Spa treatment by condition
Spa treatment for coronary heart disease and after a heart attack
Symptomatic coronary heart disease and the condition after a heart attack are separate positions on the Czech indication list. In Marienbad, treatment runs through measured outdoor exercise, group sessions for cardiac guests and the local carbon dioxide treatments — always under medical supervision and always as a supplement to cardiological treatment.
What is treated here
- Symptomatic coronary heart disease in a stable condition under cardiological care
- Condition after a heart attack, once acute treatment is complete and with clearance from the cardiologist
- Declining stamina and uncertainty about resuming exercise
- Accompanying risk factors such as overweight, elevated blood lipids, high blood pressure or lack of exercise
- Condition after procedures on the vascular system outside the heart, and after percutaneous angioplasty
How the cure works
Initial examination on arrival day
The spa physician reviews your cardiological findings and medication, measures blood pressure and pulse, and assesses your stamina. Bring your cardiologist's clearance and the examinations required by the indication list for the circulatory disease group; without them the plan cannot be drawn up in full.
First week: building up exertion cautiously
Treatment begins with short, level walks and low-intensity group exercise. Of the local natural remedies, the dry gas bath is used most, because it involves no strain on the circulation from heat.
Second week: building endurance
The walks become longer and the climbs steeper, always in graded stages and with monitoring of pulse and blood pressure. Nutrition counselling on blood lipids, salt and weight runs in parallel.
Final examination and a plan for home
Your stamina and progress are assessed and recorded in writing; you take the report home for your cardiologist. You receive an exercise programme for home — the benefit depends on continuing it.
Treatments used
- Dry gas bath in Mariengas
- The natural carbon dioxide from the Marien Spring is applied in a sealed bag, without water and without the strain of heat — which is why it is often the first choice for heart diagnoses.
- Gas injections with Mariengas
- Injections of natural carbon dioxide placed under the skin; in Marienbad they are part of the programme for ischaemic heart disease and are prescribed only by the physician.
- Carbon dioxide bath in mineral water
- A bath at around 34°C; the low temperature keeps the strain on the circulation small while the carbon dioxide is absorbed through the skin.
- Terrain cure and climate therapy
- Guided walking on graded paths with gradually increasing exertion, at an altitude of 630 metres and under medical supervision.
- Group exercise for cardiac guests
- Guided sessions put together specifically for cardiological diagnoses, with breathing, endurance and mobility components.
- Exercise therapy in the pool
- Exercises in warm water that spare the joints and allow the exertion to be dosed precisely.
- Nutrition counselling
- Individual sessions on blood lipids, salt and weight, accompanied by the spa diet during the stay.
How long, and when
The Czech indication list distinguishes two positions here. Symptomatic ischaemic heart disease (II/1) provides for an initial stay of 21 days of contributory care, and a repeat stay likewise runs to 21 days of contributory care, in certain cases 14. For the condition after a heart attack (II/2), 28 days of comprehensive spa care are provided for; there is no separate repeat-stay position for it. Self-paying guests agree the length with the spa physician and the cardiologist. Timing follows the cardiological course, not the season.
What the studies show
The exercise component of the cure is best supported, not the bathing. A Cochrane review of exercise-based cardiac rehabilitation in coronary heart disease found, within twelve months, a lower risk of heart attack (RR 0.72) and of hospital admission (RR 0.58), probably also a slightly lower all-cause mortality, and in the longer term lower cardiovascular mortality and somewhat better quality of life (Dibben et al., 2021, Cochrane Database Syst Rev). Important for context: what was studied were outpatient and clinical rehabilitation programmes, not spa stays; fewer than 15 percent of participants were women, and the reporting quality of the individual studies varies. For the carbon dioxide treatments themselves, a review describes three main effects — a drop in body temperature, stronger skin blood flow and a feeling of warmth — and calls for methodologically stronger studies (Pagourelias et al., 2011, Int J Biometeorol). None of these papers shows that a spa cure can replace cardiological treatment or its medication.
Experience and research under way
Dry gas baths, gas injections and the guided terrain cure have long been part of the programme for cardiac guests in Marienbad; the spa physician doses the load according to the cardiological findings and from clinical experience. How the individual guest fares is not left unchecked: every treatment stay begins with an initial and ends with a final medical examination and a written final report, so the course is documented and the spa physician can adjust the plan along the way. Systematic evidence for spa medicine as a field is being built for the first time in a long while. The Institute of Spa Medicine and Balneology (Institut lázeňství a balneologie, v.v.i.), founded by the Karlovy Vary Region in 2019, has been running the first clinical study of this format in thirty years since 2026, together with Léčebné lázně Mariánské Lázně. It covers urological and nephrological diagnoses rather than the one described on this page: more than a hundred patients are examined before and after the spa stay for health status and quality of life, with prim. MUDr. Ladislav Špišák, CSc. as professional guarantor, and results are not yet available. The study runs within the Spa Research Centre project (2024 to 2027), funded by the Just Transition Operational Programme and working with the Czech Technical University, the University of West Bohemia and the Czech Academy of Sciences. What such work can produce is shown by the same institute’s earlier collaboration with the Marienbad spa houses: their joint study of spa rehabilitation after COVID-19 received the European Spas Association Innovation Award in 2021 in the Medical Spa Scientific Research category.
