The Wellness Concierge®: How to Deal With Cardiac Emergencies on the Road

What Everyone—Especially Travelers—Needs to Know About Heart Health

By Marlene R. Fedin, The Wellness Concierge®

without express permission of the author

In This Special Heart-Health Awareness Issue:

How Travel Can Up Your Risk of Sudden and Serious Heart Problems

Before You Fly...

2002 In-Flight Medical Emergency Stats

Heart-Healthy Dos and Don'ts

Are You Having a Heart Attack? What You Must Do

Cardiac Emergencies: How to Help • Resources

What You Don't Know Can Kill You

•••

I wanted to start this column with a (forgive me) heart-stopping statistic. A piece of data that would convince even the young, the fit, and the seemingly healthy flyers among you that you, too, are at risk of sudden—and serious—cardiac emergencies such as a heart attack or sudden cardiac arrest (SCA) on the road. A stat that would make all of you (and especially women) realize how vulnerable any traveler can be when you are, literally, heartsick on the road, especially at 35,000 feet. I yearned for a stat that would make you realize that blood clots and DVT are not your only real medical concerns as you fly and drive.

But delving into the flotsam and jetsam of health data unearthed no singularly scary factoid to inspire you as a road warrior to pay more attention to your heart's health. (Although I did come across a French study that suggests that the changes in air pressure that characterize air travel could up the risk of heart attacks, even for those who had no history of cardiac problems.)

The People Behind the Numbers

Long before my professional path led me to travel-health writing, I had my first encounter with the vulnerability of the human heart—and a heart-wrenching lesson in the connection between heart health and travel. In college, my best friend’s father, an international business traveler for a Fortune 100 company, suffered a fatal heart attack while flying home from Europe. Contrary to the airline’s report, he did, in fact, die in flight.

With no history of heart problems, his family was truly shocked by the 54-year-old’s sudden death. To this day, I wonder if he had any idea, any symptoms that he might have ignored, before he boarded. Given the nature of heart disease, it’s possible that he truly had no warning.

IN-FLIGHT CARDIAC INCIDENTS:

STATISTICALLY SMALL...AND UNPREDICTABLE

Although in-flight cardiac incidents are still the main reason that planes make emergency landings—and the leading cause of death on airliners—statistically, the overall number of cardiac-related in-flight deaths is small (admittedly not much comfort to the families of the deceased) compared with the number of individuals who fly. And the in-flight mortality rates are very small in comparison to the total number of Americans who die (anywhere) from sudden cardiac arrest (SCA) or a heart attack, the most dramatic and deadly forms of heart disease.

[FYI: According to American Heart Association research, cardiovascular disease (CVD) claims the lives of 39 percent of the more than 2.4 million Americans who die annually. And the risks are greater for different sexes and ethnic groups.]

2002 In-Flight Medical Stats*
TOP REASONS FOR AIRCRAFT DIVERSION			TOP IN-FLIGHT MEDICAL PROBLEMS
1	Cardiac	35.5%	1	Vasovagal	21.5%
2	Neurological	18.4%	2	Gastrointestinal	15.4%
3	Gastrointestinal	9.7%	3	Respiratory	10.2%
4	Respiratory	8.0%	4	Cardiac	9.6%
5	Vasovagal	8.0%	5	Neurological	8.7%
Source: MedAire, based on 8,465 in-flight calls from commercial airlines. MedAire provides medical and related in-flight services to air carriers worldwide.

According to 2002 In-Flight Medical Emergency Stats, cardiac incidents, at 9.6% (down from 12.2% in the prior year), are only the fourth-ranked in terms of overall medical incidents. That's about 812 flyers in 2002 who experienced some type of cardiac-related in-flight medical emergency. Not great if you were one of those flyers, but not a number that rivets your attention or motivates behavioral changes.

WHAT WILL IT TAKE TO GET YOUR ATTENTION?

Cardiovascular (AKA heart) disease (CVD) is the number-one killer of American men and women. It can take you out wherever you are, on or off the road. Most important, you can be at risk for CVD without knowing it.

If you spend most of your time traveling, do you need statistics to convince you that you could experience a serious cardiac emergency on the ground or in the air?

Maybe you'll have to witness a seemingly healthy person—possibly yourself—close to death from a heart attack or sudden cardiac arrest before you'll accept that the risk exists and start taking better care of yourself. Let's hope it doesn't come to that.

