Right heart function during simulated altitude in patients with pulmonary arterial hypertension

Seccombe, Leigh M.; Chow, Vincent; Zhao, Wei; Lau, Edmund; Rogers, Peter G.; Ng, A.; Veitch, Elizabeth M.; Peters, Matthew J.; Kritharides, Leonard

doi:10.1136/openhrt-2016-000532

Cited by 21 publications

(34 citation statements)

References 27 publications

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“…One study of 8 healthy volunteers flew on commercial airline flight from London, United Kingdom, to Denver, Colorado, for 9 hours, showed an approximately 20% raise in pulmonary artery pressure during flight, and about a 10% elevation 12 hours after landing . A similar rise was observed in patients with PAH exposed to simulated cabin altitude using hypobaric oxygen for 20 minutes, yet without worsening of the right ventricular function . The latter was likely due to the short duration of the simulation (only 20 minutes).…”

Section: Air Travel and Heart Diseasementioning

confidence: 86%

“…33,34 A similar rise was observed in patients with PAH exposed to simulated cabin altitude using hypobaric oxygen for 20 minutes, yet without worsening of the right ventricular function. 35 The latter was likely due to the short duration of the simulation (only 20 minutes). In a cohort of 34 patients with PAH, mainly with NYHA class II/III, who flew for a median of 3.6 hours on commercial flights, the arterial oxygen saturation dropped by a median of~5%, and about 26% of the patients developed significant desaturation, with arterial oxygen saturation <85%.…”

Section: Pulmonary Arterial Hypertensionmentioning

confidence: 99%

“…[35][36][37] Flight duration and resting use of supplemental oxygen were the 2 most important factors to predict significant desaturation during air travel. [35][36][37] Thus, a careful assessment of this group of passengers must be made before clearing them for air travel.…”

Section: Pulmonary Arterial Hypertensionmentioning

confidence: 99%

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Navigating air travel and cardiovascular concerns: Is the sky the limit?

Hammadah

Kindya

Allard-Ratick

et al. 2017

Clinical Cardiology

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As the population ages and our ability to care for patients with cardiac disease improves, an increasing number of passengers with cardiovascular conditions will be traveling long distances.Many have had cardiac symptoms, recent interventions, devices, or surgery. Air travel is safe for most individuals with stable cardiovascular disease. However, a thorough understanding of the physiologic changes during air travel is essential given the potential impact on cardiovascular health and the risk of complications in passengers with preexisting cardiac conditions. It is important for clinicians to be aware of the current recommendations and precautions that need to be taken before and during air travel for passengers with cardiovascular concerns. | INTRODUCTIONMore than 2.75 billion passengers travel globally by air each year. As the population ages and our ability to care for passengers with cardiac disease improves, an increasing number of people with cardiovascular disease will be utilizing air travel. Among these individuals, some have had pacemakers or automatic defibrillators implanted, recent revascularization, or surgery that might predispose to deep venous thrombosis (DVT). 1-3 Also, the use of air medical transport services provided by private and insurance-affiliated companies has risen significantly over the past 15 years. 4 In the largest observational study of medical emergencies during air travel, which analyzed data of 744 million airline passengers between 2008 and 2010, the medical incidence rate was reported to be 1.6 per 100 000 passengers, with medical deaths occurring in 36 passengers. 3 Cardiac causes represent 8% of the medical emergencies, whereas cardiac arrest was the most common cause of medical death (31/36) and flight diversion. 3,5 Myocardial ischemia is the most common cause of cardiac events during air travel. 6 DVT is another concern for people who fly long distances, with incidence reaching up to 5.4% in high-risk groups flying an average of 12.4 hours. 2 The risk of venous thromboembolism (VTE) is about 3 times higher in passengers on long distance flights than in the general population. 7Air travel is safe for most individuals. Importantly, a thorough understanding of the physiologic changes during air travel is essential for every physician, as special precautions are needed for higher-risk passengers. | PHYSIOLOGICAL CHANGES DURING AIR TRAVELMultiple factors can affect cardiovascular health during air travel, including decreased atmospheric pressure, decreased humidity, gas expansion, prolonged immobility, and increased physical and emotional stress.Most commercial aircraft fly at an elevation somewhere between 22 000 and 44 000 feet above sea level (cruising altitude), with a corresponding decline in partial pressure of inspired oxygen of approximately 4 mm Hg per 1000 feet above sea level. 8 This altitude is associated with an approximate 65% to 85% decrease in atmospheric air pressure and a 60% to 90% decrease in partial pressure of inspired oxygen in comparison with sea lev...

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Section: Air Travel and Heart Diseasementioning

confidence: 86%

Section: Pulmonary Arterial Hypertensionmentioning

confidence: 99%

See 1 more Smart Citation

Navigating air travel and cardiovascular concerns: Is the sky the limit?

Hammadah

Kindya

Allard-Ratick

et al. 2017

Clinical Cardiology

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“…Echocardiography demonstrated an increase in pulmonary vascular resistance (PVR) in parallel with right ventricular (RV) impairment (increased right: left ventricular (LV) end diastolic area ratio) and a non‐changing cardiac output (Q). Figure shows this case subject's HCT results (solid line) in comparison to data collected from subjects with primary pulmonary hypertension (dotted line, square) and healthy normal subjects (dotted line, circles) .…”

Section: Case Reportmentioning

confidence: 99%

“…The case subject's response to a hypoxic challenge test (FIO 2 0.15) at rest and with mild exercise in comparison to patients with primary pulmonary hypertension (PAH) and healthy controls . FIO 2 , fraction of inspired oxygen; LV, left ventricular; PAH, pulmonary arterial hypertension; PVR, pulmonary vascular resistance; Q, cardiac output; RV, right ventricular; SpO 2 , pulse oximetry.…”

Section: Case Reportmentioning

confidence: 99%

Exertion during a hypoxia altitude simulation test helps identify potential cardiac decompensation

Seccombe

Peters

Farah

2019

Respirology Case Reports

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A 64‐year‐old female with a history of chronic thromboembolic pulmonary arterial hypertension (CTEPH), moderate airway obstruction (forced expiratory volume in 1 second (FEV1) 58% predicted), and resting oxygen saturation below the normal range (SaO2 94%) underwent a hypoxic challenge test (HCT) to determine suitability for long‐haul air travel. The HCT showed only a mild decrease in SaO2 (89% at 0.15 fraction of inspired oxygen (FIO2)) at rest. However, a HCT coupled with mild exercise at two metabolic equivalents demonstrated significant hypoxia (SpO2 77%) with worsening right ventricular impairment and an inability to increase cardiac output measured with echocardiography. The case highlights the importance of the evaluating cardiac and pulmonary reserve during hypoxic stress. Resting measures alone may not identify risk, and the addition of an exercise component was essential in this case.

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