When a spa cure is not an option
- Unstable angina pectoris, and a recent heart attack without completed acute treatment
- Heart failure at NYHA class IV, second- to third-degree AV block and active endocarditis — the indication list excludes these for the whole group
- Severe heart disease listed on the spa town's general contraindication list
- Missing clearance from the cardiologist, or missing initial examinations required by the indication list for group II
- Continued smoking: the indication list requires nicotine abstinence for the circulatory group
Whether and when a spa cure is appropriate for your heart condition is decided by the spa physician at the initial examination, based on the cardiological findings and your cardiologist's clearance. The stay supplements cardiological treatment and replaces neither it nor your medication; do not change your medication without your doctor's agreement. This page provides information and does not replace medical advice.
Frequently asked questions
May I go for a spa cure after a heart attack?
Yes, once acute treatment is complete and with clearance from the cardiologist. The condition after a heart attack is position II/2 of the Czech indication list and provides for 28 days of comprehensive spa care. Excluded are unstable courses, as well as the conditions the indication list excludes for the whole circulatory group: second- to third-degree AV block, heart failure at NYHA class IV, and active endocarditis.
What can a spa cure do for coronary heart disease?
The part with the best evidence is measured exercise. A Cochrane review of exercise-based cardiac rehabilitation found, within twelve months, fewer heart attacks and fewer hospital admissions, and in the longer term lower cardiovascular mortality — though in outpatient and clinical programmes, not in spa stays. In Marienbad, the guided terrain cure, group exercise for cardiac guests and the carbon dioxide treatments come together, under daily medical supervision.
Do I have to stop smoking for the cure?
For stays run through the Czech indication list, yes: nicotine abstinence is a requirement for the circulatory disease group, set out in the decree itself. Independently of that, smoking is the risk factor that most limits the benefit of a spa stay for this diagnosis.
Which treatment is gentlest for heart disease?
Usually the dry gas bath in Mariengas. It works through the carbon dioxide absorbed through the skin, but involves no water and no strain from heat. Peat packs, by contrast, are a heat-intensive treatment and a clear strain for people with cardiovascular disease; the physician always decides on their suitability.
What documents should I bring?
The clearance and current findings from your cardiologist, a complete list of your medication, and the examinations required by the indication list for the circulatory disease group. The more complete the documents, the more precisely the spa physician can dose the exertion; without them, the plan is more cautious.
Sources
Studies and official documents this article relies on. Our content does not replace medical advice.
- Clinical study of the objective effects of comprehensive spa care in kidney and urological conditions (NCT07435844) — Ongoing study by the Institute of Spa Medicine and Balneology with Léčebné lázně Mariánské Lázně, more than a hundred patients, started 2026. It covers urological and nephrological diagnoses; results are not yet available.
- Czech indication list for spa treatment (Decree No. 2/2015 Coll.), Group II — positions II/1 and II/2 — Symptomatic ischaemic heart disease: initial stay 21 days of contributory care, repeat stay 21 days (14 in certain cases). Condition after a heart attack: 28 days of comprehensive spa care, with no separate repeat-stay position.
- Decree No. 2/2015 Coll. on the professional criteria for spa medical rehabilitation care — Group II — Full text of the indication list for circulatory diseases, including contraindications (second- to third-degree AV block, NYHA IV, active endocarditis), required nicotine abstinence and initial examinations. Czech-language text.
- Dibben G et al. 2021, Cochrane Database Syst Rev — review of exercise-based cardiac rehabilitation in coronary heart disease — Within 12 months, fewer heart attacks (RR 0.72) and hospital admissions (RR 0.58), and lower cardiovascular mortality in the longer term. Outpatient and clinical programmes, not spa treatment; under 15% women.
- Pagourelias ED et al. 2011, Int J Biometeorol — review of CO₂ balneotherapy in cardiovascular disease — Three main effects: a drop in body temperature, stronger skin blood flow, a feeling of warmth; the authors call for methodologically stronger studies.
- Resch KL, Just U 1994, Wien Med Wochenschr — review of the possibilities and limits of CO₂ balneotherapy — Controlled evidence only for peripheral arterial disease, trophic ulcers, microangiopathies and mild hypertension. Older review.
Health claims last reviewed:
