The coronary arteries are the blood vessels that run along the outside of the heart and provide the heart muscle with itís own blood supply. The term "coronary artery disease (CAD)" means the development of areas of narrowing in the coronary arteries, usually due to cholesterol deposits. Commonly, the first indication that an individual has developed CAD is the presence of chest pain (angina pectoris), usually with exertion. We believe now that most heart attacks (myocardial infarctions) are the result of a blood clot that forms in one of these narrowed areas and suddenly stops the flow of blood through the artery.
There are several different treatments available now for these conditions including medications or "interventions". When the FAA refers to inteventions, this means surgical or procedural therapies such as CABG (bypass surgery), angioplasty (the "balloon" procedure), stent implantation, and atherectomy. One thing that all these individuals have in common is the need for risk factor modification. This includes things like smoking cessation, weight control, regular exercise, and cholesterol control.
The Federal Aviation Regulations (14 CFR 67) identify significant CAD, angina pectoris, and a history of myocardial infarction as disqualifying medical conditions. Part 67.401 states that, in order to obtain a special medical certificate, any applicant with one or more of these conditions must prove "to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of medical certificate applied for can be performed without endangering public safety." What this really means is that if you have one of these conditions, then there is extra testing that you must do to show that you are still safe to operate aircraft. The following paragraphs outline what is needed.
Before certification can be considered, a six-month recovery period must elapse. If the applicant has had a heart attack, then this allows time for the heart to adequately heal. If the individual has undergone a procedure, the most likely time that a restenosis (renarrowing) will occur is during the first six months. After this time, complications are much less likely.
The following is required for Class III (recreational and private pilot duty) applicants with Coronary Artery Disease:
[The blood pressure/pulse recordings at various stages and actual electrocardiographic tracings must be submitted. Tracings must include a rhythm strip and a full 12-lead ECG recorded at rest (supine and standing) and during hyperventilation while standing, as well as one or more times during each stage of exercise, at the end of each stage, at peak exercise, and every minute during recovery for at least 5-minutes or until the tracings return to baseline level. The worksheet and interpretive report must be submitted.]
- Hospital admission summary (history and physical), coronary catheterization report, operative report and discharge summary regarding your infarction, angina, bypass surgery or angioplasty.
- A current cardiovascular evaluation. This evaluation must include an assessment of personal and family medical history, a clinical cardiac examination and general physical examination, an assessment and statement regarding the applicantís medications, functional capacity, modifiable cardiovascular risk factors, motivation for any necessary change and prognosis for incapacitation during the certification period; and a current report of fasting blood sugar and a blood lipid profile to include: total cholesteraol, HDL, LDL and triglycerides.
- A maximal ECG treadmill stress test must be performed no sooner than 6-months post event. All stress testing should achieve 100 percent of maximal predicted heart rate unless medically contraindicated or prevented either by symptoms, conditioning, or concurrent use of medication; such as, B-blockers, calcium channel blockers (spec. diltiazem and verapamil), and/or digitalis preparations. With the consent of the attending physician, these medications should be discontinued for at least 48 hours prior to testing in order to attain maximal stress.
The following is required for Class I and Class II applicants with Coronary Artery Disease:
- First- and second-class certificates may be issued only by AAM-300 and only upon the recommendation of one or more of the Federal Air Surgeon's consultants, providing the requirements of paragraphs 1, 2 and 3 from above (for class III) are met. Six-month post event coronary angiography is required, and dynamic radionuclide myocardial perfusion must reveal no evidence of ischemia or significant myocardial dysfunction.
- Consideration for the issuance of a functionally limited second-class certificate (e.g., "Not Valid for Carrying Passengers or Cargo for Compensation or Hire", etc.) is reserved for AAM-300. Requests for consideration must be accompanied by a completed Operational Questionnaire (FAA Form 8500-20).
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