Cardiology and Travel (Part I): Risk Assessment Prior to Travel

Traveling has always been a distinction of man. In Homer's Odyssey, we find a narrative description of the astonishing and long-standing adventures of Odysseus returning to Ithaca from Troy, and later on Thoukedides and Herodotos described different civilizations and historic events based on personal experiences obtained from traveling. At that time, the only available means of transportation were animals and ships. Therefore the trips were time consuming and frequently accompanied by unpredictable events. Nowadays, the use of modern means of transportation has made traveling much more enjoyable and faster; however, it can occasionally become stressful and, as a result, can be associated with a variety of medical problems both in healthy patients and in subjects with cardiovascular diseases. Previous epidemiologic studies have consistently demonstrated that cardiovascular events (including myocardial infarctions and cerebrovascular events) are one of the leading causes of morbidity and mortality among adult travelers.1-6 Since the population of many industrialized countries shows aging trends, the potential problems occurring in elderly passengers, many of whom are more likely to have cardiopulmonary problems, are anticipated to increase. Assessment of the risk of cardiopulmonary problems prior to travel in a mobile society becomes an issue for the public and, in particular, for physicians. The data regarding the cardiovascular risks prior to traveling are limited because of the lack of a central registry for the collection of information regarding health problems or emergencies among travelers. However, review of the literature provides us with important observations in which we can make specific recommendations for assessing cardiovascular status and risk prior to travel during a pretravel medical consultation.