Hole in heart boosts stroke risk on long flights
Apr 04 (Reuters Health) - Long airplane flights may increase the risk of stroke in people with a relatively common heart defect called patent foramen ovale (PFO), according to a new report.
In PFO, an opening between the heart's two upper chambers that normally closes during fetal development remains open.
Long flights are thought to increase the risk of developing blood clots in the legs, or deep vein thrombosis. These clots can possibly break free and travel to the lungs, leading to a potentially fatal pulmonary embolism. These conditions are known collectively as "economy class syndrome."
In a study reported in the March 26th issue of Neurology, Dr. Patrick M. Pullicino, from New Jersey Medical School in Newark, and colleagues describe three healthy middle-aged individuals who experienced a stroke during or immediately following a long flight. None of the patients were smokers and none had any known risk factors for blood vessel disease.
The first case involved a 46-year-old man who experienced sudden vision loss 4 hours into a 12-hour flight from Tokyo. An MRI revealed that he had suffered a stroke, and echocardiography showed that he had a PFO. The patient was treated with the anti-clotting drug warfarin but still had some vision loss 12 months after the event.
In another case, an athletic 46-year-old man developed weakness in the left side of his body and shortness of breath at the end of a 14-hour flight while reaching for his luggage. MRI revealed that he had a stroke, and testing also showed he had a PFO. Anti-clotting therapy almost completely resolved his symptoms.
The final case involved a 41-year-old woman who experienced sudden left-sided hearing loss, transient vertigo and left- sided facial numbness several hours after two flights of about 1.5 hours duration each, plus 6 hours of sitting in an airport lounge. MRI showed a stroke, and the woman was also discovered to have PFO. She was treated with warfarin but still had deafness on most recent evaluation.
Laboratory results in all three patients revealed no evidence of blood-clotting disorders. In the first two patients, an ultrasound test showed no evidence of blood clots in their legs. But the authors note that both patients were undergoing anti-clot therapy at the time of the test.
A blood clot linked to the patients' PFO is the most likely cause of stroke in these patients, the authors suggest. "As air travel increases worldwide, physicians should be aware of the potential association between stroke during or after prolonged air travel and PFO," they add. Screening for PFO may be warranted for frequent flyers at high-risk for developing blood clots, they conclude.
SOURCE: Neurology 2002;58:960- 961.
Reprinted with permission
