Traveling Safely With Heart Disease

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Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute. This podcast will explore disease prevention, testing, medical and surgical treatments, new innovations and more. Enjoy.

Dr. Ashish Sarraju:

Hello, everybody. Welcome. My name's Dr. Ashish Sarraju. I'm a preventive cardiologist here at the Cleveland Clinic in the Heart, Vascular & Institute. I'm the director of the Center for Inherited Lipid Disorders and the Director of Research for Preventive Cardiology. Today, we're joined by Dr. Abhayjit Singh, who is also a preventive cardiologist, a rising star in this section and the officer of patient experience here at the Heart, Vascular & Thoracic Institute. Welcome, Dr. Singh.

Dr. Abhayjit Singh:

Thank you guys for having me. Thank you, Dr. Sarraju, for that introduction.

Dr. Ashish Sarraju:

Absolutely. Today, we're going to talk about a topic that I think is going to be applicable to a lot of people, and that is, what is the relationship between traveling and heart health? Who can travel? What conditions are safe for travel? More importantly, what conditions are unsafe for travel? Maybe, Dr. Singh, you can start off with when you meet a patient with a heart condition, what are the first things you think about when deciding whether it's safe for them to travel?

Dr. Abhayjit Singh:

Yeah, definitely. I think this is a really important topic, and it's something that you and I both in clinic get asked about nearly every day, when I think primarily about when it comes to advising patients with heart conditions. For the patients out there, a lot of what those heart conditions might include are things like coronary artery disease, with or without things like stents or bypass surgery. They might include things like heart failure, heart arrhythmia, such as atrial fibrillation, or valvular which disease kind of make up the bulk of what we treat in clinic.

Primarily what I focus on is not the actual condition itself as much as the clinical stability of the patient. We'll go through each of those. If, for example, a patient's in front of me, first and foremost, if they are feeling good – that means no recent hospital stays, no very recent procedures, they're able to live their life and perform their activities to the best of their liking – then I generally advise them, with some caveats that we'll get into, that travel is very likely safe.

The other thing is in terms of medication. Patients with those conditions that I just mentioned very often are on one, or often multiple cardiac, medications. First off, I try to make sure that there has been no rapid or very recent medication changes made to manage their conditions. Then I also take certain precautions with specific medications so that we can get more into detail about. But to answer your question, yes, if a patient comes to your clinic and they're feeling good and their medications have been the same, then I generally tell them that, yes, it is okay to travel. We get into a little bit more details about their trip and their mode of transportation after that.

Dr. Ashish Sarraju:

Yeah, let's talk about that. Talk to me about traveling by road versus flying. Is there a difference between the two?

Dr. Abhayjit Singh:

Definitely. What we think about road travel and air travel are very separate. When I think about road travel, I first try to determine the length of travel. The primary reason for that is, number one, long periods of immobility do lead to an increased risk of blood clot formation. I advise all patients who are going to travel for more than four hours or so to take frequent breaks, stop, get out, walk around, stretch frequently, as well as kind of move their calves and muscles. For very, very long trips, exhaustion and other things may play a role. If the trip is going to be excessively long, I'll often recommend a stop in between for a prolonged amount of time. Less than two, three hours, I generally don't think of anything unique to that situation.

Air travel is a little bit different, and that's primarily because of the altitude. Most air cabins, as you guys know, are pressurized. Generally, the pressurization is about what feels like 6,000 to 8,000 feet. This, again, for most patients that we mentioned above, doesn't pose much of an issue. But for specific patients, primarily those who have any issues with oxygenation, meaning they get either short of breath very easily or they have something called pulmonary hypertension, can be more of an issue. I do recommend that patients with those conditions or who are getting short of breath with very little exertion speak to their doctors about how long the plane ride will be, as well as the destination. Because sometimes those patients require additional measures, such as supplemental oxygen while on the plane, or just extra caution with their medications. Again, for air travel, there's also a period of immobility. I do advise patients to frequently stretch their calves, get up and walk, select an aisle seat if they're able to, and/or, in some select patients, we'll recommend graded compression stockings.

Dr. Ashish Sarraju:

That's great. When you say “graded compression stockings”, can you tell us a little bit? Can you buy those over the counter? Do they need a special prescription?

Dr. Abhayjit Singh:

They sometimes require a prescription. You can find them over the counter or even at places like Amazon or other online retailers. But the thing to know about them is they generally have a much higher amount of compression than our usual compression socks do that are available at most pharmacies. You really want to double-check with your doctor that they provide an appropriate amount of protection.

