Can a cardiologist go on vacation
Tips for a relaxing holiday, also for those with heart disease
Eat. Do you have a heart condition and want to travel? Then you should prepare your vacation well, advise cardiologists. Four heart specialists gave important tips on this on our newspaper's health hotline. What Prof. Thomas Budde (Alfried Krupp Hospital, Essen), Prof. Jan Gummert (Heart and Diabetes Center NRW, Bad Oeynhausen), Prof. Dietrich Baumgart (resident cardiologist in Essen and Düsseldorf) and Dr. Andreas Kleemann (resident cardiologist in Ratingen) advise.
Question:I just had a heart attack and they put stents in me. Now I have to go to rehab. I actually wanted to go on vacation to Namibia in six months. Can I do that at all?
Experts: Basically, you can travel three months after a heart attack if your physical performance is not significantly restricted. You should definitely have a stress ECG and an ultrasound of the heart performed by your treating cardiologist six to eight weeks before you travel. Your doctor should then assess whether you are fit to travel. Of course, there is the risk that in Namibia - just in case - there is usually no cardiologist who can help you. If you are able to postpone the trip, do so!
Question:I have to take Marcumar and am going on a trip to Andalusia in the fall. What do I have to consider?
Experts: People who take anticoagulant medication such as Marcumar should bear in mind that the need for Marcumar can change when the climate changes while on holiday, but also when the stress of everyday life is eliminated. A different diet in the holiday destination can also change the effect of anticoagulants - as well as other medications. The blood coagulation value INR should therefore be checked at shorter intervals: at the beginning of the trip and then at least once a week.
You can determine the INR value yourself with a small device and a spade on your finger. You can learn how to properly test yourself in a course offered by clinics and cardiological specialist practices. Depending on how the blood coagulation value turns out, you can then adjust your tablet intake independently. Those who can check the INR value themselves make themselves more independent of visits to the doctor at the holiday destination.
General rules when choosing a travel destination
Question: Are there general rules about what people with heart disease should keep in mind when choosing a travel destination?
Experts: You shouldn't travel to areas that are extremely warm or extremely cold. Even a holiday at an altitude of over 2000 meters is not for those with heart disease. Do not plan any difficult mountain tours, desert safaris or Greenland tours. Also avoid long car journeys. Always plan stopovers when traveling to and from the holiday destination, or an overnight stay on long tours. Because: What stresses healthy people can overstrain those with heart disease.
Question: As a heart patient, what kind of medical care does the travel destination have to offer so that I can feel safe?
Experts: Choose a destination that offers good medical care in the event of an emergency. If you have a complex heart problem, there should be a cardiologist in or near the resort. Before you travel, you should also clarify under which phone numbers you can reach a doctor, a clinic specializing in heart disease or an ambulance at the holiday destination. It is also very important whether there is outpatient or family doctor emergency care at the holiday destination.
In the countries of the EU the emergency number is 112. Very important: You should also clarify whether you can make yourself understood at the holiday resort. The German Heart Foundation in Frankfurt / Main offers a so-called travel set for heart patients, which contains practical tips with checklists and a phrasebook. To be ordered online at: www.herzstiftung.de/sicherheit-reisen or via Tel. 069/955 1280. Important documents about the illness should be carried in hand luggage on the plane and also with you during the day at the holiday destination - just in case.
Question:What medical examinations should a person with heart disease do before traveling?
Experts: You should definitely have your doctor or cardiologist examine you three weeks before the start of your vacation. People whose coronary arteries are damaged should also do an exercise ECG. You should definitely take with you (in the case of flights in hand luggage): the last doctor's letter, the ID card for a pacemaker or defibrillator, an ID card for an anticoagulant, and possibly the last cardiac catheter finding, which provides precise information about changes in the coronary arteries.
Anyone who suffers or has suffered from heart failure must also bring the latest ultrasound findings with them. Before going on vacation, you should also have your pacemaker checked. Before traveling abroad, it is also advisable to call the manufacturer of a defibrillator in order to obtain addresses abroad that can provide help in the event of an incident. Outside of Europe, for example in Turkey or North Africa, there are only a few defibrillation centers!
