We use necessary cookies to make our website work. We'd also like to use optional analytics cookies to help us improve it.
For more information, please read our cookie policy.

UK – EU Transition, and UK Civil Aviation Regulations

To access current UK civil aviation regulations, including AMC and GM, CAA regulatory documents, please use this link to UK Regulation. Please note, if you use information and guidance under the Headings below, the references to EU regulations or EU websites in our guidance will not be an accurate information or description of your obligations under UK law. These pages are undergoing reviews and updates.

Hypobaric hypoxia i.e. hypoxia due to the lowered oxygen pressure at altitude, is a potential concern for travellers with cardiovascular disease. In some patients arterial oxygen saturation may fall sufficiently to trigger the physiological responses to hypoxia, with an increase in ventilation and a mild tachycardia, resulting in increased myocardial oxygen demand. In patients with limited cardiac reserve, the use of supplemental oxygen (Table 1) may be required and most commercial airlines will supply this when requested in advance, although a charge may be levied. Some airlines may permit passengers to carry and use their own oxygen cylinders and passengers who wish to do this should contact the airline for information on their policy. Passengers may also be able to use approved portable oxygen concentrators and again, those wishing to do so, should discuss this with the airline.

Table 1

Cardiovascular indications for medical oxygen during commercial airline flights

Use of oxygen at baseline altitude

CHF NYHA class III - IV or baseline PaO2 less than 70 mm Hg

Angina CCS class III-IV

Cyanotic congenital heart disease

Primary pulmonary hypertension

Other cardiovascular diseases associated with known baseline hypoxemia

CHF - Congestive Heart Failure
NYHA - York Heart Association
CCS - Canadian Cardiovascular Society

Despite the physiological changes that occur at altitude, the majority of patients with cardiac conditions can travel safely as long as they are cautioned to carry their medications in their hand baggage.

Specific diseases

Angina Pectoris, if stable, is usually not a problem in flight.

Patients with a recent myocardial infarction may travel after 7 to 10 days if there are no complications. If the patient has undergone an exercise test which shows no residual ischemia or symptoms, this may be helpful, but is not a mandatory requirement.

Coronary Artery Bypass Grafting (CABG) and other chest or thoracic surgery should prove no intrinsic risk in the aviation environment as long as the patient has fully recovered without complications. However, as air is transiently introduced into the thoracic cavity, there is a potential risk for barotrauma due to the gaseous expansion which occurs at altitude. It is therefore prudent that patients should wait until the air is reabsorbed, approximately 10 to 14 days before travelling by air.

Patients with uncomplicated Percutaneous Coronary Interventions such as angioplasty with stent placement may be fit to travel after 3 days, but individual assessment is essential.

Symptomatic valvular heart disease is a relative contraindication to airline travel. Individual assessment by the treating physician is essential, paying particular attention to the functional status, severity of symptoms and left ventricular function, in addition to the presence or absence of pulmonary hypertension.

There is no contraindication to air travel for patients with treated hypertension, as long as it is under satisfactory control and the patient is reminded to carry their medication with them on the flight.

Those with pacemakers and implantable cardioverter defibrillators may travel without problems by air once they are medically stable. Interaction with airline electronics or aviation security devices is highly unlikely for the most common bi-polar configuration.

Following a cerebrovascular accident, patients are advised to wait 10 days following an event, although if stable may be carried within 3 days of the event. For those with cerebral arterial insufficiency, supplementary oxygen may be advisable to prevent hypoxia.

Clinical judgement has an important role in the individual assessment of fitness to fly. However, some cardiovascular contraindications to flight are shown in Table 2.

Table 2

Cardiovascular contraindications to commercial airline flight

Uncomplicated myocardial infarction within 7 days

Complicated myocardial infarction within 4-6 weeks

Unstable angina

Decompensated congestive heart failure

Uncontrolled hypertension

CABG within 10 days

CVA within 3 days

Uncontrolled cardiac arrhythmia

Severe symptomatic valvular heart disease

Provide page feedback

Please enter your comments below, or use our usual service contacts if a specific matter requires an answer.

Fields marked with an asterisk (*) are required.

Latest from UK Civil Aviation Authority

  1. UK Civil Aviation Authority update on ATOL Reform consultation
  2. 2022 quarter one flight data
  3. Continued focus on change for GA Team

View all latest news