Dr. Ashish Sarraju:

Dr. Singh, does it matter where they're going? Let's say they're going to Colorado or they're going to sort of a really mountainous place versus going to a beach somewhere. Does that matter?

Dr. Abhayjit Singh:

Yeah, great question. Yes. The three things that I think about there are altitude and then the temperature, either hot or cold. A place like Denver, Colorado, which is at a little bit of altitude, again, for the vast majority of our patients is going to be fine. But if you have, say, a more adventurous patient who might be going to a more mountainous region or somewhere in the Himalayas, then yes, the altitude, it does become important.

Certain medications need to be potentially added depending on whether the patient is actually going to be mountain climbing or not, or if they're simply going to be staying at altitude. Again, the same rules apply that we spoke about in terms of a pressurized cabin, meaning you do want to make sure that the oxygenation and that the breathing is well accounted for. That's again, because at altitude, the air is thinner and the air pressure is lower, so patients who get short of breath when at normal altitudes will get worse at higher altitudes.

To the second half of your question in terms of a beach or other places like that, I don't think so much of the setting as I do of the climate. Climates that are very warm can certainly precipitate dehydration, particularly for our patients who are on diuretics or water pills, as we commonly call them, or other medications that can affect your blood pressure, which a lot of our cardiac patients are on. You want to be really careful to avoid things like dehydration in very hot climates because that can lead to feeling like you're going to pass out or potentially even passing out.

Cold climates, a little bit less of a concern, but it is something that we also think about as well, particularly in the winter months or if people are going skiing, or other winter activities. Cold causes all of the blood vessels to constrict. Patients, for example, who have say coronary artery disease and maybe have an issue with getting enough blood flow to their coronaries, that can make those symptoms worse. Again, I always go back to if the patient is feeling well in front of you, it's very unlikely that they're going to experience any trouble when they're traveling. But if you're nervous about them or if they recently were in the hospital for something, then I always do a second check of everything to make sure they're safe to go to their destination.

Dr. Ashish Sarraju:

And once the patients get to their destination, are there certain warning signs you tell them to watch out for where they say, "Oh, this could be my heart condition acting up?"

Dr. Abhayjit Singh:

Certainly, yeah. What I will say is this is not terribly different if they're traveling or if they're not traveling. Generally, the warning signs that I give patients of when to either seek some advice or to seek emergency care are the same as if they were in their place of residence. Chest pain, shortness of breath that occurs at rest, severe dizziness or feeling like they're going to pass out, racing heart that's not getting better or inability to breathe. These things are warnings and signs of something potentially dangerous going on in your heart here, abroad, on vacation, everywhere. The same kind of advice that I give patients locally, I tell them to pay a lot of attention to.

What is different is the kind of resources or access that they'll have to medical professionals or medical care when they're abroad. My patients generally know who to call, what to do, where to go when they're stateside. When they're in a foreign place, domestic or international, they might not know. They might not know, "Do I have the health insurance? Where am I going to go? Are they going to understand the language that I speak," et cetera. I say a little bit of preparation can go a long way here.

First on the front end, I tell patients to make sure you have a list of all the medications that you're prescribed for your heart and otherwise. And also, to bring an extra supply, at least an extra week or so, I advise patients when they're traveling, just in case there's unexpected delays, flight, they get stranded somewhere, they have those.

Then I always advise them to have an understanding of what kind of medical care is available, number one. Number two, I don't advise everybody do this, but it might be worth considering getting the travel insurance because most stateside insurance companies or Medicare have either limitations or won't cover care abroad at all. Travel insurance, which can generally be purchased either from your carrier, your flight carrier or a third party source will often include medical coverage during travel. Those are the things I say, again: know their medications, have backup medications and know where you're going to seek care if you ever need it.

Dr. Ashish Sarraju:

Fantastic. All that was fantastic advice. Do you have a personal travel tip that you would recommend to patients when they're traveling? A top travel tip perhaps?

Dr. Abhayjit Singh:

Well, I really like to empower my patients. I think a lot of my patients feel that the condition that they have should render them either limited in what they can do, or they were really looking forward to taking this big trip, it's really important to them, anniversaries and things like that. I really try to advise them that, "Yes, you can go. Let's sit down in clinic, have a conversation, make sure everything is squared away." And then I really try to encourage them to know that, with the right preparation, they're going to be just fine.

Dr. Ashish Sarraju:

Okay. Great reassurance for all of us. What a wealth of information. I want to thank you again for joining us today. Thank you, everybody, for listening to us.

Dr. Abhayjit Singh:

Thank you for having me.

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