More than 100 years after the first commercial airplane flight, flying is so routine that we often don’t think twice about it. Yet our bodies weren’t built to exist thousands of feet above Earth’s surface. Could cruising through the sky take a toll on the heart?
“Commercial air travel is generally very safe, and most people can tolerate it without any problems. However, air travel does cause some stress on the human body, so it’s wise to take some precautions—especially if you have active symptoms of heart problems,” says Khaldoon Alaswad, M.D., a cardiologist at Henry Ford Health (and a licensed pilot).
Dr. Alaswad explains how air travel affects the human body—and shares tips for protecting your heart when you travel by plane.
Air Travel and Heart Health
Flying thousands of feet above the ground can affect your body in a variety of ways:
Air pressure changes
“Up at the altitude where airplanes travel, there is less air pressure than there is on the ground,” Dr. Alaswad says. Commercial airplanes pressurize the cabin to make it more comfortable. But even still, the pressure inside a plane is lower than the air pressure down at sea level. As a result, airplane passengers have slightly lower oxygen levels in their blood. In response, the body raises the heart rate a bit to compensate.
The slightly lower oxygen levels and increased heart rate can make you feel tired, though they don’t typically cause problems for most people in good health. “But in people with preexisting heart problems, those conditions could trigger symptoms like increased chest pain,” Dr. Alaswad adds.
Small planes can be even more problematic, since they aren’t always pressurized. “At a certain altitude, authorities require pilots to offer supplemental oxygen for passengers to breathe,” Dr. Alaswad says. He recommends that anyone with heart problems consult a doctor before taking a flight on an unpressurized plane.
Dehydration
Flying can also affect the fluid balance in your body. When you’re at high altitudes, fluids can shift from one area to another, often settling into the tissues. That’s one reason your legs sometimes swell on a long flight. Meanwhile, the cabin air is extremely dry, which speeds up moisture loss as you breathe. “Those factors can lead to dehydration, which can also increase the burden on someone with heart symptoms,” Dr. Alaswad says.
Reduced activity
On long flights, you’re stuck sitting for hours on end. That, in addition to fluid shifts, can cause blood to pool in your legs. Combined with dehydration, the pooling increases the risk that blood clots can form in the legs—a condition known as deep vein thrombosis. If a clot breaks loose, it can make its way to the lungs, causing a dangerous blockage called a pulmonary embolism.
Can You Fly With Heart Problems?
If you’ve been diagnosed with a heart problem such as heart failure, coronary artery disease or atrial fibrillation (AFib), that doesn’t necessarily mean flying is off the table, Dr. Alaswad says. But it’s always a good idea to touch base with your doctor first.
“If you have active symptoms, like shortness of breath, chest pain, dizziness or swollen legs, consult your doctor before you travel,” he says. “And anyone who is flying, whether or not they have heart problems, can take some basic precautions to offset the stress of air travel on the body.”
Protect Your Heart When You Fly
Dr. Alaswad recommends these tips to protect yourself when you fly:
- Hydrate: Drink plenty of water when you travel and limit caffeine and alcohol, which can be dehydrating. (One caveat: People with heart failure have to take special care to regulate their fluid levels, Dr. Alaswad says. Talk to your doctor about how much to hydrate so you can strike a healthy balance.)
- Move: On long flights, stand up and walk the aisle to prevent blood from pooling in your feet and legs. “On a long-haul flight, you should aim to get up and move around the cabin every 90 minutes to 2 hours, at a minimum,” he says. “Just remember to listen to the captain, and don’t get up and walk around if there’s turbulence and the pilot has put on the seatbelt sign.” While you’re seated, you can perform a series of ankle circles and heal raises every 30-60 minutes to help keep blood moving, he adds.
- Compress: Compression socks can help prevent fluid from building up in your legs. They’re especially useful for pregnant women, he says, but might also be beneficial for people with heart symptoms.
- Treat anxiety: Fear of flying is common, and that anxiety can make your heart race—something you might want to avoid if you already have heart problems. If you get anxious on planes, talk to your doctor about ways to manage your fear before your next flight to help keep your heart rate in check. And avoid using alcohol to calm your nerves, Dr. Alaswad adds.
- Avoid germs: Unfortunately, it’s not uncommon to catch viruses or other infections when you travel. You’re sitting in close quarters with other travelers, breathing the same air and touching surfaces that many travelers before you have touched. To avoid catching something, wipe down the surfaces around your seat, wash hands often and consider wearing a mask.
- Ask for help: If you’re experiencing concerning heart symptoms on a flight—such as shortness of breath, lightheadedness, dizziness, chest pain, or a racing or irregular heart rate—don’t try to tough it out until you land. “Airlines have first aid kits on board, and they will land a plane in an emergency,” Dr. Alaswad notes.
Reviewed by Khaldoon Alaswad, M.D., an interventional cardiologist and the medical director of the cardiac catheterization laboratory at Henry Ford Hospital
