Can You Fly with Heart Anxiety? Your Cardiac Health

Q: Can You Fly with Heart Anxiety? Your Cardiac Health

Dear "Seeker of Help"： 1. Since you have undergone so many detailed examinations, it is important to discuss with your attending physician whether your heart and lung functions are suitable for a two-hour flight. 2. Your concerns seem to lean more towards pani

Fear of flying due to heart problems?

Hello Doctor,
Below is the report from the previous cardiac examination, specifically the Ambulatory Holter ECG report:
1.
The baseline ECG showed sinus rhythm with a heart rate ranging from 46 to 112 beats per minute (bpm).
The average heart rate was 71 bpm.
2.
There was sinus bradycardia without any long pauses.
3.
No paroxysmal supraventricular tachycardia (PSVT), paroxysmal atrial fibrillation (PAF), ventricular tachycardia (VT), or ventricular fibrillation (VF) were observed.
4.
A few premature ventricular contractions (PVCs) were noted (totaling 42 beats), and premature atrial contractions (PACs) (totaling 8 beats) during the examination period.
5.
No significant patient events were recorded.
Report:
- Atrium and Aortic Root:
- Aortic Diameter (AO) = 31 mm
- Left Atrial Diameter (LA) = 26 mm
- Left Ventricle:
- Interventricular Septum (IVS) = 7 mm
- Posterior Wall (PW) = 6 mm
- End-Diastolic Diameter (EDD) = 39 mm
- End-Systolic Diameter (ESD) = 25 mm
- Left Ventricular Ejection Fraction (LVEF) by M-mode measurement = 66%
- Valves:
- Mitral Stenosis (MS): nil
- Mitral Regurgitation (MR): nil
- Aortic Stenosis (AS): nil
- Aortic Regurgitation (AR): nil
- Tricuspid Stenosis (TS): nil
- Tricuspid Regurgitation (TR): nil
- Pulmonary Stenosis (PS): nil
- Pulmonary Regurgitation (PR): nil
Conclusion:
- Rhythm and Appearance: Sinus rhythm
- Left Ventricle:
- Systolic function: Normal
- Wall motion: Normal
- Diastolic function: Normal
- Right Ventricle:
- Systolic function: Normal
Holter Report:
- Code No.: LHA110-1124
- Clinical Diagnosis: Cardiac arrhythmia
- Test Date: 2021/6/23
- Analysis Date: 2021/6/24
- Hookup Time: 11:41
- Recording Time: 23 hours 57 minutes
- Analysis Time: 23 hours 57 minutes
- Analysis Result:
- Technical quality of record: Good
- Dominant rhythm: Sinus
- Total Beats: 101,016
- Minimum Heart Rate: 49 bpm at 00:49:29
- Average Heart Rate: 72 bpm
- Maximum Heart Rate: 120 bpm at 08:17:05
- Heart Rate Variability:
- ASDNN 5: 67.1 msec
- SDANN 5: 95.3 msec
- SDNN: 117.7 msec
- Atrial Fibrillation (AFib) Beats: 0 (0.0%)
- AFib Duration: 0.0 min
- PVCs/Couplets/Triplets/VT: 0/0/0
- PACs/Couplets/Atrial Tachycardia (AT): 2/0/0
- Fastest: 0 bpm
- Drops (delay > 2.0 sec)/Late: 0/3
- Longest N-N Interval: 1.3 sec at 05:24:06
Comments:
- Sinus rhythm with a rate ranging from 49 to 120 bpm and a mean of 72 bpm.
- 2 premature atrial beats.
- No AV block.
- No significant long pauses.
Subsequently, due to experiencing shortness of breath, a pulmonary function test was conducted:
- Pre-bronchodilator:
- Forced Vital Capacity (FVC): 2.71 L, 97%
- Forced Expiratory Volume in 1 second (FEV1): 2.11 L, 87%
- FEV1/FVC Ratio: 77%
- Maximum Mid-Expiratory Flow (MMEF): 60%
Interpretation:
1.
Rule out small airway disease.
A non-contrast-enhanced chest CT scan shows:
1.
No evidence of interstitial lung disease (ILD).
No pleural effusion.
2.
Prominent lymph nodes in bilateral neck (see images 26-27).
3.
No bulky mass in the upper abdomen.
Gallbladder stone.
4.
No destructive bone lesions.
Remark: Vessels and solid organs are inadequately assessed based on this non-enhanced CT.
Impression: No evidence of ILD.
Prominent lymph nodes in bilateral neck (see images 26-27).
Currently, I am taking medication for panic disorder at bedtime, including Lorazepam and Clonazepam (with Alprazolam as needed).
Occasionally, I still experience sudden heart rate increases that cause feelings of panic, similar to an impending attack, but these episodes are brief.
The frequency and severity of these episodes have not reached the point of requiring emergency care.
Sometimes, my heart will suddenly race for a few beats.
I am currently taking heart medication, Kankang tablets, twice daily.

Could you please advise if it is safe for me to fly? The flight duration is approximately 2 hours.
Thank you for taking the time to address my concerns regarding my panic and fear.

Qiúzhù de rén, 30~39 year old female. Ask Date: 2023/12/06

Dr. Xiao Yongxun reply Family Medicine

Dear "Seeker of Help":
1.
Since you have undergone so many detailed examinations, it is important to discuss with your attending physician whether your heart and lung functions are suitable for a two-hour flight.

2.
Your concerns seem to lean more towards panic disorder, so you should have a thorough discussion with your psychiatrist or psychologist on how to better manage it.

3.
Based on the information you provided, I believe that as long as you adhere to your medication regimen, there is no evidence suggesting that you cannot undertake short-distance travel.

Reply Date: 2023/12/06

More Info

Flying with heart anxiety can be a complex issue, especially when you have a history of cardiac evaluations and anxiety disorders. Based on the detailed information provided from your Holter ECG report and other examinations, it appears that your heart function is generally stable. You have sinus rhythm with a normal left ventricular ejection fraction (LVEF) of 66%, which indicates that your heart is functioning well. The presence of a few premature ventricular contractions (PVCs) and premature atrial contractions (PACs) is not uncommon and, in many cases, does not pose a significant risk, especially if they are infrequent and not associated with other symptoms.

However, your anxiety, particularly related to flying, can complicate matters. Anxiety can manifest physically, leading to symptoms such as palpitations, increased heart rate, and feelings of panic, which can be distressing, especially in the confined space of an airplane. The fear of flying, particularly the sensations associated with takeoff and turbulence, can trigger these symptoms, leading to a cycle of anxiety that may exacerbate your physical sensations.

Recommendations for Flying with Heart Anxiety:
1. Consult Your Doctor: Before making any travel plans, it’s crucial to discuss your concerns with your healthcare provider. They can assess your current health status and provide personalized advice based on your medical history and recent evaluations.

2. Medication Management: Since you are already on medications for anxiety, ensure that you have a plan for managing your anxiety during the flight. Discuss with your doctor whether you should take your anxiety medication before the flight or if you need an additional dose for the day of travel.

3. Breathing Techniques: Practice deep breathing exercises or mindfulness techniques to help manage anxiety. These can be particularly useful during takeoff and landing when you might feel the most anxious. Focusing on your breath can help calm your nervous system and reduce the sensation of panic.

4. Distraction Techniques: Bring along books, music, or movies to distract yourself during the flight. Engaging your mind in something enjoyable can help take your focus off the flight experience and reduce anxiety.

5. Gradual Exposure: If possible, consider taking shorter flights before your longer trip. Gradual exposure to flying can help desensitize your anxiety over time.

6. Stay Hydrated and Avoid Stimulants: Drink plenty of water before and during the flight, and avoid caffeine or other stimulants that may increase your heart rate and anxiety levels.

7. Inform the Flight Crew: If you feel comfortable, let the flight attendants know about your anxiety. They are trained to assist passengers who may need extra support during the flight.

Understanding Your Cardiac Health:
Your Holter monitor results indicate that while you have some PVCs, they are not frequent enough to be concerning in the context of your overall heart health. The absence of significant arrhythmias, such as atrial fibrillation or ventricular tachycardia, is reassuring. It’s also important to note that anxiety can cause physiological changes, such as increased heart rate and palpitations, which can feel similar to more serious cardiac issues but are often benign.

Conclusion:
In summary, based on your cardiac evaluations and the management of your anxiety, it appears that you are likely fit to fly for a short duration, such as a two-hour flight. However, it is essential to have a thorough discussion with your healthcare provider to ensure that you are adequately prepared and supported for your journey. Managing your anxiety effectively will be key to having a more comfortable flying experience. Remember, many people experience anxiety related to flying, and with the right strategies, you can work towards overcoming these fears. Safe travels!

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