Also very important: take enough medication with you on vacation, preferably a third more than you need. There can always be delays when traveling. Do not forget the instruction leaflet. Medicines belong in hand luggage when traveling by air. So that there are no problems with baggage control, you should have a medical certificate with you stating that you need it. For non-German-speaking countries, a translation of the doctor's letter can also be useful.
Question: With which heart problems are you not allowed to travel?
Experts: You are not allowed to travel up to three weeks after a heart attack. If this was complicated, you will no longer be able to travel. You are not allowed to travel up to three weeks after you have had a pacemaker or defibrillator or your coronary arteries have been dilated.
If you have had a heart operation, traveling for up to six weeks after the operation is taboo. If there were complications during the operation, the period is significantly longer. You can travel particularly safely three months after a heart attack or an operation if your physical performance is not significantly restricted. Basically: Always talk to the doctor treating you about your ability to travel!
Despite chest pain to Spain?
Question:I suffer from angina pectoris and have problems or pain in the chest even with low stress. Can I fly to Spain?
Experts: No! Not with such complaints. Neither do patients with increasing angina pectoris. Even those who suffer from shortness of breath during low exertion or increasing shortness of breath are not allowed to travel, as are people with increasing edema (water retention) in their legs. Even those with heart disease who have repeated dizziness or who have recently been unconscious do not.
Question:I have a heart condition. Are there general recommendations as to who can and who cannot fly?
Experts: You should only fly with a stable heart. The reason: The increased oxygen consumption of the heart on board can lead to angina pectoris, arrhythmias and worsening of the symptoms of cardiac insufficiency in cardiac patients - especially if the coronary arteries are constricted. People with unstable angina pectoris, those with uncontrolled arrhythmias, those with anemia (lack of red blood cells) and those with severe heart defects should stay on the ground.
Basically, heart patients should also think about the length of a flight and talk to the doctor about it. If you get health problems on a transatlantic flight, it can be very problematic. Anyone who has a defibrillator should inform the airline in advance.
Question: I would like to travel to Italy for two months, but I will live there alone, around seven kilometers from the next village. I've been in the clinic for two months now because I had water in my pericardium and lungs. The doctor tells me I actually need a pacemaker. But first I want to travel and think about everything in peace, because I'm afraid of the procedure.
Experts: No, traveling in this physical condition would be wrong! There is more reason to be afraid of the water in the pericardium and lungs than of a pacemaker! If you want, you can ask a second cardiologist again whether he would recommend the pacemaker as well. If so, I would recommend the procedure to you too. As a rule, you should expect to stay in the clinic for two to four days.
Four stents six weeks ago - can I ride a bike?
Question:I had four stents placed six weeks ago. We would like to go to the North Sea, to Cuxhaven, in August. I want to ride my bike there. Is this a problem?
Experts: I don't see a problem if you feel good. But first go to your cardiologist one more time. He should use an exercise ECG to check how far you can take a load.
Question:I'm 76, had a heart attack in July 2012 and had bypasses and multiple stents. I would like to travel.
Experts: I wouldn't recommend long flights or a vacation in the mountains. Rather go to sea, where you can walk on level ground and do not have to exert yourself. And you should make sure that you have good medical care at the resort if you need to. This is the case on the German North and Baltic Seas.
Question: I'm 83 and got a pacemaker in 2005. In 2011 I had a heart attack. But today I feel good, go swimming every day and also do water aerobics. We have been going to Gran Canaria for many years and want to go back there now. Is there something against this?
Experts: No. But please remember your last (cardiological) doctor's letter, your pacemaker card, your medication (with an additional "reserve") and possibly a blood pressure monitor.
Question: I am 72 and have had an artificial heart valve for three years and am also a Marcumar patient. I suffer from atrial fibrillation, but am well adjusted medically. I would like to go to Borkum.
Experts: No problem. You may want to avoid paddling against a strong wind as it can be exhausting. You can also go for a swim.
Question: I'm 85 have multiple bypasses and stents. I have a rollator and unfortunately I also have problems climbing stairs. Last year I took a boat trip from Passau to Budapest, which was good for me. I would like to fly to Mallorca again.
