What Advice Should I Give Patients About Driving And Flying After Myocardial Infarction?

Compared to other forms of international travel, flying presents fewer demands on the invalid passenger than the alternative modes of travel. Airlines have a duty of care to other passengers who may be inconvenienced by emergency diversions, unscheduled stops and delays in the event of a medical emergency. Recertification of drivers and pilots following myocardial infarction depends upon their subsequent risk of incapacitation whilst at the controls. All pilots and all professional drivers have a duty to inform the relevant licencing authority as soon as possible following myocardial infarction.
There are no international regulations governing the prospective passenger who has recently suffered a myocardial infarction and no statutory duty to inform the airline concerned. Most will be guided in the decision whether to fly or not by their cardiologist or family doctor. Modern passenger aircraft have a
cabin atmospheric pressure equivalent to 5–8,000 feet, and alveolar oxygen tension falls by around 30%. This may exacerbate symptoms in any patient who experiences angina or shortness of breath whilst walking 50 metres or climbing 10 stairs. The enforced immobility of the passenger on a long flight,
airport transfers and the crossing of time zones should be considered. If fewer than 10 days have elapsed since myocardial infarction, or if there is significant cardiac failure, angina or arrhythmia the patient may require oxygen or suitable accompaniment. The airline should be informed, and will request a report on a
standard medical information form (MEDIF). Professional pilots are disqualified from flying for nine months after myocardial infarction.

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