Graded Exercise Stress Test - BBB
Additional Pilot Medical Requirements Addressed by FAA
If the Bundle Block Branch (BBB) has been previously documented and evaluated, no further evaluation is required.
A medical certificate should not be issued to any class if the applicant has a new onset of a bundle branch block.
BBB in an otherwise healthy person 30 years of age or younger should not require a CVE
All other individuals who do have a right BBB require a CVE
but a radionuclide study should not be required unless
the standard exercise stress test cannot be interpreted. A stress echocardiogram may be sufficient in most cases.
BBB in a person of any age should have a CVE
and should include a radionuclide perfusion study.
Those individuals who have a negative work-up may be issued the appropriate class of medical certificate
No followup is required
. If any future changes occur, a new current CVE
will be required.
If areas of ischemia are noted, a coronary angiogram may be indicated for definitive diagnosis. According to the current literature, approximately 40% of individuals with LBBB will demonstrate a false positive thallium reperfusion defect in the septal area. If significant CAD
(CHD) is diagnosed, refer to Special Issuance guidelines. Some cases may be forwarded to a FAA-selected cardiology consultant specialist for review and recommendation for medical certification.
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