Whether you’re planning a short road trip of just a few hours or a lengthy voyage requiring you to spend eight to twelve hours on a plane (perhaps with multiple layovers and connecting flights to add to your stress), you want to ensure that your travel experience is as safe and enjoyable as possible. When you are living with chronic heart issues, such as cardiovascular disease or congestive heart failure, traveling by plane, train, or automobile suddenly becomes less straightforward than it once was.

But your heart condition doesn’t have to preclude you from traveling altogether; in fact, many patients with chronic heart issues are able to travel regularly with few concerns. It’s always imperative to get clearance from your primary care physician or cardiologist before planning any trip to be sure that there are no underlying concerns that may make travel unsafe for you. But as long as you’re in the clear medically and your condition is currently well-controlled, a few extra precautions and a bit of pre-planning allows those with chronic heart issues to have a pleasant and safe travel experience using practically any mode of transportation with minimal risks.

To help you figure out what steps to take, what precautions are necessary, and what risks may be tied to different modes of travel, we’ve put together this comprehensive well-travel guide tailored specifically to people living with chronic heart conditions. Whether you need to understand the risks associated with different types of travel before making travel arrangements or you’re looking for information on what steps to take before, during, and after your trip, we’ve covered every angle to help you have the most enjoyable and stress-free travel experience possible.

Travel Health Risks for Those with Chronic Heart Issues

Traveling can be stressful for even the healthiest of people, but it’s often even more so for those with chronic heart conditions. Worries such as being too far from a trusted and competent cardiology team, running out of medication, or suffering an acute health crisis are all potential concerns. The following resources provide information on the health risks associated with different modes of travel for chronic heart conditions, as well as information on determining when it’s safe to travel.

Patients with chronic but well-controlled heart issues are, in most cases, given clearance to travel by their physicians. It’s always a good idea to check with your cardiologist to ensure that there are no medical concerns that may preclude you from safe travel before you make any travel arrangements. In some cases, your cardiologist or primary care physician can provide you with tips or resources to make your trip safer and more enjoyable. This resource from the Centers for Disease Control (CDC) also includes a handy chart outlining various chronic conditions and special travel considerations that apply to each, including both absolute and relative contraindications to air travel, pre-travel considerations, and immunization considerations.

Sufferers of congestive heart failure (CHF) may experience worsened symptoms associated with the disease at altitudes of 5,000 feet or more. “Heart failure patients may also be particularly susceptible to the symptoms of altitude sickness, which may include shortness of breath and profound fatigue,” Dr. Matthew Rusk of the Hospital of the University of Pennsylvania explains in this article. “Symptoms of worsening congestive heart failure, such as shortness of breath and a rapid heartbeat, are also commonly seen in altitude sickness. In general, patients with congestive heart failure should avoid traveling to locations at high altitudes.”

Generally, flights longer than eight hours pose the greatest risk to travelers with chronic heart disease.  That’s because sitting for extended periods of time, along with dehydration and the lower oxygen levels typically found in the cabin of a plane, can increase the risk of blood clots. In fact, “One of the biggest risks facing people with heart disease when flying is venous thrombosis, or the formation of a blood clot in the veins of the leg, pelvis, or arms,” according to this article from WebMD.

Any long period of immobility increases a person’s risk of deep vein thrombosis (DVT) and pulmonary embolism. Long periods of immobility can include “being bedridden from illness, recovering from surgery, or sitting for extended periods while traveling,” according to this article from MedicineNet. Precautions such as wearing compression stockings and getting up and moving around at least once per hour during long trips can help to reduce this risk.

Some passengers with chronic heart disease may experience some minor physical effects of low blood oxygen (hypoxia), including those who are already at risk of angina, myocardial infarction (heart attack), heart failure, or abnormal heart rhythms. Other patients may be advised to defer travel until their condition is stabilized, including those with an ejection fraction of less than 40 percent, a patient showing signs and experiencing symptoms of heart failure that is not well-controlled, patients with unstable angina or uncontrolled arrhythmias, or anyone who is awaiting further diagnosis or treatment. However, this article from MyHeartSisters.org also points out that even patients who are otherwise fully recovered from a cardiac procedure may experience severe fatigue during air travel, so it’s often a good idea to request a wheelchair or a ride to connecting gates in the airport.

If you’re traveling on a cruise ship, keep in mind that medical services may be limited on-board. The American College of Emergency Physicians (ACEP) has created general guidelines, which are followed by most major cruise lines. The CDC explains that these guidelines outline the minimal capabilities cruise ship medical facilities should have, including “providing emergency medical care for passengers and crew, stabilizing patients and initiating reasonable diagnostic and therapeutic inventions, and facilitating the evacuation of seriously ill or injured patients.”

