100 QUESTIONS IN CARDIOLOGY
michael s
(Michael S)
#1
31 What advice should I give patients about
driving and flying after myocardial infarction?
John Cockcroft
Compared to other forms of international travel, flying presents
fewer demands on the invalid passenger than the alternative
modes of travel. Airlines have a duty of care to other passengers
who may be inconvenienced by emergency diversions,
unscheduled stops and delays in the event of a medical emergency.
Recertification of drivers and pilots following myocardial
infarction depends upon their subsequent risk of incapacitation
whilst at the controls. All pilots and all professional drivers have
a duty to inform the relevant licencing authority as soon as
possible following myocardial infarction.
There are no international regulations governing the
prospective passenger who has recently suffered a myocardial
infarction and no statutory duty to inform the airline concerned.
Most will be guided in the decision whether to fly or not by their
cardiologist or family doctor. Modern passenger aircraft have a
cabin atmospheric pressure equivalent to 5–8,000 feet, and
alveolar oxygen tension falls by around 30%. This may
exacerbate symptoms in any patient who experiences angina or
shortness of breath whilst walking 50 metres or climbing 10
stairs. The enforced immobility of the passenger on a long flight,
airport transfers and the crossing of time zones should be
considered.
If fewer than 10 days have elapsed since myocardial infarction,
or if there is significant cardiac failure, angina or arrhythmia the
patient may require oxygen or suitable accompaniment. The
airline should be informed, and will request a report on a
standard medical information form (MEDIF).
Professional pilots are disqualified from flying for nine months
after myocardial infarction, but may subsequently be allowed to
fly in a multi-pilot aircraft provided that investigations, carried
out by a cardiologist acceptable to the licencing authority, are
satisfactory, as follows:
- Exercise ECG to Bruce protocol stage 4 reveals no evidence of
ischaemia
- 24 hr ECG reveals no abnormality
