Heart failure: are air travel and sex allowed?

Larissa Melville completed her traineeship in the editorial team of . After studying biology at Ludwig Maximilians University and the Technical University of Munich, she first got to know digital media online at Focus and then decided to learn medical journalism from scratch.

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Heart failure is a common disease, especially in old age. Water retention, poor performance, easy fatigue, shortness of breath and shortness of breath, especially during physical exertion, are some of the limitations of this disease. But what can those affected expect: Is it still possible to fly to Mallorca or even Thailand? And do you have to be careful during sex?

"Patients with mild cardiac insufficiency who, according to NYHA classification I and II, show little or no symptoms, can usually travel without any major restrictions," says the Dr. Magnus Baumhäkel, cardiologist at the Caritas Clinic St. Theresa in Saarbrücken. The lower oxygen concentration on board an aircraft does not cause you any problems. "A simple rule is that any patient who is able to climb two floors without shortness of breath is normally fit to fly."

For distances of more than 1000 kilometers, the plane is even the preferred mode of transport, because a long journey by car or train is often more stressful than a flight. "But even patients with mild cardiac insufficiency have an increased risk when traveling that their state of health will deteriorate if they drive to target areas at high altitudes (over 1500 meters above sea level) or with high levels of humidity," warns Baumhäkel.

Better not fly?

The German Heart Foundation recommends that patients with severe cardiac insufficiency (NYHA IV *) refrain from flying. "As a result of the lower oxygen concentration, these can reach the limits of their resilience," says the heart expert. But not only the oxygen concentration is lower on board, but also the humidity (5 -25%). The patients then drink more, which puts additional strain on the heart.

In the case of moderate heart failure (NYHA III), a decision regarding flying should be made on a case-by-case basis. “These patients usually have no symptoms during the flight. However, it can happen that problems arise at the destination, where they have to be treated - depending on the medical care available, ”reports the expert. In order not to take any risks, people with moderate or severe heart failure should definitely contact their doctor before going on vacation and weigh the dangers.

Always carry medication with you

In general, people with heart disease should always make sure that they take enough medication with them on vacation - in hand luggage, in case the suitcase gets lost. A list with the names and active ingredient names of the drugs is also useful. It is also advisable to check the medical care at the holiday destination. "Risk patients with coronary heart disease or advanced heart failure should not travel to countries with poor medical care," advises Baumhäkel.

In addition, it is important to prevent thrombosis on longer flights, especially if you have a weak heart. Move as much as possible. Wiggle your feet, raise and lower your legs and, if possible, walk up and down the aisle. Also avoid crossing your legs. Avoid long-acting sleeping pills, because they chain you to the seat. Take off your shoes and open tight zippers. And don't forget: Avoid drinking coffee and alcohol, as both have a washout effect.

Sex without restriction?

Many patients with heart failure are not only concerned with traveling, but also another question: Sex can get you really out of breath - does it harm the weak heart? "The concern may well be justified, for example in the case of patients who have developed heart failure after a heart attack," explains Baumhäkel. Here, too, the rule applies: Anyone who can manage two floors at home without shortness of breath can also be sexually active.

If the heart function is more limited, you should have an exercise ECG made. "If the patients manage 75 to 100 watts over a period of three minutes, there is usually no increased risk."

In general, it is advisable to take time for foreplay. This is how you get your body used to the higher levels of activity. Comfortable positions during sex are also beneficial. For example, lie on your back or on your side.

And what about drugs for impotence, which are often associated with heart failure? "In general, patients whose resilience is sufficient for the sexual act are allowed to take medication for impotence after consulting their family doctor or cardiologist," says Baumhäkel. Nitro preparations are not advisable, however.

Recognize warning signs

People with heart failure can live well for many years to come if they adhere to medication and follow a healthy lifestyle - normal weight, healthy diet, adequate exercise, smoking cessation and little alcohol. However, it is important to recognize possible warning signs and to know when to go to the hospital.

Some specific symptoms indicate that something is wrong with the heart: "For these warning signals, those affected have to be vigilant, especially for water retention in the body, on the ankles, lower legs or in the abdomen," reports the cardiologist and long-time director of the clinic and polyclinic for Cardiology and Angiology of the University Heart Center Hamburg Prof. Dr. Thomas Meinertz.

These so-called edema are easy to spot if you weigh yourself daily. If the weight gain exceeds two kilos in three days, you should immediately consult a doctor or a clinic. The same applies if the shortness of breath increases or you wake up more often at night due to breathlessness. “Another warning signal is when you need more and more pillows under your upper body to sleep at night in order to raise your upper body so that more fluid flows out of the lungs and breathing is easier when you are lying down,” reports Meinertz.

What derails the heart

Frequent reasons that acutely worsen cardiac insufficiency are therapeutic errors - that is, when the patient forgets his medication, stops taking his medication or reduces the dose on his own. But other drugs such as too high a dose of diuretics or drugs that weaken the heart muscle (e.g. tricyclic antidepressants, heart rhythm drugs or anti-rheumatism drugs) are critical. An increase in blood pressure and pneumonia are just as dangerous. "The combination of pneumonia and heart failure is dangerous because the already weakened heart is often challenged even more than the weakened heart muscle can do," reports Meinertz.

* If the heart is weak, the heart's pumping capacity is so weak that the body can no longer be adequately supplied with blood. The lack of oxygen and nutrients also damages other organs such as muscles, kidneys and brain over time. Depending on the severity of the symptoms, doctors divide heart failure into four classes:

• NYHA I: no physical symptoms at rest or during everyday stress.

• NYHA II: slight limitations in exercise capacity, but no symptoms at rest.

• NYHA III: restrictions even with everyday physical exertion. Complaints such as exhaustion, cardiac arrhythmias, shortness of breath and "chest tightness" (angina pectoris) occur even with low stress.

• NYHA IV: Symptoms appear with any physical exertion and at rest. Those affected are mostly immobile (bedridden) and depend on permanent help in their daily life.

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