A Larger World for Heart Patients : Technology has made medical care more transportable, giving patients more range than they may realize.

Travelers with heart problems are often more cautious about travel than they need to be, according to Dr. Norman Kaplan, professor of internal medicine at the University of Texas Southwestern Medical Center, Dallas, and a leading expert on hypertension treatment. Safe travel is actually becoming easier to achieve for those affected by heart disease, Kaplan said, if they heed their doctor’s advice, don’t rush or lift too much heavy luggage and follow instructions for self-care. Some cardiologists do not even rule out “adventure travel” for those heart patients who are fit and healthy.

Should a traveler become ill on a trip, technology is making it easier for doctors at their destination to confer with the traveler’s personal physician and to review his or her health records within a short time. It is possible, for example, for a doctor abroad to obtain a patient’s previous electrocardiogram from home within minutes to assist in making treatment decisions.

Still, advising travelers with heart conditions on the prudence of travel is no simple proposition, said Dr. Joseph Perloff, a cardiologist and Streisand/American Heart Assn. Professor of Medicine and Pediatrics at UCLA. “It depends on the nature of cardiac disease,” he said. Advice for those with high blood pressure might not apply to those with congestive heart failure or bypass patients, he said.

“Advice has to be individualized,” agreed Dr. Stuart Rose, a Massachusetts emergency physician and travel medicine specialist. But Rose said there is growing agreement among doctors that heart patients who are fit enough should not be restricted even from active travel or adventure vacations.

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Those with heart problems should minimize stresses that accompany travel, experts agree, and avoid overeating and over drinking. “Patients with angina pectoris (chest pain caused by lack of oxygen to the heart) should avoid rushing,” Perloff advised. “They should get to the airport ahead of time and avoid lifting or carrying heavy bags,” he added. “The anxiety of trips is an important factor. These patients should consider prophylactic nitroglycerin.”

Patients with high blood pressure should also avoid rushing and lifting, Kaplan and Perloff agree, because it can elevate pressure. And travelers with varicose veins and other forms of peripheral vascular disease should periodically get up and walk around on long flights, Perloff advised, to encourage circulation.

High altitudes can increase the risk of health problems for patients with heart and blood vessel disorders. To minimize such problems, travelers with high blood pressure should be sure it is under control before embarking, Kaplan advised. “I don’t think having high blood pressure, as long as it is under reasonable control, ought to prevent people from traveling,” he said. “But if pressure is, say 180/120 (normal range is 120/80), that is pretty bad and ought to be looked at before someone jumps on a plane or a train.”

If a traveler is on anti-ypertensive medicine and his or her blood pressure is not well-controlled, it is best to postpone travel at least until the pressure comes down, Kaplan said.

Even those with well-controlled blood pressure might encounter problems at altitude, he said. “There is a potential, when you go to high altitude, for blood pressure to go up.” Kaplan encourages his patients to monitor their own blood pressure at home and to continue doing so while on a trip, especially one that involves altitude changes. “I think if anyone is going to stay at altitude for any length of time, it might be a good idea for him to check his pressure after a day or two and see if it’s any higher. If it’s higher and he is hypertensive and taking medicine, he may need to take a little more,” said Kaplan, who advises patients to consult a doctor if they are unsure about dosage increases. For his hypertensive patients traveling to mountainous areas, he often prescribes Diamox (acetazolamide), a diuretic to speed altitude acclimatization.

Consulting your doctor about plans for an adventure vacation is wise, Rose suggested. You might be advised to undergo testing to assess your condition and exercise capacity before your doctor decides if an adventure vacation is safe. (Even travelers without heart problems planning a high altitude climb might want to undergo a stress test to evaluate the presence of coronary artery disease, if they are over 50 with risk factors such as a family history of heart disease and high cholesterol, according to Rose.) But climbing and trekking could be possible for those with heart problems. “If heart patients tolerate exercise at sea level, they can probably go to altitude,” Rose said. Travelers to remote areas, though, should be aware that medical facilities might be hours away.

Some airlines are trying to make travel easier for passengers with heart conditions. Last year, Qantas Airways equipped 16 of its 747-400 aircraft with Heart Start defibrillation machines, and eventually all 51 craft will be equipped with the device, according to a spokeswoman.

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American Airlines is testing equipment that allows an aircraft crew to maintain contact with a doctor’s office in the event of an in-flight medical emergency. So far, the equipment is on two aircraft, a spokesman said.

If heart patients do need medical care while traveling, it is becoming easier for the doctor at their travel destination to confer with their personal physician, thanks partly to high-speed transmission of electrocardiograms: the graphs that show the heart’s electrical activity.

Physicians can obtain a patient’s previous EKG on a 24-hour basis from a Manhattan Beach-based medical supply manufacturer called CompuMed. More than 2,000 health care providers now subscribe to the system and more than 5 million EKGs are on file, according to company spokesman David Edelstein. Through its Global Access program, physicians abroad can request a patient’s EKG and receive it in as little as three minutes. Or it can be sent via facsimile machine.

Having a patient’s previous EKG can help the physician at the traveler’s destination, Edelstein said. “It can save the patient from unnecessary tests or even unnecessary hospital admission.”

Heart patients can also carry along their own portable EKG monitoring devices, that can be leased for $250-$350 per month. CompuMed’s version--one of a handful on the market, according to Edelstein--is called the Omega 2000 and is a unit weighing less than two pounds. Another company, Medtronic CardioCare, offers the Cardiac Event Detection Service that includes a small monitor given to the patient to record cardiac symptoms wherever the location, said Dick Reid, Medtronic spokesman. The monitor can record and store an EKG, which can then be transmitted to CardioCare. There, staff works round-the-clock to interpret readings.

CardioCare’s pacemaker monitoring service can also be a boon for travelers, Reid said. Pacemaker users carry a unit that attaches to any telephone. On a schedule determined by the patient’s doctor, CardioCare personnel call the patient and instruct him to apply specialized finger electrodes to transmit heart signals. The technician at CardioCare interprets the signals to tell if the pacemaker is working properly. If not, the patient is told how to make adjustments and the doctor is informed.