troublesome ekg finding

[busboy12]

Hello, I am a corporate pilot in the us who had an abnormal ekg on my last medical. It was my first ekg as I was 35 at the time. My Ame looked at it before sending it in and said it looked fairly normal to him. The FAA kicked it back sayimg I needed a full cardio eval. I did that and on the holter monitor it showed evidence of mobitz 2. I had to see a ecp and they said it was likely benign and he will write a letter to the FAA. This information will all go to the FAA for evaluation and I am not sure what they will say. Just wondering if anyone else has had something similar as I am getting a lot of bad information so far.

[stilton]

I wouldn't get too stressed, there are a lot of cardiac conditions that can be allowed for on a 'special issuance' medical certificate.



It really is a case by case evaluation, the only one I know that will lock you out for sure is a heart transplant !



Hang in there and stay positive.

[busboy12]

Thanks for the reply and good advice. I am hoping that they issue the medical under special issuance and don't suggest a pacemaker. If they do I will have a hard time getting insured to fly our corporate jet. It is a very frustating experience as I feel no symptoms and the doctor says a pacemaker is completely unnecessary at this point.

[lbfjrmd]

the faa will never advise a treatment (pacemaker) but will request tests and consultations.

[busboy12]

Thanks, yeah I figured they wouldn't. I am just hoping they take what the specialist says and don't deny my medical. This is how I support my family. So many times we think in the back of our minds what we would do if we lost our medical, but just assume that it will never happen. I am in good health, surf almost everyday, run, and go to the gym. This is one thing that life style and eating habits has nothing to do with.

[Jarvy]

The biggest problem I have found (I have special issuance class2) is the fact that it takes 3 months for the FAA to look at it.

[busboy12]

Three months after you sent in the paperwork with the test results? That is crazy. I did hear that the board of doctors in OKC only meet once every couple of months though so that makes sense. Guess all I can do is wait and see what they say.

[Jarvy]

Yes,reports sent in October medical issued January and that was with no change to condition.

[Molokai]

In the course of discussing this thread, a colleague stated that an EKG reveals much more than a stress ECG. He reckoned that a lot of cardio problems were missed because of the inaccuracies of ECG and stress ECG simply because the cardio technicians weren't too careful in attaching the probes or even using the plethora of probes and wires properly. Does anybody has an informed opinion on this?

I once had an ECG test with an automated test result indicating myocardial infarction, only to be disproved after a stressed ECG and I am wondering if we all have been wasting our time undergoing the usual ECG tests.

[CRayner]

black art. While the relationship between the traces and the electrical activity of the heart is fairly simple, the interpretation of the electrical activity and the prognosis are not. The introduction of automatic report writing software in the recent generations of machines has resulted in a huge amount of overdiagnosis of cardiac disease, as the algorithms have been designed to be fail safe. Fine clinically, but a complete pain when an otherwise apparently fit person, such as the original poster here is suddenly saddled with a potentially life changing diagnosis.

Having said that, the particular observation here is fairly straightforward. What is not straightforward is the interpretation, which should incorporate a full clinical assessment of the individual, including family history, social factors etc. etc. It is true that this conduction disturbance is associated with a higher degree of heart disease, but it is not an automatic sentence to pain, suffering and death! It is interesting to see that the incidence of this condition is higher among athletes than it is in the general population. Good luck to the original poster in the process of recovering his employment health status.:ok:

I well remember years ago in my former life as a rural GP I had a patient who was given an ECG as part of his employer's health benefits. He was a keen long-distance runner; not marathons, oh no no no, faaaar too short; fifty to sixty miles at least! He was a rather diffident anxious man, and came to me in a state of some alarm, having been told he had an enlarged heart. He was tall, lightweight, and had a pulse of about 40 beats per minute (known in the profession as 'change the batteries in your pacemaker'). I did my best to reassure him that he was probably the fittest man on my books, but he was not content. I referred him to one of my local specialist cardiology colleagues. The letter back said that his was the healthiest heart my colleague had ever seen.

Machines are good servants, and poor masters in the exercise of any technical skill.

[lbfjrmd]

3 months is reasonable IMHO. SI's can be issued after review by multiple physicians in disparate locations.

EKG's are screening tools. The algorithm generated interpretation is ignored in the SI process.

and . . . the safety of many outweighs the desire of one.

:ok:

[Babablackship]

Molokai, I think you must have mixed up what was related to you...you mentioned EKG vs stressed ECG. Well stress ECG is some kind of enhanced EKG ( I think ECG = EKG ); your friend could have meant echocardiogram, which certainly gives a much more comprehensive look at the heart than ECG or EKG.