Staff note: We receive a lot of letters that are, shall we say, rather aggressive toward the FAA and the whole aeromedical system. Some are critical of AOPA and our efforts to assist members. First, please remember, shooting the messenger is not helpful and everyone at AOPA does their very best to help but are not directly responsible for either the Federal regulations nor how the FAA works. Many of the regs are constructed to be highly protective of the flying – and non-flying – public, and regulatory medicine is always more conservative than the clinical medicine regular doctors practice. Second, FAA has limited resources and tardy responses have been a problem for a long time. One thing is for sure, though – although squeaky wheels and engines may get the grease, being rude or nasty to people will never smooth the way.

So our new year wish for all our readers is this: Look after your health as much as possible so that you can avoid dealing with FAA, but if you have to, be nice!

QUESTION: I’m an AOPA member and have searched all over but cannot find the answer to this.
I was planning on getting my first-class medical in January 2019 but am concerned a government shutdown would prevent this from going through. Do I even have time to get it now before it happens?

ANSWER: I am sure your concern and frustration mirrors that felt by millions of Americans who do not know how our government can get to this position and how it will affect them. History tells us that if there is a shutdown, it would not last long – just long enough to allow each side to posture and try to drive their message home to the electorate. Assuming all is well with your medical, a shutdown would not affect your AME issuing a medical in the office, so we do not anticipate there will be a problem with this. And hopefully our government can behave in a manner that prevents the lack of confidence a shutdown induces. Let’s hope we all have a better 2019! 

QUESTION: I have a special issuance now. If I qualify for Basic Med, can I avoid the costly cardiac treadmill tests that the FAA doctor says I must get in March 2019 and take to my AME?

ANSWER: The cardiac stress test is a means to evaluate how your heart responds to additional demands and may indicate coronary artery disease. If you have a special issuance medical now and want to change to BasicMed, you can do that and will no longer be required to submit annual records to the FAA for continuation of the special issuance authorization. You will have a medical examination done with a state licensed physician, complete the online medical self-assessment course, and medically self-assess that you are safe to fly, but FAA medical will no longer be involved in the process. Please do take the self-assessment of ability to fly very seriously – it is an obligation we all have but with a cardiac history you must protect yourself and others.

QUESTION: I have a heart condition. My cardiologist found I had one artery that was completely blocked and another partially blocked. The partial blockage was treated with a stent, cardio rehab, and medication. The other blockage was left alone because my heart had developed collateral blood vessels which bypassed the blockage with normal blood flow. A follow-up stress test was normal and follow-up lab tests show cholesterol and triglyceride levels so low my doctor says he has patients that would kill for those numbers! He recently gave me a copy of my treatment and stress test records along with a statement that says I am cleared for flying.
In the meantime, my class three medical expired. Do I go back to my flight medical examiner with a copy of my medical records and just request a new class three exam or is there something else needed?

ANSWER: The heart requires blood supply just like the rest of the body and there are three arteries that branch off the left main coronary that supply both sides of the heart, the Right Coronary Artery, the Left Anterior Descending, and the Circumflex. When blocked, or “occluded,” blood supply to heart muscle is compromised, which can lead to a heart attack, disordered rhythm, or even sudden death. Treatment to reduce blood pressure and blood fats and open up the blockage with a balloon and holding it open with a “stent” is a common and highly successful approach. You have a fairly common cardiac scenario for pilots, but your situation is a bit more complicated by having a totally occluded, but untreated coronary artery. The fact that you had the partially occluded artery stented before it became occluded is definitely a good thing. Depending upon which artery remains occluded, that may complicate your pathway to medical certification, but not necessarily. A totally occluded Right Coronary Artery often is left alone if the patient is asymptomatic and if the body has created natural “collateral circulation,” meaning new vessels have developed to make up for the compromised circulation through the blocked vessel.

The FAA is looking at the total picture of coronary artery disease, and an untreated, but totally occluded artery will get the attention of the FAA doctor that reviews your case. However, you report a “normal” stress test, so if the FAA determines that the stress test is, in fact, normal, and the occluded artery is the right coronary, you may be fine for special issuance. Keep in mind that when your cardiologist calls a treadmill test “normal,” that determination is made in the context of “clinical medicine” rather than “regulatory medicine,” the world the FAA lives in. The special issuance process operates with the expectation that if the medical certificate is issued (usually for 12 months), the pilot is not likely to experience an event that could result in incapacitation during the time the medical is in effect. The process is “predicting” that the screening and evaluation you submitted to the FAA will result in your being able to safely operate in the national airspace during the authorization period.  

A stress ECG showing no electrocardiographic evidence of “ischemia,” medical-speak for lack of blood supply, is required for a cardiac special issuance, so if the occluded artery is not considered critical, and all other factors are favorable, you should be granted a special issuance authorization.

Since your medical has expired, you will need to complete a new online FAA medical application and schedule a flight physical with your aviation medical examiner, who will defer your application to the FAA. You will then mail all your cardiac records to the FAA for special issuance review.

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.

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