TRAVEL DOES UP YOUR RISK

Let's get real here. Life on the road can be filled with unhealthy lifestyle choices that can increase your risk of heart disease. Is it possible that you're totally unaware that the physiological and physical debris of life on the road—the junk food, the missed meals, the lack of sleep and exercise, and the hectic, often-out-of-control pace coupled with anxiety and stress (not to mention fear of flying)—can increase your risk of experiencing serious, even life-threatening, cardiac problems? And let's not forget your exposure to polluted urban air, which can up your risk of a heart attack.

BEFORE YOU FLY: ONE ABSOLUTE RULE

THE ONE AND ONLY RULE YOU MUST HEED:

Don’t Board a Plane If You Even—Remotely—Think

You Might Be Having a Heart Attack

Other than an asthma attack—or otherwise being unable to breathe—there’s probably nothing as frightening as having—or thinking you might be having—a heart attack. Well, wait, there is: 1) Not knowing you are having attack and not getting immediate aid. or 2) Experiencing sudden cardiac arrest, when you're unconscious and at the mercy of those around you. Even worse: Having symptoms while you’re trapped in an airplane, minutes, or even hours, away from essential medical care that can only be found on the ground.

I've said it before, and I'll say it again: Airplanes are not flying hospitals.

Yes, many now have AEDs (automatic external defibrillators) and yes, statistics indicate that a flight is likely to have some type of medical professional onboard who can assist you. But in a cardiac emergency, every minute counts.

Do the math. Survival decreases by 10 percent for each minute following the onset of sudden cardiac arrest. If you've had a heart attack, doctors caution that you need to get to a cardiac care unit within 20 minutes or less.

It takes about one minute per 1,000 feet to descend. You're at 30,000 feet or higher. How many planes can land fast enough? How fast can you be deplaned, whisked into an ambulance, and be admitted to a specially equipped hospital within a very small window of time? The odds are not in your favor.

Heed the advice of the medical director of a major U.S. carrier: “…an airplane is the last place in the world where you would want to receive medical care for an emergency.”

Top of Page

HEART-HEALTHY DOs & DONT'S

►EAT (LIGHTLY) BEFORE FLYING

The American Heart Association recommends having a light snack and a nonalcoholic drink before takeoff. The recommendation is based on the findings of a Japanese study that found that eating and drinking before flying increased oxygen in the body, thereby improving circulation and reducing the risk of fainting or cardiac incidents.

►AVOID HEAVY MEALS

U.S. researchers have found that the risk of a heart attack rises four-fold in the two hours after eating a heavy meal. Like extreme physical exertion and anger outbursts, stuffing yourself with lots of food and/or a lot of high-fat food can trigger a heart attack.

►DON'T ASSUME YOU'RE HEART-HEALTHY

Forget the stereotypes. A lot of misinformed folk believe that heart attacks and cardiovascular disease only happen to (pick one or more): men, older people, the overweight or obese, smokers, and possibly some diabetics.

But real life (and data) tell us otherwise. Men and women in their twenties and thirties, physically fit and heretofore healthy folks, and even some athletes, can and do suffer sudden—and often fatal—heart attacks and sudden cardiac arrest.

Sadly, in fact, for some people, the first inkling of a heart problem may come when they have a heart attack or sudden cardiac arrest, both of which can be fatal the first (and only) time they happen.

►KNOW—AND TRACK—YOUR ‘NUMBERS’:

We're talking blood pressure and cholesterol and triglyceride levels, as well as your weight. You're never too young to start monitoring these important barometers of heart health.

Create a chart in Excel so you can quickly note changes and consider keeping such info on your PDA for easy access on the road.

►CHECK YOUR FAMILY'S HEALTH HISTORY

Scientists believe that there is "familial clustering" of heart disease, which makes a detailed history an important tool in both prevention and treatment. Knowing what ailments and diseases exist among parents, grandparents, aunts/uncles, and siblings may make the critical difference in correctly assessing your risks and evaluating your symptoms in a cardiac emergency.

Knowing your family health history is especially important in the case of sudden cardiac arrest because the risk of SCA goes up 50 percent for individuals whose parent, brother, or sister has had a heart attack or sudden cardiac arrest.

The good news: A family history of heart disease and/or vascular problems doesn’t mean a death sentence. With lifestyle changes and monitoring, you can do a lot to minimize or prevent heart disease.

TIP: Even the closest families can resist disclosing intimate personal health info. Do what you have to do, but gather as much information as you can.

One solution: Consider using a third-party service to research and retrieve pertinent data. Healthcare executive Lawrence (Lan) Lievense, FHFMA, CMPE, has created a unique "Hereditary Health Documentation" service to help families assemble a complete and accurate history.

