Class II Medical and Ectopic Beats

[FlyEJF]

Hi,

Is it possible to obtain a class II CAA medical if you have ectopic beats? I have been to a consultant and they monitored my heart over over a period of 24 hours using a data logger. They said that i was experiencing ectopic beats which are perfectly normally and there is nothing to worry about.

Thanks
E

[Albert Driver]

Yes. Ectopics are very common.

Depending on how frequently you get them, whether they occur in "runs" and how long these last, you will find the CAA takes either no interest, some interest or asks to see a 24 hour record.

Have you thought of trying to control them? The problem is they tend to increase in frequency with age and while they might not hinder you now they may be called into question if they get worse in future years.

Biggest trigger is stress - which you can probably do little about. Next is caffeine which you can reduce (remember there's also a lot in chocolate and some drinks). Some people report cheese as a trigger, others artificial sweeteners, others still excessive intake of wheat products. I've even heard bananas cited. If you do experiment, remember to give it several days as it takes a long time to eliminate some substances from the body.

Good luck. Tell us how you get on.

[beechgal]

FlyEJF,

I have a similar situation as i posted on the thread "Not such great news for an 18 year old" in this section. However, i have not been able to identify the reasons for my palpitations, although i have noticed if i am overly tired or stressed, it aggravates the situation :sad: I also had the halter ECG done, with nothing conclusive apart from the fact that the palpitations were picked up.. had all the routine tests done as well as thyroid tests. It's very frustrating :ugh: and also a little worriesome :sad: I am just hoping i can get my Class II medical in light of the condition, just like you :confused:

[QDMQDMQDM]

beechgal,

See the other thread. 'Palpitations' or 'tachycardia' are not diagnoses. If anything was picked up on the Holter monitor, it must have a more specific name, such as sinus tachycardia or supraventricular tachycardia. I suggest you do a little more digging into your past medical history.

QDM

[2close]

I developed these benign ectopic heartbeats last summer following a particularly stressful event at work.

I had an ECG, BP, blood tests, treadmill test, 24 hour holter and an echocardiogram, all of which revealed NAD, and they went away shortly afterwards.

The paperwork is now sitting with the CAA and I await their verdict with some trepidation, however, they're not rushing.

[beechgal]

QDM,

Appreciate your advice. I would definitely like to get to the bottom of it, so i will get in touch with my doctor and find out what exactly the results were, or perhaps even go for a second opinion :uhoh:

Beechgal

[FlyEJF]

I am trying to sort out a medical for next week. Is it best for me to mention that i have ve ectopic beats when i book the medical or should i wait until the day of the medical? I think i will mention it at the time, although i'm not sure if the person i book it with will a Dr.

Any advice is gratefully received

Thanks
Ed

[Albert Driver]

Depends on why you went to the Consultant in the first place.

Did you go because you suffered some kind of incident, feeling faint etc? Then you need to mention this during the medical to the doc, not beforehand to non-medical staff. It's confidential.

Did you go because you were naturally concerned at something that's caused no problems but you felt needed checking out? In that case you've been checked out and told that they are normal and there is nothing to worry about. They are common. End of story. Say nothing. Write on the medical form, where it asks if you have seen a consultant recently: the date, the reason for the consultation <investigation of occasional ectopics> and the result <no treatment required>. Let them take it from there if they want. Aside from giving you a bit more time with the stethoscope, they may say nothing at all..

BUT: go very easy on the caffeine and alcohol this week, and I'm serious!!

Good luck.

[FlyEJF]

The reason i went to the Dr in the first instance was that every now and then i felt that i was getting a "premature" heart beat followed by a more severe (than normal) beat. I first noticed this after playing a hard game of squash. I also noticed them after i have had some alcohol.


I have booked my medical for Wedneday so i'll let you guys and gals know how i get on.

Ed

[Thylakoid]

You probably have PVC (premature Ventricular contraction).
It is, usually, an anomaly of the conduction system of the heart which, in the absence of heart disease is more of an annoying thing than it is a problem.
Cardiologists would ask you to undertake a stress test with echo to discard any heart disease.

