Airline Chair-Rest Deconditioning

Travelling with heart failure: risk assessment and practical recommendations

Patients with heart failure are at a higher risk of cardiovascular events compared with the general population, particularly during domestic or international travel. Patients with heart failure should adhere to specific recommendations during travel to lower their risk of developing heart failure symptoms. In this Review, we aim to provide clinicians with a set of guidelines for patients with heart failure embarking on national or international travel. Considerations when choosing a travel destination include travel distance and time, the season upon arrival, air pollution levels, jet lag and altitude level because all these factors can increase the risk of symptom development in patients with heart failure. In particular, volume depletion is of major concern while travelling given that it can contribute to worsening heart failure symptoms. Pre-travel risk assessment should be performed by a clinician 4-6 weeks before departure, and patients should receive advice on potential travel-related illness and on strategies to prevent volume depletion. Oxygen supplementation might be useful for patients who are very symptomatic. Upon arrival at the destination, potential drug-induced photosensitivity (particularly in tropical destinations) and risks associated with the local cuisine require consideration. Special recommendations are needed for patients with cardiac implantable electronic devices or left ventricular assist devices as well as for those who have undergone major cardiac surgery.

Up in the Air: Evidence of Dehydration Risk and Long-Haul Flight on Athletic Performance

The microclimate of an airline cabin consists of dry, recirculated, and cool air, which is maintained at lower pressure than that found at sea level. Being exposed to this distinctive, encapsulated environment for prolonged durations, together with the short-term chair-rest immobilization that occurs during long-haul flights, can trigger distinct and detrimental reactions to the human body. There is evidence that long-haul flights promote fluid shifts to the lower extremity and induce changes in blood viscosity which may accelerate dehydration, possibly compromising an athlete’s potential for success upon arrival at their destination. Surprisingly, and despite several recent systematic reviews investigating the effects of jet lag and transmeridian travel on human physiology, there has been no systematic effort to address to what extent hypohydration is a (health, performance) risk to travelers embarking on long journeys. This narrative review summarizes the rationale and evidence for why the combination of fluid balance and long-haul flight remains a critically overlooked issue for traveling persons, be it for health, leisure, business, or in a sporting context. Upon review, there are few studies which have been conducted on actual traveling athletes, and those that have provide no real evidence of how the incidence rate, magnitude, or duration of acute dehydration may affect the general health or performance of elite athletes.

A case of paradoxical embolic ST-segment elevation myocardial infarction triggered by sleep apnea

This report describes an obese 39-year-old man who experienced ST-segment elevation myocardial infarction with total thrombotic occlusion of the right coronary artery. Culprit vessel flow was improved by aspiration. Data suggested that myocardial infarction had resulted from paradoxical embolus via a patent foramen ovale triggered by the Mueller maneuver, which had induced negative intrathoracic pressure following an acute increase of right-heart volume in the context of obesity and sleep-disordered breathing (SDB). Obesity is increasing among younger populations and it represents a risk for SDB and thrombosis. Thus, this mechanism should be included within the differential diagnosis for myocardial infarction in young patients.

Effects of Mild Leg Exercise in a Seated Position on Haemostatic Parameters Under Normobaric Hypoxic Conditions

This study tested the hypothesis that in humans mild leg exercise affects haemostasis in normobaric hypoxia and thus avoids the development of a deep venous thrombosis (DVT). Eight young men breathed in a 15.4% oxygen in nitrogen gas mixture for 2 hrs while seated at rest (R) or seated and performing a 3-min mild leg exercise program (Ex) at 15-min intervals to assess the impact of mild leg exercise on haemostatic parameters related to the risk of developing DVT, as has been discussed for hypobaric hypoxic conditions during commercial airline travel. Capillary blood gases were analysed every 30 min. Heart rate was monitored continuously. Haemostatic parameters were analysed from venous blood at the beginning, after 1 and 2 hrs, and after a 30-min resting period in normoxic conditions. Plasminogen-activator-inhibitor-1 diminished in both tests in hypoxia, but not after the resting period. Antithrombin-III decreased in R in the hypoxic period. Platelet count, international normalized ratio, partial thromboplastin time remained unchanged, as did highly sensitive parameters like tissue-plasminogen-activator, α2-antiplasmin, d-dimers, thrombin-antithrombin-III-complexes, and prothrombin-fragments 1 and 2. The haematocrit decreased significantly in R. The mild leg execise prevented the decrease of antithrombin-III and caused an increase in haematocrit after an initial drop in the first hour. The present study revealed that normobaric hypoxia did not have clinically relevant effects on haemostasis in humans. Mild leg exercise carried out under those conditions did not lead, via alterations in haemostasis, to a reduced risk of DVT. Key words: local aerobic exercise, haemostasis, hypoxia, thrombosis