Travelling with a heart condition –
understanding your medication
Travel Tips from Dr Ruth Handford
Here’s the good news: International travel is both possible and enjoyable if your heart condition is stable. As long as your condition is well-managed and your doctor clears you for travel, there’s no reason to avoid travelling.
Make sure you have travel insurance in place and have declared full details of your heart condition. Travel insurance is there to cover the cost if you need emergency medical treatment whilst you are away.
Talk to your GP
Before you plan your trip, talk to your doctor or nurse. Ensure that you are physically fit for the activities you’re planning. Even leisurely trips can become exhausting if you’re walking more than usual. Some travel-related medications (such as some antimalarials) should not be used by people with heart disease, so bear this in mind when planning your next destination.
Taking oxygen on your journey
If you use oxygen or a portable oxygen concentrator (POC), make arrangements at least 6 weeks before your trip. Contact your airline to coordinate oxygen on the flight, and contact a specialized medical company for oxygen at your destination. Many airlines will have paperwork for your GP to complete regarding how much oxygen you need and for how long. Travellers who have heart failure or coronary heart disease may also need in-flight oxygen due to lower air pressure in the cabin, even if you don’t normally have supplemental oxygen. Speak to your GP about this well in advance of travel.
Regulations differ between airlines and some will charge an additional fee if you use additional oxygen. The European Lung Foundation maintains a database of oxygen-related services offered by airlines in Europe, and Oxygen Solutions provides a list of airlines that allow POCs. Check out their websites for more information.
Stress-less travel!
The stress of flying and navigating airports can take a toll on your health. Plan a low-stress route with lots of extra time for getting to the airport and making connections. If you need assistance with your bags or transportation within the airport terminal, contact the airline before your trip to coordinate mobility assistance such as a wheelchair. Try to break up your journey if this helps you, and make your journey as comfortable as you can – if you can splash out on extra leg room or even upgrade from economy seating, treat yourself!
Medical care abroad
If you are taking Warfarin to thin your blood, your doctor may recommend that you have your international normalized ratio (INR) levels checked during your trip. This can be done with an accurate portable INR testing (point-of-care) device which you can purchase yourself, or your doctor may be able to refer you to INR monitoring clinics at your destination. Talk to your doctor about therapy adjustment across 6 or more time zones. This may include increasing or decreasing the dose or taking it earlier or later than you normally would.
Be careful about dietary changes, alcohol consumption and new medication which will require more frequent INR testing. Alternatively, novel oral anticoagulants (NOACs) are not affected by dietary changes, but they can affect kidney function. If you’re taking NOACs, ask your doctor how to manage this during travel.
If you happen to need medical attention whilst abroad, your hotel should be able to help you access this.
In Transit - Security screening at the airport
If you have an implanted medical device such as a pacemaker or implanted cardiac defibrillator (ICD), carry a letter from your doctor or cardiologist specifying the device manufacturer, brand, model name and number, and date of insertion. Show the letter to security personnel. Request a hand search instead of passing through the scanner. Ask security personnel to avoid passing over your device with the hand-held metal detection security wand.
Travelling with your heart medication
Every country has different regulations for travellers carrying medications. In most countries, travellers can bring a supply of medication for personal use. You can typically bring medication for 30-90 days, depending on the medication. Check with the embassy of your destination country before your trip.
Always keep medication in its original packaging and bring a letter from your doctor describing your health condition and why you need the medication. Carry the medication in your hand luggage – not in your checked luggage (this can get very cold in the aircraft hold which can affect the quality of the medication). Bring a copy of your latest ECG (heart tracing) results and prescription script. If your medication gets lost or stolen, having your results and prescription with you will make it easier to communicate with a local doctor and replace the medication.
Travellers’ Diarrhoea
Travellers’ Diarrhoea can happen to anyone, but it can have more potential consequences if you are on anticoagulation (blood thinning) therapy or high blood pressure medication. In the case of Warfarin, diarrhoea interferes with its absorption.
Pack over-the-counter Oral Rehydration Salts and talk to your doctor about taking an antibiotic for treatment of moderate and severe diarrhoea (more than 3-5 stools a day). Due to the medication you are taking, some antibiotics may not be recommended.
