Travel Tips For Hypertrophic Cardiomyopathy

Traveling with hypertrophic cardiomyopathy (HCM) presents some challenges, but the condition doesn’t have to ground you. “Most patients with HCM can travel safely, especially when their condition is stable and well managed,” says Mariko Harper, MD, medical director of the Hypertrophic Cardiomyopathy Center at Virginia Mason Franciscan Health in Seattle. “The key is preparation, hydration, and understanding personal limits.”

The first step is to talk with your doctor about any precautions you need to take. “It’s a crucial step to clear you for travel based on your unique heart structure and function,” says Cynthia Kos, DO, a cardiologist with the Advanced Heart Failure Center at Hackensack Meridian Health’s Jersey Shore University Medical Center in Neptune, New Jersey. “Some HCM patients do not tolerate changes in altitude and the physical demands of moving through airports.”

These expert tips can help you have a safe and enjoyable trip.

Pack an HCM Travel Kit

Medications

“Many HCM patients are on medications like beta-blockers or calcium channel blockers to slow the heart rate and reduce the force of contractions, or diuretics to manage fluid,” says Dr. Kos. “Missing even a single dose can lead to a rapid return of symptoms like shortness of breath, chest pain, or palpitations.”

Be aware that it may be difficult to obtain certain drugs if you forget them or run out. “Some of the medications, such as cardiac myosin inhibitors, come from specialty pharmacies and are not available at a local pharmacy,” says Patrycja Galazka, MD, a cardiologist and co-director of the Hypertrophic Cardiomyopathy Center at Aurora St. Luke’s Medical Center in Milwaukee. “If you lose or forget this medication, make sure to call or message your clinic right away so medication can be delivered quickly.”

Documents

• A summary of your condition, including whether you’ve experienced an irregular heartbeat, severe obstruction, or advanced heart failure symptoms, and whether you have any kind of implantable devices, such as a pacemaker or implantable cardioverter-defibrillator (ICD)
• A list of all medications you take, dosing information, and drug allergies
• Emergency contact information, including your cardiologist
• Copies of your prescriptions
• The device card, if you have an ICD

“A copy of your baseline ECG can also be helpful to doctors taking care of you,” says Victoria Parikh, MD, an associate professor of cardiovascular medicine at Stanford Medicine in California. “It is also helpful for your travel companions to know about your condition and (be able to) communicate about your HCM diagnosis to doctors in a new location.” She recommends wearing a medical alert bracelet if you’re traveling alone.

Infection Prevention

Monitoring Devices

Snacks and Drinks

If You’re Flying

• Declare your ICD or pacemaker to TSA. “Request a manual pat down instead of body scanner if preferred,” says Dr. Galazka. “Scanners are generally safe, but check with your electrophysiologists.”
• Stay well hydrated. Cabin air is notoriously dry. “Bring a bottle of water that you can refill,” says Galazka. Or you can buy water once you’re through security.
• Know your limitations. Some airports are huge, and it may be a long trip to get from check in to your boarding gate. Galazka advises requesting a wheelchair if long walks are a concern.
• Try to move on long flights. This will help improve circulation in your legs and lower the risk of developing a blood clot (called deep-vein thrombosis, or DVT). “Get up and walk around the cabin when able to avoid long sitting periods,” says Galazka. “Choose an aisle seat for easier movement.”
• Avoid alcohol. This is smart for several reasons. Cabin air pressure causes a drop in blood oxygen, and drinking alcohol makes that worse. Plus: “Alcohol is a diuretic and can cause dehydration,” says Kos. “It also can also trigger arrhythmias, which are a known risk in HCM.”

Manage Medications on the Move

Travel can disrupt your medication routine, especially if you cross multiple time zones. Eastbound travel shortens your day, which increases the risk of doses being too close together. Westbound travel stretches your day and you risk having large time gaps in your dosing schedule.

Talk with your doctor and figure out a strategy ahead of your trip to avoid confusion later on. “Everyone has a different way to stay organized,” says Dr. Parikh. “In general, mimicking your routine at home as much as possible is helpful.”

Sidestep Triggers

• Dehydration
• Physical strain
• Stress
• Sleep disruption
• Eating and drinking more than usual
• Temperature extremes
• High altitudes

Kos says you should listen to your body. Symptoms like dizziness, shortness of breath, and palpitations are warning signs your heart isn’t coping with the demands you’re placing on it. Trying to push through could lead to a dangerous event.

Optimize Nutrition on the Go

Finding healthy food can be a challenge on the road. “Most airport and travel foods tend to be higher in sodium, added sugars, and saturated fat, which can leave you feeling more fatigued, sluggish, bloated, and less energized during your trip,” says Michelle Routhenstein, RD, CDCES, a cardiology dietitian at Entirely Nourished, who is based in New York City.

But with some planning and preparation, you can stick to your nutrition goals. Some expert tips:

Pack your own snacks. If you’re flying, Routhenstein recommends bringing along freeze-dried fruit, unsalted seeds, roasted chickpeas, and protein and fiber bars. If you’re driving, fill a cooler with fresh fruit, cut vegetables with hummus, and low-fat yogurt.

Scout out grocery stores. Unless you’re traveling somewhere very remote, you should be able to find a grocery store when you get there or on the way. DiMaria suggests picking up foods high in fiber or lean protein, such as:

• Greek yogurt
• Precooked hard boiled eggs
• Fresh fruit
• Roasted dried legumes
• Meat sticks
• Reduced-fat cottage cheese cups
• Baby carrots, sugar snap peas, or cherry tomatoes with hummus or bean dip cups
• Tuna or salmon pouches with seeded crackers or whole grain rice cakes

Make a restaurant plan. Traveling can mean eating out more often than you would at home. Routhenstein advises her clients to research restaurant options before they go. You can usually find healthier choices on any menu. “Avoid any fried food and choose foods that are baked or grilled,” says DiMaria. “Choose a vegetable side and/or replace a side of french fries with either an additional vegetable or a whole grain option.” She also suggests you resist adding salt to your food, and go easy on sauces and dressings.

Emergency Care When Traveling

While emergencies can happen any time, you need to prepare for the unexpected when you’re traveling with HCM. “Being aware of how you would be able to get care — and where – in the event of worsening symptoms or an emergency is absolutely critical before any travel,” says Parikh.

Locate a hospital at your destination, ideally a heart or HCM specialty center. “If an HCM patient experiences a serious symptom like fainting or sustained arrhythmia, they require immediate, specialized medical attention,” says Kos.

Another consideration is health insurance. Be sure you understand how your policy covers you when you travel, and consider buying a special travel insurance policy that pays for chronic disease treatment as well as emergency evacuation if you’re going overseas.

“A cardiac event in a foreign country can be extraordinarily expensive,” Kos says. “Many standard insurance policies exclude preexisting conditions, so an HCM patient needs to find a specialized policy.”