Ectopic beats in runs and Class 1

[flatspin1]

Hi everyone,

Not a pilot yet, was planning to get initial class 1 and head CPL path.
However
Couple months ago i had some stressful events and i started experience strange sensation within chest. I went to cardiologist and got 24h ECG done + echo. This is the letter that i obtained from cardiologist:

" ***** had a holter monitor performed elsewhere which reported a normal heart rate range from 44-138 with an average of 58 bpm. There were rare ventricular and supraventricular ectopic beats. No pauses were noted. There was one 8 beat supraventricular run. I actually got the strip sent through to me and it does look like a short supraventricular run with an atypical pacemaker site as the P wave are inverted.

***** therefore has short atrial runs, with a structurally normal heart. I am sending a copy of this letter in this direction. At present i do not need to see him regularly. If he has ongoing issues with the palpitations then he may require further investigations including a possible electrophysiology study."


Now as the stressful situation is already in the past so are the ectopic beats. Havent experience them in a while.

So obviously my question is what will be the DAME view on this? Is it still possible to get initial class 1 without restrictions?

Thank you!

[Deeply Concerned]

After many years as a pilot with trouble free medicals I've recently been diagnosed with an ectopic heartbeat. Referral to a cardiologist to undertake an exercise ECG, cardiac MRI and echocardiogram produced a detailed report, and the UK CAA placed a restriction on my medical essentially allowing me to fly two crew aircraft only, and subject to a further review in six months.

Having had a long discussion with my cardiologist, I now realise how complex this area is and I suspect you need to go into a lot of detail about your specific situation. This is a complex area and I think only detailed investigation with your medical authority will give you the answer.

On the other hand, one cause of ectopics is stress, and you now say this is behind you and you haven't experienced them for a while and I'm assuming you're much younger than me, you may well be ok.

Interestingly enough, my own family doctor wasn't in the least bit concerned.

[flatspin1]

Thank you for your reply. Yes im a younger folk- only 23.

May I ask whether you were having frequent ectopics? in runs?

[Deeply Concerned]

In my case there were no runs, I've heard the term salvos used which sounds like it might be the same thing. In the UK the CAA seem to have a limit of 8%, but in my case it was considerably more. I could get the ectopics to just about disappear after 15 minutes on the stress ECG, which is probably why I'm still flying albeit with a restriction. If the ectopics become erratic or in salvos I think that's much more of a problem.

All this requires a detailed investigation because a lot depends on where these are occurring. For example the left ventricle seems to be more serious than the right. My consultant spent 40 minutes with me explaining the detail of all this in my case and I have to say it's a complex area. I'm sure each case a different.

Under some circumstances there my be a medical solution, maybe with medication or surgery, which is not without its risks. I'm aware of pilots that in order to carry on flying have had surgery that the medical profession would actually advise against, but it all depends on your situation.

Good luck. DC

[Radgirl]

In the broadest of terms, at your age the only concern is that you have an abnormal electrical pathway in the heart. Otherwise it is 'stress'

Your cardiologist unfortunately is sitting on the fence. He is saying he is unsure so leave things but if it recurs investigate for this pathway (which can then be destroyed by a wire from the groin - not a big deal)

Next we have your regulator who seems from other threads to be rather strict and sometimes sadly out of date

So I suspect the regulator will not look favourably on your case.

I would go back to your cardiologist and explain your dilemma. Tell him your career depends on the regulator being satisfied. Ask him to reconsider his opinion now you are asymptomatic. If he says no get a second opinion. Armed with a good and firm opinion from a cardiologist that this has resolved and is not an accessory pathway gives you the best chance.

Good luck

[flatspin1]

Thank you all for your replies!

I live in AU so in order to me see cardiologist again i need referral from GP. It might be difficult to get since i dont have any other reason other than getting another letter....

What would be the best approach when going to DAME? I never did any medical so im not sure how it works?

Should i just mention that i had 24h ECG with ectopics and say nothing more?
Should i bring that letter from cardiologist?

I would much rather have them redoing the 24h ecg because im pretty sure this time it would be clean. Will they redo it if i mention that i dont feel ectopics anymore?

My cardiologist also mentioned in the letter that "sometimes i feel short of breath" even though i said it is after exertion which i believe is normal for any person....

Any advise what to say and how to approach DAME?

Thank you again for your replies

[Radgirl]

Flatspin 1

You have identified one reason for not just going to a DAME - the cardiologists letter is wrong. They won't just check your 24 hour tape and sign you off. The cardiologist in their view will have raised the risk of an accessory pathway which untreated is a no no and you have possible heart failure ( horror of horrors even though it is not true!!!!!) so you are in no mans land

I would hope your GP would be responsive to your need to get a definitive diagnosis whereas at present you have a differential diagnosis ie a list of possibilities plus an error. Several months on you have a good argument for wanting to know if everything has settled and it was just stress or if you face a significant operation sometime in the future. This is risking your career. He may say leave it 6 months but I hope he will understand a low cost consultant review is very cost effective

[gingernut]

Sifting through your history and investigations so far, this statement seems pertinent...

Couple months ago i had some stressful events and i started experience strange sensation within chest.

There are a couple influences on your heart rhythm which I can think of

a) a problem with the wiring-sometimes congenital, (you're born with it), or acquired. Reading between the lines, this seems unlikely, which is good news. I'm wondering if a further cardiological opinion could support this. As radgirl says, sounds reasonable to ask for.

b) a chemical influence-anaemia, thyroid gland problem, drugs, alcohol, nicotine are common culprits. These are usually discounted fairly easily by blood tests and someone listening carefully to the story of your symptoms.

Noradrenaline can be a big factor, particularly if you have had issues with worry.

I'm wondering if this could be the reason for your symptoms.

Rather telling,is the fact that the cardiologist doesn't want to see you again.

[flatspin1]

Thank you Radgirl and gingernut for your insight.

I will try to persuade my GP to get another opinion.

If i do decide to go to DAME with my current letter and opinion- will i be shooting myself in the foot? Wont they clear me after more investigation?

Thank you

[Radgirl]

Sorry I can't help you with that. My perspective from Pprune is that your regulator is rather strict, out of date and unpredictable, which is why I have my concerns. I also think GPs in your country are normally reasonable, sensible and supportive!

[Alchemy101]

I'm not a DAME but I am a medical doctor in Australia-

Occasional PVCs are not a worry, and are often increased by things like caffeine. The run of 8 is potentially concerning, and it would depend what it looks like as to determine the significance. I suspect this is the finding which will cause regulatory excitement.

If (as I think you have described) it is a short self terminating run of supraventricular tachycardia from a possible ectopic atrial source, this is considerably less concerning than a run of ventricular tachycardia, re-entrant tachycardia, or in the presence of some other concerning aberrant pathway, all of which are potential warning signs of fatal arrhythmias.

Ultimately there will be a rule about what is or isn't acceptable to CASA, which I don't know. But unfortunately the 'smell' of electrophysiology studies (EPS) when you are assessing fitness, as a doctor, is concerning. It's like if someone has an angiogram, even if it's negative, it raises subconscious doubts - why did they have the angiogram? Surely someone thought things were risky if they were willing to take them to the cath lab?

Obviously this isn't fair, but it's the real world, so take this into account when making your enquiries, as many specialists may not realise that their investigations could cause career troubles for you.