UK residents make over 64 million visits abroad each year, with European Union countries accounting for 70% of destinations.¹ Unfortunately taking a holiday is associated with an increased risk of having a myocardial infarction.² Current guidelines recommend a delay of up to 21 days after uncomplicated myocardial infarction before commercial air travel.³

The main concern for transportation of cardiac patients is the effect of hypoxia at altitude. Aircraft are pressurised to achieve cruising altitude cabin pressures equivalent to 2440 m above sea level and at these pressures oxygen tension decreases 60% to a PaO₂ of 55 mm Hg, which results in a haemoglobin saturation of about 90% in patients with normal cardiorespiratory function.⁴ This presents no problem for healthy people but may be detrimental to patients with cardiac ischaemia. Hypoxia results in tachycardia with increased cardiac output and subsequent decrease in ischaemic threshold.⁵ Cardiac ischaemia may also be aggravated by raised catecholamines caused by patient anxiety. Transportation of a patient with a recent acute coronary syndrome in a hypoxic environment is therefore potentially hazardous.

Two small studies have examined the safety of …