CAUTION: Don't let a family health history devoid of heart disease lull you into a false sense of security. Depending on their age, many parents and siblings may not yet know that they have heart disease.

Top of Page

►KNOW YOUR PERSONAL RISK FACTORS

The "bad" news: Some things that raise your risk—heredity, race, increasing age, diabetes, arterial disease—can't be changed. The "good" news: You can make lifestyle changes (stop smoking, get more exercise, lower blood pressure and cholesterol, lose weight) that can lower your risk of disease and death.

FYI for Women: A woman's risk of heart attack increases as she approaches menopause and keeps increasing as she ages.

TIP: Don't let the seeming absence of risk factors lull you into a false sense of security. Half of those who have heart disease have none of the usual risk factors.

►KNOW (ALL) THE PHYSICAL SYMPTOMS OF A HEART ATTACK
NB: 1) There is no single, universal symptom for a heart attack. Heart attacks can, and do, signal their presence in many different ways. 2) If you have one or more symptoms for more than 30 minutes, you should assume you're having a heart attack.

Crushing pain in the middle of your chest and numbness in your left arm is what signals heart attack to most people. But although that's the most obvious and dramatic symptom, you can have a heart attack with only mild discomfort or pain—or none at all! There are many other ways that your heart can signal it's in distress. These include pain in the neck, jaw, back, or arms; shortness of breath; profuse sweating or clamminess; nausea or indigestion.

For women, the symptoms are even more vague and commonplace (which may partially explain why heart attacks are frequently undiagnosed in females): nausea, fatigue, dizziness, unexplained anxiety or weakness, palpitations, cold sweat or paleness, and atypical back, chest, stomach, or abdominal pain.

BEWARE THE 'SILENT' HEART ATTACK: It's estimated that about a quarter of all heart attacks occur without any identifiable symptoms.

►EDUCATE YOURSELF ABOUT HEART DISEASE—AND RISK FACTORS

Consumer magazines, newspapers, and TV regularly cover major heart-related news. Pay particular attention to the results of studies that detail new risks as they are identified and note preventative measures. A recent study, for example, noted that women who have rheumatoid arthritis have double the risk of a heart attack than women who do not have this condition.

►DEAL WITH YOUR LIFE AND YOUR EMOTIONS

Anxiety, anger, fear, depression, and stress can up your risk of heart disease.

►GET MORE EXERCISE!

More and more research is showing the importance of an active lifestyle in reducing the risk of cardiovascular disease.

►PAY ATTENTION TO WHAT YOU EAT

Obesity, diabetes, and heart disease are on the rise in this country. Do you think there is any link between that and what we eat?

How many people who eat lots of sugar- and fat-laden foods, packaged and processed foods, and unrefined carbs are healthy and fit? (Note: I said healthy, not model thin.) Forget those slim-and-sketchy studies that allege that ingesting artery-clogging foods is healthy. There are other ways to lose weight and eat well and reduce your risk of heart disease.

►CONSIDER TESTS THAT CAN HELP IDENTIFY HEART-DISEASE RISKS

Some forms of heart disease can only be diagnosed by expensive and complicated testing. However, there are newer and inexpensive tests such as the CRP blood test that can identify other risk factors.

►LOBBY FOR PUBLIC AEDs

Want to help save lives? Support initiatives to make external defibrillators readily available in public gathering places. Only 5 percent of the victims of sudden cardiac arrest survive. That rate increases when AED units are immediately available to help restart the heart.

►LEARN CPR

In a few hours, you could learn how to save someone's life. Enough said. Already know CPR? Check the 2005 updated CPR guidelines.

Top of Page

If You Think You May Be Having a Heart Attack

If there is even the remotest possibility that you could be having a heart attack,

don’t get on a plane or drive alone in a car or other vehicle.

The absolute worse-case scenario—the one you want to avoid at all costs—is being airborne and unable to land when your symptoms strike. If this doesn’t scare you enough to not fly when you might be having a heart attack, you have a death wish and I can’t help you with that.

►Try to stay as calm as you can given the circumstances and try to breathe as normally as possible. Don't eat or drink anything.

►Take an aspirin: According to research, taking an aspirin "early in the treatment of a heart attack can significantly improve your chances (of recovery)." You should ask the emergency medical professional (when you call 911) about taking an aspirin. Some conditions or an allergy to it would rule out taking aspirin.

Warning: If there is any possibility that the you or another person is having a stroke, do not take an aspirin, which could cause, or exacerbate, bleeding.