All the best

[FlyEJF]

I had my Class II Medical today and all went well. After telling the receptionist that i had an investigation into some ectopic heart beats last year she told me to bring along some more information regarding the outcome from my GP. I obtained the letter that the cardiologist sent to my GP explaining that i had had a 24 hour ECG and and echo scan and that everything appeared to be normal.

The AME was excellent and he issued me with the required medical certificate at the end of the medical.

Let me know if anyone has any questions.

Ed

[homesick rae]

I have posted before on other related threads.

I started getting severe ectopic/ irregular beats 9 years ago and still have them. Currently undergoing tests and have echo cardiogram scheduled for next week.

24 holter and ECGs found nothing except "a few extra beats, but not enough to concern us" whatever that means!?

Have had one severe sudden chest pain which came and went in seconds, the odd light cramp and that's it. Live life normally.

Have heard stories of people with same symptoms that have lived with this for many more years.

It is bloody annoying though and scares the **** out of me at times but what to do.

Good luck

Cheers

HR

[Albert Driver]

"...but what to do."

You're doing it!

You've had the tests and been told there's no reason for concern. You're having an echo for extra reassurance. Trust the medics. Listen to what they say. You say you've posted about this problem before. Presumably you read all the threads on this topic? Then you'll have read that ectopics are common and normal and cause no damage.

Sure they can be a bit alarming to start with but people learn to live with them and eventually don't notice them at all. Cut out caffeine, cut back on alcohol, try some of the other suggestions mentioned here and on the earlier threads. But if after trying all that you still have them then you need to start being relaxed and accept them.

What's probably happening here is that even after nine years you still haven't accepted they are harmless so when you feel one you get a big shot of adrenaline which then makes everything worse. Next time you get them try some physical exercise. For one thing, exercise can sometimes quieten them down. If not then at least you'll be reassured when your heart responds perfectly normally, that you're not about to keel over.

Good luck with the echo.

[homesick rae]

Albert,

Thanks mate.

Well, this is the first time that the docs have decided to investigate further which I am happy about.

My main concern is that 9 years has gone by and perhaps this route could have been suggested before? In Qatar...blood tests/ECG. US....24 holter/ UK ECG....hmmm...yes I might be perfectly fine or slightly not BUT Hurrah!!! Someone is actually making sure either way!!

Appreciate your thoughts.

Thank you again.

Cheers

HR

[moosp]

Coming into the thread a bit late, but I have posted on this subject before, so don't want to duplicate and waste storage space...

Rules for Ventricular ectopics, by an amateur sufferer holding an ATPL. Disclaimer; IANAD. (I am not a doctor.)

1) Do not exercise for three days before an ECG. Do not exercise massively for five days before an ECG. A 10 km run the day before an ECG will put you in the, "Lets take this one as a sample," level of the result.

2) Do not drink alcohol for five days before an ECG if you think you have an ectopic problem. Even two glasses of red the night before can trigger an event that is of interest to the doctors.

3) Do not drink coffee, (even decaffe, and I have yet to discover why) for three days before the ECG. Strong tea and all caffeine drinks must not be taken.

4) Do not have an emotional relationship with a partner, or a loneliness without one, that causes you to feel tightness in the left chest area for at least a month before the ECG. I realise that this is impossible, but it is an indication of the impossibilities that the medical profession require to regain your licence. Live with it.

5) Arrange your licence medical at a time to suit your own body clock. If you know that you have a stable heart in the mornings, (and you will know) then book it so. Do not acquiesce to your company making you fly halfway across the world as flight crew, arriving in UK at 0-God-00 and then requiring you do a stress ECG at Gatwick on the treadmill three hours after blocks. You will fail.

6) Ventricular ectopics are almost unheard of in pastoral or hunter peoples. It is a disease of over exertion and is endemic in marathon runners, orienteerers and others who over the age of 50 keep their heart beat rate above 170 for hours in a day. It seems to be caused by an over fit heart at rest, getting below 60 bpm, and the secondary nerves say "Oi, your primary nerve hasn't fired for at least a second, we better fire or our host is toast." So they fire, and then the primary fires just when it wanted to, knowing that you are so fit that you only need 40 pumps a minute- information that the secondary nerves did not know.

