need to make frequent trips to the bathroom (a common effect of CHF) and so you can get up and walk around periodically.
  • Make sure you pack all your prescriptions within reach so you won't miss any of your scheduled doses, even if there's a delay in your flight or connections.
  • Consider wearing compression socks, especially on a long trip, to help prevent blood clots in your legs.

During Your Flight

If you have been cleared by your doctor to fly, rest assured that you are at very low risk of developing a problem. You can relax and do whatever you like to do on flights—snack, read, rest, or enjoy entertainment or games.

Stay hydrated and avoid excessive alcohol and caffeine, which are both dehydrating. And, if possible, get up and walk for a few minutes every two hours on a long flight, or do leg exercises, such as pumping your calves up and down, to prevent DVT.

If you develop any concerning issues while flying, let your flight attendant know right away.

People with heart disease are at higher risk for developing severe complications from COVID-19, so it's especially important for those with heart disease to wear a mask and practice social distancing while traveling.

Warning Signs

Complications can manifest with a variety of symptoms. Many of these might not turn out to be dangerous, but getting prompt medical attention can prevent serious consequences.

Symptoms to watch for:

  • Anxiety
  • Lightheadedness
  • Dyspnea (shortness of breath)
  • Angina (chest pain)
  • Palpitations (rapid heart rate)
  • Tachypnea (rapid breathing)

To prepare for health emergencies, the U.S. Federal Aviation Administration mandates that supplemental oxygen and an automated external defibrillator (AED) is on board for passenger airplanes that carry 30 passengers or more. Flight crews receive training in the management of in-flight medical emergencies and there are protocols in place for flight diversions if necessary.

A Word From Verywell

For most people who have heart disease, it is possible to fly safely as long as precautions are taken.

Only 8% percent of medical emergencies in the air are cardiac events, but cardiac events are the most common in-flight medical cause of death. This means that you don't need to avoid air travel if you have stable heart disease, but you do need to take precautions and be aware of warning signs so you can get prompt attention if you start to develop any trouble.

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