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Cardiac troponin (Tn) plays a central role in the evaluation of patients with angina presenting with acute coronary syndrome. The advent of high-sensitivity assays has improved the analytic sensitivity and precision of serum Tn measurement, but this advancement has come at the cost of poorer specificity. The role of clinical judgment is of heightened importance because, more so than ever, the interpretation of serum Tn elevation hinges on the careful integration of findings from electrocardiographic, echocardiographic, physical exam, interview, and other imaging and laboratory data to formulate a weighted differential diagnosis. A thorough understanding of the epidemiology, mechanisms, and prognostic implications of Tn elevations in each cardiac and non-cardiac etiology allows the clinician to better distinguish between presentations of myocardial ischemia and myocardial injury—an important discernment to make, as the treatment of acute coronary syndrome is vastly different from the workup and management of myocardial injury and should be directed at the underlying cause. [ABSTRACT FROM AUTHOR]

Almost 2 billion passengers embark on international and domestic air travel each year. An increasing number of travelers will have cardiovascular disease as the population continues to age and our ability to treat cardiac disease improves. Guidelines for safe air travel in this population vary and are supported by few concrete data from randomized trials. Although the overall risk for clinically significant myocardial ischemia and arrhythmia during flight seems to be low in the population with stable cardiovascular disease, certain groups may be at increased risk. In-flight venous thrombosis is an increasingly recognized potential complication of prolonged air travel. Travelers with cardiovascular disease may be at increased risk for venous thrombosis as a result of depressed ejection fraction or immobility. This case-based review describes the risks of air travel in a 65-year-old man with known cardiovascular disease. After reviewing the limited data on safe air travel after myocardial infarction and the common complications after both percutaneous intervention and coronary artery bypass grafting, we provide recommendations on safe air travel after myocardial infarction. We discuss the safety of both preflight screening and the in-flight environment with regard to pacemakers and implantable automatic defibrillators. We also review the literature on in-flight venous thrombosis and provide recommendations to prevent in-flight deep venous thrombosis. [ABSTRACT FROM AUTHOR]

The number of air travelers with cardiac disease will continue to increase. Advances in pacemaker, automatic implantable cardioverter defibrillator (AICD) and revascularization will allow many who could not travel only a few decades ago to do so with relative ease. This growing population will face a variety of hazards related to air travel, including in-flight ischemia, arrhythmia, and venous thromboembolic events. Although there is a dearth of research specifically examining the air traveler with cardiac disease, we have attempted to provide a set of guidelines based on available evidence and basic pathophysiology. These guidelines should not substitute for cardiologic consultation when warranted. Future research is needed to further asses the risk of air travel after myocardial infarction in the age of more complete revascularization and more aggressive antiplatelet therapy. None of the trials cited discuss the use of glycoprotein IIb/IIIa inhibitors, clopidogrel, or drug-coated stents. American Medical Association guidelines on this topic may require revision based on these advances. The current generation of pacemakers and implantable cardioverter defibrillators would allow easy access to data regarding in-flight arrhythmia and might help to further elucidate the impact of altitude on the occurrence of ventricular and atrial arrhythmias.

Presents a response by Stephen Possick and Michèle Barry to a letter to the editor about their article "Air Travel and Cardiovascular Diseases" in the Volume 11, Number issue of the "Journal of Travel Medicine."