Experts: Basically, stents and bypasses are not an obstacle to travel. But you have to ask yourself whether this is not a strain for you at your age, where you also have to rely on a rollator. I would choose another destination that might be in Germany and that is easy to achieve. It would also be great if someone could accompany you. Basically, you should discuss this with your cardiologist again and do a stress ECG again before going on a tour to test whether the heart is functioning properly.
Are mountain hikes at an altitude of 1,100 meters a problem?
Question: I suffered a heart attack six months ago and then had bypass surgery. In September I want to go hiking in the mountains. Are mountain hikes at an altitude of 1,100 meters a problem for me?
Experts: If you are regularly checked by your doctor and there have been no noticeable abnormalities so far, you are able to take a lot of stress, for example on a bike, then such a mountain hike is quite possible for you even up to 2000 meters. However, you should slowly get used to the holiday destination, so don't go on mountain tours in the first few days or lie in the sun for hours.
My tip: wear a heart rate monitor when hiking so that you can better control your level of exercise. There may be a shortage of air on steep paths. Be sure to take your medical records (the last surgery report, doctor's letter) and your medication with you. And find out before you travel whether there is well-organized medical care at your holiday destination.
Question: I had a bypass operation in 1996 after a front wall infarction and would like to travel to Southeast Asia in a few weeks. During a stress MRI examination in November, I was diagnosed with circulatory disorders in the supply area of the bypasses. I was advised to have a catheter examination. I am unsure because I feel good under stress, but when I am at rest I feel angina pectoris pain. May I travel and do you advise me to have a catheter examination?
Experts: I advise you to discuss a catheter examination with your doctor. This examination could definitely clarify whether you have a narrowing of the coronary arteries. A trip to the tropics or subtropics is problematic because of the climatic, especially the temperature conditions, when the blood vessels are constricted.
If there is no circulatory disorder, I would not have any concerns about a trip to Southeast Asia. However, you should have another check-up with your doctor three to four weeks before you start your journey. Just keep in mind that if the coronary arteries are distended, at least three weeks' rest is necessary. When you travel, be sure to take your last surgery report, a list of medications and the latest medical report with you.
Can I still snorkel in Egypt with a defibrillator?
Question: I have coronary artery disease and three years ago I received three stents to treat my coronary artery narrowing. In the morning I feel chest pains without exerting myself. With little exertion, my blood pressure rises to 170 and I feel a tightness in my chest and shortness of breath. What do you advise me?
Experts: Be sure to discuss this pain with your treating cardiologist. Since your blood pressure rises sharply even at rest, this may be an indication of a constriction in a coronary vessel, which requires a catheter examination. This is the only way to clarify whether one of the stents has clogged or whether a new constriction has formed that needs to be treated.
In order to avoid the sudden increase in blood pressure, it is necessary to control your blood pressure with the help of medication. That is why I recommend that you speak to your cardiologist if your blood pressure has risen in the morning or in the evening. The best way to do this is to document these increases in a blood pressure pass or on a piece of paper.
Question: I had a posterior infarction. My heart function is reduced by 35 percent and my ability to exercise is limited as a result. I am wearing a defibrillator, but would like to travel to Egypt by plane and snorkel in the sea there? Am I allowed to do that?
Experts: As a heart patient, you are limited in your physical resilience due to your illness, but protected by the defibrillator. However, you should travel to Egypt in the milder seasons of spring and autumn to avoid the heat. Snorkeling on the surface of the water is harmless for deficit wearers.
My advice: It is best to find someone to accompany you for snorkeling. This increases security should an incident occur. The defibrillator does not pose a problem when traveling by air. The German Heart Foundation recommends informing the airline before traveling by air and calling the manufacturer of the defibrillator before traveling abroad in order to obtain addresses abroad who can provide help in the event of an incident.
Question: I had a heart attack and am now going to an outpatient rehab. But I would prefer to do inpatient rehab because I don't feel that strong yet.
Experts: If you are not yet able to do so, ask someone in your family to contact your health insurance company. Here you should describe your case and ask whether this decision can still be corrected. A supplementary certificate from the clinic doctor or family doctor / cardiologist may be required for this, in which this is medically justified.
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