Heart Attack Basics:

►Speed Is of the Essence:
The sooner you get appropriate medical care, the better. When it comes to your heart, minutes count.

►Don't Go Solo
Dealing with a heart attack is not something you should do on your own.

Don’t wait to find airport or hotel personnel. Ask (or find) the nearest person for help. Let someone else track down on-site help and secure emergency medical assistance. If you’re with someone, let them call for assistance, answer questions, and otherwise assist you until help arrives.

►CALL 911 and get emergency medical assistance to come to you.

►Don’t even think about driving yourself (or having someone drive you)—or taking public transportation—to a local hospital. You need monitoring and care that only specially equipped EMS or paramedics can supply. Depending on your symptoms and condition, these trained specialists can determine where to take you for the best care. Plus, they can get you wherever you’re going faster than anyone else can.

Note: If you are in an extremely remote location where emergency medical help cannot quickly reach you, get someone to drive you and have emergency workers meet you en route. In some cases, you may need to be evacuated by air.

►Don’t Self-Diagnose

It's tough enough to get an accurate diagnosis even when you've undergone testing by medical professionals. What makes you think you know whether you're having a heart attack?

Sometimes chest pain is simple indigestion. Sometimes jaw, neck or shoulder pain or severe nausea and clamminess is unrelated to any problem with your heart. But sometimes, especially with women who have different symptoms than men, it’s a heart attack.

►Trust Your Instincts So You Don't Become a Statistic
Oprah Winfrey's two-part heart health show in 2002 may have done more to help educate the average American about the seriousness of heart disease than the combined efforts of the print and broadcast media in the last few years. Why? Oprah's guests included young, fit, and otherwise healthy women who had heart attacks and survived. Their advice: Heed your instincts. If you think something is not right, you're probably correct. The two women guests who didn't listen to their bodies almost died.

►Don't Worry That You'll Look Foolish
Yes. It might be indigestion or something else far less serious. And yes, you may feel silly after being rushed to an emergency room only to find that you are not, in fact, dying of a myocardial infarction. But look at it the other way: You’re alive. Consider the alternative and don’t play Russian Roulette with your health. You could lose, big time.

►Make Sure Your Concerns Are Taken Seriously

It’s hard enough to admit to yourself that you may be seriously ill, even dying, and then have to fight to get proper medical attention and care from medical professionals who are dismissive and uneducated about your real risks.

Getting an accurate diagnosis is crucial and especially important for women, who are often misdiagnosed and dismissed and who may not get appropriate and necessary medical attention. Unfortunately, some physicians often (erroneously) dismiss symptoms as being indigestion or stress-related. Numerous men and women have had normal EKGs, been sent home, and died of heart attacks minutes or hours after leaving a hospital emergency room. You don't want to be one of those statistics. Press for comprehensive testing and monitoring.

Top of Page

How to Help in a Cardiac Emergency

The Cardinal Rule: ALWAYS Seek Professional Aid

If You Suspect Someone is Having a Heart Attack:

• Keep the person as calm as you can.

• Don't let them talk you out of calling 911 or getting emergency medical care.

• Call 911 or ask someone to find on-site or other emergency assistance.

If a Person Has Sudden Cardiac Arrest (SCA):

• Call 911 immediately or ask someone to find on-site or other emergency assistance. Without prompt medical attention, death can occur in minutes. (The survival rate is two to five percent if defibrillation is provided more than 12 minutes after the onset of SCA.)

The Good News: Applying effective CPR immediately after the onset of SCA can double a victim's survival rate.

• Apply CPR (cardio-pulmonary resuscitation) until medical help arrives.

• Ask someone to locate an on-site AED, which can be used to restart the heart.

Heart Health: What You Don’t Know Can Kill You

Statistics are scientific, impersonal, and, on occasion, so threatening and scary that we instantly dismiss them. But instead of insisting that “They don’t apply to us,” we need to review relevant data to raise awareness—then take action to make healthier lifestyle choices.

Despite all the number of deaths from heart disease, for example, there are things we can do to prevent and minimize heart disease. Don't think you're at risk for heart disease? Here are just a few statistics that may inspire you to take better care of your heart—just in case you're wrong:

HEART DISEASE IS MORE PREVALENT THAN YOU MIGHT IMAGINE

▪ 61.8 million Americans have some form of cardiovascular disease (CVD). This includes diseases of the heart, stroke, high blood pressure, congestive heart failure, congenital heart defects, hardening of the arteries and other diseases of the circulatory system.

