Electrocardiogram (ECG) : What to Expect at the Flight Physical

I. Code of Federal Regulations

First-Class: Legal References: 14 CFR 14 CFR 67.111(b)(c)

(b) A person applying for first-class medical certification must demonstrate an absence of myocardial infarction and other clinically significant abnormality on electrocardiographic examination:

(1) At the first application after reaching the 35th birthday; and

(2) On an annual basis after reaching the 40th birthday.

(c) An ECG will satisfy a requirement of paragraph (b) of this section if it is dated no

earlier than 60 days before the date of the application it is to accompany and was performed and transmitted according to acceptable standards and techniques.

Second and Third Class: No Routine ECG Requirement

FAA Note: All applicants for certification (any age, any class) may be required to provide ECGs when indicated by history or physical examination (history of cardiac problems, etc).

II. Examination Techniques

1. Date. The date of the most recent ECG shall be entered in Item 58 of FAA Form 8500-8 for all first-class applicants.

   1. If a first-class applicant is due for a periodic ECG, the Examiner performs and transmits a current tracing according to established procedures. (See Section II. D. below). However, some applicants (such as airline transport pilots who are employed by air carriers with medical departments) may have their company transmit a current ECG directly to the FAA. The Examiner need not require such an applicant to undergo another ECG examination and, if the applicant is otherwise qualified, a medical certificate may be issued. The Examiner should attach a statement to FAA Form 8500-8 to verify that a tracing has been transmitted from another source. The date of that ECG should be entered in Item 58.
   2. If a first-class applicant is not required to have a periodic ECG with the current examination, the Examiner should record the date of the preceding ECG in Item 58.
   3. If a second- or third-class applicant gives a history of having had an electrocardiogram, the test and date may be entered in Item 59. More importantly, the Examiner should indicate in Item 60: AME Comments on History and Findings of FAA Form 8500-8 the history and its significance, if any.
   4. If the applicant provides no statement and refuses to have a current ECG submitted by the Examiner, the Examiner should defer issuance of the medical certificate. When an ECG is due but is not submitted, the FAA will not affirm the applicant's eligibility for medical certification until the requested ECG has been received and interpreted as being within normal limits. Failure to respond to FAA requests for a required current ECG will result in denial of certification.

2. Currency

   1. In order to meet regulatory requirements, a first-class applicant's periodic ECG must have been performed and transmitted within 60 days prior to the date of the first-class application (FAA Form 8500-8). The AMCD verifies currency of all periodic ECGs.
   2. There is no provision for issuance of a first-class medical certificate based upon a promise that an ECG will be obtained at a future date. In such circumstances, the Examiner should defer issuance and transmit the completed FAA Form 8500-8 to the AMCD

3. Interpretation

   1. All ECGs required to establish eligibility for medical certification must be forwarded for interpretation to the Manager of the AMCD. This does not preclude submission of an interpretation by or through the Examiner.
   2. Interpretation is accomplished by the staff and consultant cardiologists at the AMCD. Abnormalities are investigated to determine their significance, if any.

4. Technique and Reporting Format for Required ECGs on First-class Applicants

   The method for recording and transmitting ECGs is by digital electronic data transfer by the Examiner to the AMCD. Senior Examiners who perform first-class medical examinations are required to have access to this capability.

   International Examiners who submit ECGs should use the following format for preparation and submission:

   1. See FAA Form 8065-1, Instructions for Preparation and Submittal of Electrocardiogram. However, the FAA also will accept 3-channel or 12-channel strips uncut or mounted on standard mounting paper. The following steps are essential to expedite processing of these tracings:

      1. All leads must be properly identified.
      2. Applicant and Examiner identification must be complete and the tracing must be dated.
   2. Such hard-copy ECGs are microfilmed for permanent retention in the AMCD. Only tracings that can be microfilmed are acceptable.
   3. Provide a Resting tracing. Tracings must be stapled to the ECG report form to ensure that all leads are appropriately coded and interpreted.