A heart attack, or in the medical vernacular, a myocardial infarction, means that tissue in your heart is dead. In the unfortunate event that you have chest pain or other symptoms that may be heart related—and show up in an emergency room, the physicians will hook you up quickly with the cardiologist on call. From that initial evaluation, you may likely be expedited to the cardiac catheterization lab for an angiogram procedure to determine if a blocked coronary artery is the culprit that’s causing your symptoms.
If the angiogram shows a problem, you may undergo a corrective procedure while in the cath lab. A PTCA or percutaneous transluminal coronary angioplasty is a procedure in which the interventional cardiologist places a catheter through the groin artery up into the culprit coronary artery and inflates a balloon on the tip of that catheter. Multiple inflations of the balloon “squashes” the cholesterol plaque off to either side of the artery to re-establish the blood flow through the artery. In the majority of cases, the procedure is concluded with the insertion of a wire mesh into the area where the blockage was. This stent is a permanent fixture in your coronary artery and it reduces the likelihood that the involved site will close off in the future.
Sometimes the coronary disease is such that the cardiologist will recommend the person go right to surgery for coronary artery bypass grafting. In this operation, your heart surgeon takes veins from your legs or even arteries from your chest wall and uses these to bypass the narrowing in the heart artery.
So what is the FAA’s policy on these procedures? In January 2013, the cardiologists that advise the FAA changed policies. First of all, you need to know that no matter how long ago these things occurred in your life myocardial infarction and coronary artery disease that has required treatment or is symptomatic are two of the FAA’s 15 specifically disqualifying medical conditions. Currently, any airman with one of these disqualifying conditions can be granted a medical only through the special issuance process (14 CFR 67.401).
For all angioplasty/stent procedures involving any coronary artery other than the left mainstem coronary, there is a mandatory grounding period of 90 days. In fact, this policy applies to airmen with a history of a heart attack even if there was no interventional treatment to the coronary arteries. The left mainstem coronary artery is a short stem of a vessel that comes directly off the aorta and then divides into the left anterior descending (LAD) and left circumflex arteries. Significant obstruction of flow through the left main coronary shuts down the blood supply to entire front-side, apex (or tip), lateral wall (side), and some of the back portions of the heart muscle! This short artery is dramatically referred to as the “widow maker” because survival of a critical left main lesion is often fatal.
Treatment to this artery requires a six-month period of grounding, as does coronary bypass grafting surgery.
During the six months of recovery before you can reapply for special issuance, you can use that time to collect the hospital admission and discharge summaries, the reports of any procedures done, including cardiac catheterization and stent or bypass procedure reports. Then you sit tight (or undergo cardiac rehab) and get better!
I recommend planning ahead and scheduling these next things way ahead of time. As you know, most cardiologists are quite busy and if you want to get back in the air sooner rather than later, schedule your follow-up testing with the doctor’s office as soon as possible. For a third class special issuance, at the end of the time period you will need a current status letter from your treating cardiologist that lets the FAA know how you have done since the procedures, making sure that the report includes all the medications that you are currently taking.
You also will need a current lipid panel (good and bad cholesterol levels) and a fasting blood sugar. Last, and important to the FAA, you will need a current maximal Bruce protocol exercise stress test. Recall several months ago, I had two articles on what the FAA wants with a stress test here and here.
There is a big difference between a third class request and a first and second class special issuance in that for the higher classes, the airman must provide a maximal nuclear stress test and a repeat heart catheterization. These cases will be seen by the federal air surgeon’s cardiology consultant panel and the FAA cardiologists who make the recommendation to the federal air surgeon to require the repeat catheterization. The panel is interested in seeing how the treated vessels now appear after the required recovery period. There is an occasional chance that the vessels can close off again and the panel obviously wants to know the status of that coronary anatomy. Also, we have seen coronary disease actually progress in arteries that were partially blocked initially, so much so that the airman is now having more problems that will require treatment for them prior to granting a special issuance.
The real moral in this story is to take care of yourself from a young age! Don’t smoke, do eat healthy, drink alcohol in moderation, and exercise so you don’t end up with these problems.
AOPA Pilot Protection Services will be featuring topics related to the heart during the entire month of February. February is American Heart Month. Cardiovascular disease is the leading cause of death in the United States; one in every three deaths is from heart disease and stroke, equal to 2,200 deaths per day.
