Athletes heart + fixed/rotary medical differences.

[roofow]

Hi all, couple of questions.


Firstly, is there anyone out there who considers themselves an endurance athlete or knows of one who's tried to get a Class 1 medical? I've been having a battle with the CAA for the past 4 months trying to get my certificate and want to know if there's anyone with a similar experience. I have the normal effects of athletes heart like LVH, sinus bradycardia and sinus arrhythmia but on a 24hr EGC my heart often pauses at night for up to 6 seconds, and it only happens at night. I've also had an exercise ECG, an ultrasound, an MRI and a selection of blood tests. All of those are good. I have never had any symptoms whatsoever and no family history of heart problems.


Secondly, is there a difference between a Class 1 medical for fixed wing and for rotary? eg. if both are for single pilot operations will the examiner look for exactly the same things?


Many thanks.

[Radgirl]

LVH and sinus bradycardia should not be a problem at all. Sinus arrhythmia and six seconds of asystole however are not normal and I am not surprised the regulator is not just handing you a certificate. I am afraid you need to work it through with them as you may need medical support separate from your flying

The class 1 is the same for rotary and fixed wing save they used to do a rather nasty strobed EEG for rotary. They gave it up as it produced more problems than answers

[roofow]

Thanks for the response, I'm just trying to fathom how much of an issue the pauses are, whether other class 1 pilots have passed their medical with them.




That's good to hear about the fixed/rotary side of things though.

[Fostex]

I hold a Class 1 with LVH and also with ST elevation occasionally being flagged on the ECG report. My ECG has been reviewed by a cardiologist more than once and been confirmed as normal. At the risk of blowing my own trumpet I am pretty fit and am a road cyclist who races regularly.

[Ulster]

Secondly, is there a difference between a Class 1 medical for fixed wing and for rotary?

Happy to confirm that the answer to that is "no". It doesn't do any harm to remind now and again that a pilot's "licence" and his "medical" are separate things (although obviously closely linked).

Extreme bradycardia at rest in a very fit person would not usually be a problem. My ECG machine prints the word "abnormal" if the HR drops below 50, but these are still "acceptable" for class 1's if there is nothing else. We are not allowed to accept a HR of 40 or less without further investigation.

For my own PPL class 2 a few months back I had to do a 24 hour Holter, which showed one single nocturnal "pause" of 2.6 secs. Because of that I had to repeat the Holter - no pauses second time around ! Quite frankly, I'm afraid I can't see the CAA medics granting a class 1 to anyone who is regularly having nocturnal pauses of 6 secs !

As always with this kind of thing, I would be delighted to be proved wrong ! :D

[roofow]

Ok thanks for that, it is a bit worrying, in my first 24hr ECG I had 275 pauses overnight and I'm awaiting the results of the 2nd, although I know they were fairly similar.

[Ulster]

in my first 24hr ECG I had 275 pauses overnight

You may regard your fitness level as akin to that of Superman, and as an ordinary doctor I would probably have little or no problem with someone so apparently fit . . . . . . . . but you must be prepared for a battle with the medics at the Belgrano ! As I said before, I had to do another Holter because of ONE pause of 2.6 seconds. The standards they apply for class 1's are obviously much more stringent !

Good luck anyway ! More and more regular ! :ok:

[Radgirl]

A pause of 2.6 seconds is acceptable IF the individual is still actively involved in significant exercise. There are papers showing 3 second pauses have no consequences, and in the US 4 seconds is taken as the cut off although many would do sleep studies to exclude obstructive sleep apnoea as this can cause such pauses even in those who are not overweight. However, it would be a brave Belgrano to ignore 6 seconds.

[roofow]

All good background info to have, so thank you. In my case, and in case it's useful to anyone else, my cardiologist believes it to be fitness combined with just the way I am built, training increases vagal tone which can influence the hearts beating in this way. What the CAA decide remains to be seen, but I'm hoping to hear back next week.

[ksjc]

I have "athlete's heart" and a similar situation....

After many years of marathoning, long distance road bike riding and other endurance sports with NO previous heart abnormalities I had a nasty bike accident and left the hospital that day with Atrial Fibrilation. Pretty certain the heart rhythm was normal prior to the crash.

5 weeks later the heart reverted back to normal sinus rhythm with the help of an anti-arrhythmia drug . Because I now have a history of AF I must deal with the FAA to get cleared for the 1st Class.

For the FAA I will get a positive letter from the cardiologist, submit all test results and be free of all meds except a daily aspirin.

Not sure what this looks like..hoping the AME can sort it out for me in short order but expecting the worst, a long delay for the FAA to review and approve. They currently have about a 10 week backlog of Special Issuance requests.

If anyone has any experience with this sort of thing I would like to hear it.

[gulfairs]

I am now in my 80th year and the NZCAA have found a reason to suspend my licence about once every 5 years for a hypertrophy of the Left Ventricle.
I rode a bicycle competitively in my teen years hence the enlarged bit.
I have had no remarkable events during my life time, and still participate in the consumption of the golden nectar, and still physically active.(read that any way you like)
The British CAA have a far better view of medicals than the NZ lot.
So don't come out here if you wish to continue with aviation.

[roofow]

Thought I'd post how I was getting on in case anyone has similar issues. The CAA are willing to give me my Class 1 medical but a restriction of no single pilot commercial roles. They want a 24hr ECG every 6 months and if after 2 years the problem decreases or stays stable then it's likely they'll remove that restriction.


It's not quite what I wanted to hear but it's totally understandable.