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Klas, share the answer with us?


From the horses mouth (FAA), they will accept angioplasty in lieu of stress test provided that prior stress tests show no issues and this is a ‘one off’ procedure to sort of ‘check’ the status of any stents and past blockages after a number of yrs.

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From the horses mouth (FAA), they will accept angioplasty in lieu of stress test provided that prior stress tests show no issues and this is a ‘one off’ procedure to sort of ‘check’ the status of any stents and past blockages after a number of yrs.


Does anyone know if the FAA accepts an angiogram in lieu of a stress test? Supposedly, the angiogram is more accurate but I don't see how it can tell you whether you can achieve the max heart rate that the stress test gives you.


For others with this same type question, only a general answer can be given without the specific medical conditions. The question seems related to the denial of a medical certificate for Heart or Vascular System issues under one or more of the following CFRs, § 67.111, §67.113, §67.211, §67.213, §67.311, or §67.313.


The question is vague; therefore, it can only be answered in general terms. That being the case, in general, a person would have to show a satisfactory record of both tests.


As an example: The Federal Air Surgeon has a team of cardiology consultants who review each airman applying for a 1st or 2nd class airman medical certificate following coronary artery bypass surgery.


The airman needs to demonstrate that there is no significant residual ischemia (inadequate blood supply). The evaluation includes a post- operative coronary angiogram performed at least six months after the operation, a radionuclide stress test performed to FAA specifications, and a good cardiovascular evaluation to include laboratory studies.


Decision Considerations - Aerospace Medical Dispositions

Heart - Other Cardiac Conditions


The following conditions must be deferred:

1. Cardiac Transplant - see Disease Protocols


2. Cardiac decompensation


3. Congenital heart disease


4. Hypertrophy or dilatation of the heart as evidenced by clinical examination and supported by diagnostic studies. (Concentric LVH with no dilatation can be issued by the AME if no symptoms.)


5. Pericarditis, endocarditis, or myocarditis


6. Cardiac enlargement or other evidence of cardiovascular abnormality, If the applicant wishes further consideration, a consultation is required, preferably from the applicant's treating physician. It must include a narrative report of evaluation and be accompanied by an ECG with report and appropriate laboratory test results which may include, as appropriate, 24-hour Holter monitoring, thyroid function studies, ECHO, and an assessment of coronary artery status.


7. Anti-tachycardia devices


8. Implantable defibrillators (ICDs)


9. Anticoagulants may be allowed, if the condition is allowed.


10. Cardioversion (electrical or pharmacologic), may be allowed. A current, complete cardiovascular evaluation (CVE) and follow up Holter monitoring test is required. A 1-month observation period must elapse after the procedure before consideration for certification.


11. Any other cardiac disorder not otherwise covered in this section.


12. Hypotension. A history of low blood pressure requires elaboration. If the Examiner is in doubt, it is usually better to defer issuance rather than to deny certification for such a history.


For all classes, certification decisions will be based on the applicant's medical history and current clinical findings. Evidence of extensive multi-vessel disease, impaired cardiac functioning, precarious coronary circulation, etc., will preclude certification. Before an applicant undergoes coronary angiography, it is recommended that all records and the report of a current cardiovascular evaluation (CVE), including a maximal electrocardiographic exercise stress test, be submitted to the FAA for preliminary review. Based upon this information, it may be possible to advise an applicant of the likelihood of favorable consideration.


Coronary Artery and Heart Disease - Types of Stress Testing




Q: In 2004, I had an exercise EKG for a UK Civil Aviation Authority first-class medical and an anomaly was found with the reading. I went to our local hospital for a follow-up examination and was found to have a narrowing of my left descending atrium. A stent was installed in 2004 and I now take one 2.5 mg Bisoprolol tablet per day. I had no indications of any heart problem before, and I have had none since. I have also recently been diagnosed with type 2 diabetes mellitus and am taking one 500mg Metformin tablet per day. I haven’t flown since 2004 and I wish to renew my second- or third-class medical, in order to exercise privileges as a fight instructor. Is this possible?

A: Yes it is. the requirements for full second-class privileges are different than those of third-class or private pilot. This especially true for the stent insertion. All airmen who request second-class medical certification for this procedure must provide the FAA with a maximal nuclear stress test performed according to the Bruce Protocol [your cardiologist or internist will be familiar with this], and a undergo coronary angiogram.

Page (9) FAA Safety briefing March/April 2012

Edited by iChris
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