Seek medical attention immediately when you are away if the diarrhoea does not improve after 1 day. ACE inhibitors (medicines ending in ‘pril’, like ramipril and enalapril) can be problematic if you become dehydrated. If you are struggling to keep fluids down orally, then speak to a doctor about what to do about taking these medicines.
Being active (safely!)
Choose activities that are appropriate for your health and fitness level. Group tours can be very taxing. Don’t feel pressured to participate in every activity. If you are feeling tired or stressed, consider taking a day or half day off the schedule. Tell your group leader and take the time to rest.
Talk to your doctor if you are planning activities that could be affected by your condition or medication. For example, falls can be especially risky if you are taking anticoagulation medication.
Environment
Avoid extremely hot or cold environments and destinations with heavy air pollution, all of which put additional stress on your heart. Talk to your doctor if you are planning to travel to high altitude (over 2,500 m / 8,202 ft) as your medication doses may need adjusting.
Travellers who have had a heart attack in the last 6 months or who have symptomatic heart failure should not travel to high altitude.
Medicines for heart conditions
Medicines can help keep your symptoms under control, prevent future problems, or treat an existing heart condition. There are several types of medication for heart conditions including:
- ACE inhibitors (angiotensin converting enzyme inhibitors – medicines ending in ‘…pril’)
- ARB (angiotensin receptor blockers – medicines ending in ‘….sartan’) Antiarrhythmic medicines (for abnormal heart rhythms; eg. Amiodarone)
- Anticoagulant medicines (blood thinners – like warfarin or ‘DOACS’ – medicines ending in ‘….aban’)
- Antiplatelet medicines (aspirin, clopidogrel)
- Beta blockers (medicines ending in ‘….olol’)
- Calcium channel blockers (for blood pressure control, eg. Amlodipine)
- Cholesterol lowering medications (eg. Statins, or ezetimibe)
- Digoxin
- Nitrates (for angina prevention and treatment)
You may also be on more than one type of medication depending on your condition. It’s important to know what you’re taking, why you are taking it, and how it will affect you. If you don’t understand what each medicine is for, spend some time talking them through with your pharmacist. It’s good to have an understanding of:
- the medication prescribed for you and its potential benefits and risks
- how to take it safely
- when to take it
- possible side effects and what to do if you notice any
- taking other kinds of medicine at the same time, including any over-the-counter medicines or supplements.
Heart medicines come in many shapes and sizes. The most common are:
- Tablets or capsules – These need to be swallowed with or dissolved in water. Sometimes you keep the tablet under your tongue until it dissolves.
- Aerosol spray – You spray the medicine under your tongue.
- Self-adhesive patch – A patch containing your medicine is placed on your skin where the medicine is absorbed.
You may find that different manufacturers use different names and packaging for your medicines. Always check with your pharmacist if you have questions about this.
When will I need to take my medication?
Most medications need to be taken regularly. Some will need to be taken when you experience a symptom such as angina. If you have a spray GTN medication for angina, make sure you take this with you when you travel, even if you don’t need it day to day at home. Carry this with you in your hand luggage so it is easily accessible.
If you’ve missed a dose, check the information leaflet that came with the medication for advice. Usually you should take it as soon as you remember. If it's nearly time for your next dose, you may need to skip the one you missed and take the next dose at its scheduled time.
If you are travelling across time zones, make a note to remind yourself of when your medicines will be due in the new time zone, maybe set an alarm to alert you, or keep a watch on ‘home’ time and use that to determine when to take your medication.
Where possible, you should keep your medicine in its original packaging to help you keep track of how much you have taken.
Always consult your own doctor before travelling
These travel tips are intended to provide general information to those planning to travel abroad. They do not replace a visit to your doctor . If you are planning a holiday you should consult your doctor to ensure that you are fit to travel and discuss any specific health requirements you may have.
About Dr Ruth Handford
Dr Ruth Handford is a GP with over 10 years' experience of working in both hospital and primary care. She is particularly interested in caring for the elderly in the community, child health, and family planning. Ruth lives and works in a rural community, and is kept very busy by her job and young family.
Travel Insurance for Medical Conditions
The Foreign and Commonwealth Office recommend that you have travel insurance in place every time you travel abroad. Make sure that your insurers are aware that you have existing medical conditions and ensure that your travel insurance provides cover for them.
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