C7. Air Traveling – Related Acute Decompensated Heart Failure, The Nightmare Begin in The Sky: A Case Report

Abstract

Abstract Background Patients with heart failure are prone to experience problem contributed air travel. The major cardiovascular problem with aviation is mainly as a result of dropping air pressure. During flight the cabin pressure will drop and be maintained at 8000 ft, bringing oxygen levels down to 15%. Case Summary A 50 yo woman presented with diaphoresis, acute worsening of dyspnea, and hypoperfused after air travel. In the first 10-15 minutes of 1-hour flying, she felt tachycardic and becoming increasingly short of breath that doesn’t relieve after debarking off. The previous history included chronic heart failure due to severe mitral regurgitation and hypertension. Echocardiography study revealed severe mitral regurgitation due to prolapse AML and dilated LA with preserved ejection fraction. Initial management with dobutamine and norepinephrine and then furosemide improved her clinical status. The patient was discharged with planning for surgical correction for mitral regurgitation. Discussion The presentation of signs and symptoms denote clinical conditions termed acute decompensated heart failure wet and cold type. The onset of symptoms revealed that this situation related to air traveling. Drop in air pressure and oxygen levels that occur at the cabin during flight make physiological and psychological stress, hypoxia, and raised sympathetic tone. In the patient with preexisting chronic heart failure, these responses will lead to clinical decompensation and deterioration.