Air Travel Restrictions and Precautions for Individuals with Chronic Heart Issues

Air travel is often thought of as one of the riskier modes of travel – not necessarily due to fear of a highly-unlikely plane crash, but rather the lack of immediate access to hospitals and health care while in the air. Also, high altitudes and cabin pressure can be a concern for some individuals with chronic heart disease. The following resources offer helpful information for those with chronic heart issues considering air travel, including specific risks, whether air travel should be ruled out as a potential travel option, and precautions travelers with chronic heart conditions can take for a safe and less stressful air travel experience.

Only when the underlying heart condition carries a “significant risk of acute deterioration” should reasonable restrictions apply to air travel. According to this report by the British Cardiovascular Society, “For those at the more severe end of the spectrum of their specific cardiovascular condition, services exist to help make the journey more easily and safely. Most carriers and airport authorities provide assistance on the ground and in the air. Oxygen is available on most major carriers, although this is sometimes subject to a charge and at least 7 days [sic] notice is normally required.”

In one study, approximately two-thirds of survey participants with chronic heart failure who had traveled by air since their diagnosis reported having no health-related issues during air travel. The 464 individuals who completed the survey ail from chronic but well-managed heart failure and are ambulatory. Thirty-five percent of respondents who had traveled by air since their diagnosis, however, did report health-related problems during air travel, primarily “at the final destination, going through security and on the aircraft.”

Individuals with congestive heart failure should always consult their physicians before traveling by air. As this article states, a general rule of thumb is that a patient should be able to walk 100 yards and climb 12 steps in order to be cleared for air travel, particularly for lengthy flights.

In general, travelers who have experienced an uncomplicated heart attack should wait between four and six weeks before traveling by air. It also states that after uncomplicated bypass surgery, patients should wait at least two weeks before traveling by air.

Sometimes while in flight, oxygen saturation levels can fall to around 90 percent. For most healthy people, this isn’t a problem, but for patients with cardiovascular disease or chronic heart issues, in-flight oxygen can help to alleviate any negative effects of a lower oxygen saturation during flight. According to this resource, oxygen is typically arranged by the airline – travelers aren’t usually permitted to bring their own – and must be notified in advance of the traveler’s need.

However, this resource explains that passengers may arrange for their own oxygen equipment, provided that it meets guidelines. “The Federal Aviation Administration (FAA) does not allow travelers to carry their own oxygen tanks or liquid oxygen aboard commercial aircraft,” the article notes. “Instead, most patients can use a Department of Transportation-approved battery-powered portable oxygen concentrator. Airlines landing in the United States are now required to allow use of these devices throughout the flight.’”

How to Travel Safely with Your Medication (and Ensure You Won’t Run Out While Traveling)

Traveling with medications can be both challenging and frustrating. With airline regulations becoming stricter every day and multiple bags, medications, and a backup plan nothing short of stress-inducing, it often seems simpler to just stay at home. But don’t let medication requirements limit your travel plans. Arm yourself with the tips and information from the following resources to be well-prepared for traveling safely with your medication.

Bring a copy of your original prescriptions in the event that you run out of your medication or happen to lose it in the midst of a hectic traveling schedule. Another option suggested in this article from the American Heart Association is to simply take a list of your current medications, dosages, and your cardiologist’s phone number. Print this helpful medication chart, fill it out completely to ensure you have all the information that may be needed, and take several copies with you (in your carry-on bag, checked baggage, and in your shoulder bag or briefcase) for peace of mind while you travel.

Don’t forget the identification card for your pacemaker or implantable cardioverter-defibrillator (ICD) if you have either of these devices. You should also alert airline security staff if traveling by air (or any screening personnel for other modes of travel that may require clearance through a metal detector) that you use these devices, as they could set off the alarm. Another suggestion offered by this resource is to ask for a hand search or screen using a hand-held metal detector, which should never be placed directly over your implanted device.

Make sure that you have enough of your medication remaining to last the length of your trip plus a few extra days. If you won’t have enough medication to last the length of your journey, talk to your pharmacist or doctor about obtaining a refill before you travel – sometimes, this may require special approval with your insurance company, as many will not refill prescriptions before a designated number of days have passed since your last refill. You should also always pack your medication in your carry-on luggage, never in your checked bags. You may wish to pack a duplicate set of medications and have your traveling companion pack them in his or her carry-on bags, which will provide a complete backup plan should you inadvertently misplace your carry-on bag during travel.

