QUESTION: I had stents put in two arteries. I have special issuance certificate now and FAA says I must have a stress test which is very expensive. Is this correct? 
ANSWER: We know it is will be unpopular to say so, but coronary artery disease is the price one pays for a family history, consuming an unhealthy diet, not exercising, smoking and other issues one can address personally. The blockage and inflammation of blood vessels which when healthy keep the hear heart muscle awash with nutritious, oxygen-rich blood, leads to angina (chest pain), heart attacks and death. This is serious stuff. 
One way doctors address this is to insert stents, metal cages that keep the vessel open after it has been stretched by a balloon and this can be a life-saving procedure. However, one must also change lifestyle or the blockages will return. That is why FAA keeps a close eye on people like you who have had proven cardiovascular disease requiring therapy, so yes, that is correct.  Once you are on a cardiac special issuance, annual stress testing, a way to ascertain how well  your heart  is performing, is required to continue the special issuance.  However, the FAA normally requires just a plain maximum exercise treadmill test that is generally not too expensive.  A nuclear exercise perfusion scan, on the other hand, is considerably more pricey, so read your authorization letter carefully to see exactly what the FAA is asking you for.  

QUESTION: The start of this may sound like a cliche but it is real....
A friend of mine had a minor heart issue 3-4 years back that was corrected and since then he has been completely stable, actively working every day in the construction trade and his cardiologist for the last couple years says he is as fit and healthy as anyone else in their 50’s.He stopped flying (Private Pilot Land in basic 4-seat VFR aircraft) because first he was unable, then he would not have been issued a medical and most recently he did not want to deal with the special issuance medical process.  He is now motivated to begin flying again.  His last 3rd Class medical expired approx. 3 years ago.  Is there any reason he cannot fly under the BasicMed rule once it becomes effective, and are there any specific things he should consider in deciding whether to go BasicMed versus now going for a special issuance 3rd Class medical. 
My thoughts to him were that it made more sense to just go BasicMed as that covers all the flying he would ever do but I am not certain there might not be a 'gotcha' somewhere down the road.
ANSWER: Obviously the type of cardiac condition your friend has impacts the recommendation, so we will presume that it is a one of the four cardiac conditions that would require a one-time special issuance authorization under the BasicMed regulations.  Those conditions include heart disease that has been treated (as in stent or bypass), a myocardial infarction (heart attack), a heart valve replacement, and a heart transplant (replacement). If his history does not include one of those four conditions, then he might be eligible to fly under BasicMed.  

QUESTION: About 10 years ago I was diagnosed with uveal melanoma in one eye.  I went through complex radiation and after a year, I was granted a special issuance with 6 month review.  This lasted about 2 years and ever since I have had normal full privileges as the special issuance was removed.  About 4 years ago, because of radiation damage, my formerly diseased eye failed vision tests and I applied for and tested for a SODA.  Going into the SODA my medical was all approved, just subject to the check ride.  Having completed the check ride without issue, they decided to throw a new wrinkle at me, a "field of vision" test which I passed and got my medical and SODA.
I am now up for renewal again, having had two third class renewals since SODA and am an otherwise very fit 65 year old.  I am trying to do my homework before renewing.  I have the option of the new BasicMed program but I like to fly outside the USA, to Canada and the Islands.  I took the "field of vision" again last week and it is fine.  My issue is I don't want to get caught by surprise by the FAA seeking some new test.  What are my risks and what might they ask for?  The "special" is long behind me and I do a battery of MRI's and other testing every year but none of that needs go to the FAA because the special went away 7 years ago.  I don't want to be surprised for lack of not thinking like some FAA examiner.
ANSWER: Thanks for writing. Since you want to fly in Canada you will need to maintain a 3rd class medical.  If your visual field tests still are okay, and good on you for checking, you should not have an issue with getting your medical renewed.  You have done a grand job providing a detailed history and we don’t see anything that would be a cause for the FAA to come back with requests for more information. I certainly can’t see anything immediately that would prompt the FAA to ask for something more and if the FAA was asking for something, it would probably be requested in the eligibility letter you received when your medical was issued two years ago. 

QUESTION: I have paroxysmal atrial fibrillation and take 20 mg of bisoprolol daily.  How would this affect my ability to fly?
ANSWER: Atrial fibrillation (AF) is a condition we have covered in quite some depth in the pages of AOPA Pilot, webinars, online articles and videos and is where one of the chambers of the heart, the right atrium, is not contracting in an organized and efficient manner. It can be completely asymptomatic or may carry a wide range of symptoms. 
Because of your history of paroxysmal AF, for operations that require at least a third class medical, the FAA would consider you for a special issuance authorization, and you would need to provide the FAA with a current cardiac evaluation to be considered for the Authorization.  The medication, bisoprolol, is a beta blocker and is an FAA-allowed medication that won’t be a problem.   

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
Frederick, MD USA
Gary Crump
Gary is the Director of AOPA’s Pilot Information Center Medical Certification Section and has spent the last 32 years assisting AOPA members. He is also a former Operating Room Technician, Professional Firefighter/Emergency Medical Technician, and has been a pilot since 1973.
Topics: Pilot Health and Medical Certification

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