Guidelines of the Spanish Society of Cardiology for airplane piloting, cardriving and underwater activities in subjects with heart disease

Car driving, airplane piloting and underwater activities by subjects with h eart disease may cause sudden incapacitation leading to the loss of the saf ety margins necessary to avoid accidents. In the case of car driving and ai rplane piloting the risk affects, not only the driver or pilot, but also pa ssengers and/or bystanders within an accident zone. In the case of diving t he risk resides basically in the loss of control of the vital support mecha nisms necessary in a very hostile medium. This document reviews the possibl e causes of unexpected incapacitation, with or without loss of consciousnes s, in the light of the pathophysiologic consequences of fatigue, hypoxia, s tress or barotrauma posed by each activity. Detailed recommendations are ma de for limiting driving, piloting and diving, based on official Spanish and European regulations and the addresses of specialized centers are provided for consultation. Moreover, recommendations for airplane travel for patien ts with heart disease are indicated.