All medication must be screened by airport security, so your medication should be clearly labeled to help facilitate this process. According to the Transportation Security Administration (TSA), “You are responsible for displaying, handling, and repacking the medication when screening is required. Medication can undergo a visual or X-ray screening.”

Always keep your medications in their original containers. It’s tempting for travelers to combine their medications in a single container or pill pack to save space when traveling, but not having your medications in their original containers can cause issues with airport security – in some cases, security may even confiscate your medication bottle.

Liquid medications can be particularly troublesome due to the TSA limit of 3.4 ounces. However, you may bring medically necessary liquids in excess of 3.4 ounces with you on a flight, provided that they are screened by airport security – but only a reasonable quantity that may be needed through the duration of the flight. This article from The TSA Blog also points out that while the TSA doesn’t require prescriptions to be stored in their original containers, many states have laws requiring the labeling of prescription information with which passengers must comply.

The Preparedness Checklist for Traveling with Chronic Heart Issues

There are a few precautions and steps travelers with chronic heart issues can take before traveling to ensure a safe and stress-free trip. The following resources provide helpful tips for preparing for safe travel despite heart issues, information on what precautions to take, and advice for coping with unexpected circumstances or health concerns while you’re away from home.

Travel health insurance is an absolute must. With a chronic heart condition, it’s possible that you’ll pay more for a travel insurance policy, but you’ll have added peace of mind knowing that the astronomical costs that may be associated with emergency care – such as a helicopter flight to the nearest on-shore hospital from a cruise ship docked at some remote island – will be covered.

If you’re taking a cruise, check in advance to find out if your cruise ship will have on-board medical personnel. Many do, but some do not, and you don’t want to end up with a medical concern when you’re hundreds of miles away from shore where the closest medical services are available.

Remember that traveling is tiresome, so expect and plan for feeling some fatigue both during and after your trip. If your trip requires multiple connecting flights, it’s often a good idea to request a wheelchair or assistance traveling between gates. It’s a much better idea to be overly cautious and plan ahead for help you may not need than to find yourself exhausted and unable to reach your gate in time without the ready availability of airline help if you didn’t request it in advance.

Make prior arrangements for dietary needs. Most major airlines and cruise ships can accommodate special diets if given advance notice. So, for instance, if you require low-sodium or low-fat meals, contact the airline or cruise line in advance and find out whether your needs can be accommodated during your trip.

Obtain a letter from your physician stating that your heart condition does not preclude you from traveling and that you have been medically cleared to do so. This letter should also include information on your heart condition, your current medications, allergies, and any medical devices that you have. You should also carry a copy of your medical history. This can help medical providers who are unfamiliar with your history to provide the most appropriate care should you require medical services while traveling. Additionally, carry phone numbers for your healthcare providers as well as family members. It’s a good idea to store copies both in a shoulder bag or briefcase (which you’ll carry with you on daily outings) and your carry-on and checked baggage (to ensure you have additional copies should your luggage be misplaced or you lose your bags elsewhere).

Determine whether you may need oxygen in-flight if traveling by air, and make arrangements with the airline well in advance of your trip. Likewise, make arrangements prior to your trip if you are traveling by boat, such as on a cruise ship or bus, to ensure that your accommodations and seating are sufficient for the use of oxygen. Even if you don’t typically require supplemental oxygen on land, you may require it in-flight to cope with higher altitudes.

Pack a travel health kit. This resource from the CDC provides a helpful checklist outlining what to pack in your travel health kit, including your prescriptions, over-the-counter medications that may be needed to cope with travel symptoms, and first aid supplies.

Take walks and stretch your legs at least once per hour during lengthy travel. This is particularly important during air travel, where altitude can compound potential issues. But as this article points out, it’s a good standard practice for any mode of travel to combat the effects of sitting for long periods of time.

If you’re traveling with oxygen, plan ahead for issues such as different electrical outlets in foreign countries, having enough battery power in your portable oxygen tank for day excursions, and getting the appropriate concentrator approved for use on your flight or ship. This article offers many helpful tips based on the author’s travel experiences for preparing ahead of time when you rely on supplemental oxygen.

Suffering from chronic heart issues doesn’t have to put a damper on your travel plans. As long as your condition is well controlled, you can take advantage of most modes of travel. You should always get clearance from your doctor prior to traveling, as your physician may be able to advise additional precautions that can make for a safer and more enjoyable travel experience given your specific restrictions related to your heart condition. With a few simple precautions and taking the time to prepare in advance for the right accommodations, transportation, and easy access to any necessary medical care, traveling can be both fun and stress-free despite your chronic heart condition.