Evaluation and management of the cardiovascular patient embarking on air travel

Almost 2 billion passengers embark on international and domestic air travel each year. An increasing number of travelers will have cardiovascular disease as the population continues to age and our ability to treat cardiac disease improves. Guidelines for safe air travel in this population vary and are supported by few concrete data from randomized trials. Although the overall risk for clinically significant myocardial ischemia and arrhythmia during flight seems to be low in the population with stable cardiovascular disease, certain groups may be at increased risk. In-flight venous thrombosis is an increasingly recognized potential complication of prolonged air travel. Travelers with cardiovascular disease may be at increased risk for venous thrombosis as a result of depressed ejection fraction or immobility. This case-based review describes the risks of air travel in a 65-year-old man with known cardiovascular disease. After reviewing the limited data on safe air travel after myocardial infarction and the common complications after both percutaneous intervention and coronary artery bypass grafting, we provide recommendations on safe air travel after myocardial infarction. We discuss the safety of both preflight screening and the in-flight environment with regard to pacemakers and implantable automatic defibrillators. We also review the literature on in-flight venous thrombosis and provide recommendations to prevent in-flight deep venous thrombosis.