HEART DISEASE (CVD) KILLS

▪ Heart disease is the No.1 killer of both American men and women.

▪ Heart disease has been the No. 1 killer in the U.S. for every year (except 1918) since 1900.

▪ Nearly 2,600 Americans die of CVD each day, an average of 1 death every 33 seconds.

▪ Half of all deaths from heart disease occur before a person can receive hospital treatment. (The CDC estimates that 400,000 to 460,000 people die each year in an emergency department or before reaching the hospital.)

▪ One of every 2.5 deaths in the U.S. in 2000 was attributed to CVD.

▪ One of three people diagnosed with heart disease before age 40 will die within 15 years.

▪ In 2000, 46.5 percent of CVD deaths were males; 53.5 percent were females.

HEART DISEASE CAN BE A SILENT—AND UNEXPECTED—KILLER

▪ Half of those who have heart disease have none of the usual risk factors.

▪ About a quarter of all heart attacks occur without any identifiable symptoms.

▪ Victims of Sudden Cardiac Arrest include men and women with no prior history of heart disease.

▪ 50 percent of men and 63 percent of women who died suddenly of heart disease had no previous symptoms.

▪ About half the people who have heart attacks have normal levels of cholesterol.

SUDDEN CARDIAC ARREST: QUICK AND DEADLY

▪ More people die from sudden cardiac arrest (SCA) annually than the combined number of deaths from breast and prostate cancer, AIDS, handguns, house fires, and traffic accidents.

▪ The survival rate for SCA is only 5 percent—95 percent of those who have SCA die before reaching a hospital.

▪ SCA can strike anyone, including children, at any time; it is difficult to predict and many victims have no prior symptoms of heart disease.

▪ The risk of SCA goes up 50 percent for individuals whose parent, brother, or sister has had a heart attack or sudden cardiac arrest.

▪ Brain damage can occur in a mere four to six minutes after the heart stops pumping blood.

▪ The number of sudden cardiac deaths (SCD) remains high, even with increased emphasis on prevention and treatment and advances in emergency medical care.

Top of Page

WOMEN & HEART DISEASE: A DEADLY COMBO

▪ Heart disease kills more women than breast cancer. Nearly one of two women will eventually die from heart disease or stroke (compared to 1 in 29 who will die of breast cancer).

▪ Since 1984, more women than men have died of heart disease: In 2000, 53.5 percent of CVD deaths were females.

▪ 1 in 5 females has some form of cardiovascular disease.

▪ 63 percent of women who died suddenly of CHD had no previous symptoms.

▪ Women are more likely to die of a first heart attack than men are.

▪ Women are more likely than men to have a second heart attack.

▪ 38 percent of women who have a recognized MI (heart attack) die within a year compared with 25 percent of men.

▪ Within six years after a recognized heart attack, 35 percent of women will have another heart attack, 14 percent will develop angina, 11 percent will have a stroke, 6 percent will experience sudden cardiac death, and 46 percent will be disabled with heart failure.

▪ Black and Mexican-American women have higher CVD risk factors than white women of comparable socioeconomic status.

▪ Women are under-treated by physicians: the rates for angioplasties, bypass surgeries, and defibrillator implants are lower than those for men.

Statistics used were compiled from a number of documents, but primarily from information published by The American Heart Association (Heart Disease and Stroke Statistics).

HEALTHY HEART RESOURCES

ONLINE:

►The American Heart Association is filled with relevant tools, aids, books and other information. (Check the Heart & Stroke Facts PDF booklet.) You can also call for brochures and other info to be mailed to you.

►Well-regarded medical Web sites such as WebMD, The Mayo Clinic, and InteliHealth have special sections on heart disease that include the latest news and research.

►For Women: WomenHeart (The National Coalition for Women With Heart Disease), the nation's only patient advocacy organization founded by and for women with heart disease. 202-728-7199.

►The Wellness Concierge Recommends:

One of the most in-depth and helpful consumer heart-health info resources is HeartCenterOnline. This patient-friendly site includes articles, news, quizzes and assessment tools to identify your risk factors, info on procedures and tests, patient guides, a video library, community center, cardiologist Q&As, and recipes. You can sign up for a variety of newsletters to help you stay on top of key research, trials, and more.

BOOKS:

Women are Not Small Men: Life-Saving Strategies for Preventing and Healing Heart Disease in Women (Nieca Goldberg, M.D.)

Would you like a list of heart-health related books? E-mail me and I'll e-mail you a bibliography.

Article and links updated: March 11, 2006