7) Once the CAA or whoever is your medical controller has found an ectopic, it becomes part of their data base. They need your data for their PhDs, or at least for their articles in the Lancet, so they can be cited in further research. Even when you have not had an unusual heartbeat for several years, they will still get you back for another visit, not because you are unfit for a licence, but so that they have a recovered reference for the guys three years behind you.

To sum up; If you are a normally fit pilot, and have no heart history:

Do not exercise for at least three days before an aircrew medical.

Do not drink coffee or strong tea or caffeine colas for 36 hours before an ECG.

Do not drink alcohol for 48 hours before a medical.

If I had done those three things, I would not have triggered the medic’s interest. In my case it was a 15 km walk in the hills and a couple of pints in the bar at the end, the day before a regular ECG. They have had me for six years since.

[2close]

Just got the thumbs up (in writing) from the CAA AMS that my ectopics are not an issue and that I'm OK for Class 2 and/or Class 1 certification.

However, I did have the full workout whilst it was at its worst; ECGs, treadmill, blood tests, 24 hour Holter, Echocardiogram, all OK.

[bunting]

I have the same ventricular ectopics and have finally received my class II in the post following 3 months of waiting following 24 hr ECG monitor, exercise ECG & ECG Scan. I now must provide a 24 hour ECG monitor to prove that this is not a progressive problem. Overjoyed that I have received my certificate though.

[homesick rae]

Well, I have just completed my 7 Day ECG and had my Echo 8 days ago. Due to go back on 01st June for the results. My question is: Do they check the Echo right away?

Good to hear of some positive outcomes above.

Cheers

HR

[homesick rae]

Hi All,

Just to inform you of the outcome of my results:


Received a letter to ask me to contact my doc further to a letter from Cardiologist
Since I was heading to DXB next day they asked my doc to call me back and she said that the Cardiologist had requested I go back on Beta Blockers...so off I went to DXB
Went to hospital today for results of my tests and was told I had arrythmia and he thought I had an "extra circuit" going off and causing these missing/ ectopics
He showed me the 7 day ECG and pointed out the problem beats
He has upped my betas from 25mg to 50mg and requested I come back in 6 months
In between a gentle treadmill test to be arranged
If the symptoms do not settle down then he plans to use a more invasive procedure and finally (if necessary) use "heat waves?" to break the circuit and correct it as a permanent cureAnyone else gone through this?

Still, cannot complain at the out come so far.

Cheers

HR

[Eddy]

Just thought I'd add a little something to this.

I've just returned from the CAA at Gatwick where I've undergone my Class One medical. Sadly, they were unable to pass me as I too am experiencing Ectopic Beats.

I was on the ECG machine for about four or five minutes and in that time experienced five beats. It was an average of one every fifty seconds. Not major.

I was told that when they see more than one together, they worry. When they see groups of ten together, they really worry. If you experience this, you're unlikely to be passed.

Anyway, they wanted to kit me out with a holter for 24h but due to my being on standby with work at the moment, I couldn't do it. I have set another appointment for a few weeks in the future.

Now, the CAA god love them will charge you about 240.00 extra on top of your 310.00 medical fee for the use of the holter and an appointment with the Cardiologist. You can, should you prefer, get the holter from your own GP and simply bring the report with you to give to the Cardiologist. You won't need to do this, however, unless they uncover something odd in your ECG.

[Albert Driver]

If you experience this, you're unlikely to be passed.

.....until there's been some further investigation!

Let's not frighten everyone, Eddy.

[Eddy]

Passing on what was suggested to me. Isn't it good to go in there armed with the facts?!

[rsuggitt]

Just to say that I'm in a pretty similar position having had episodes of Atrial Fibrillation (AF)... which I understand is caused by redundant but overactive nerves in the left atrium. The 'heat waves' treatment is what I'm hoping for / waiting for at the moment.... more properly called Catheter Ablation which involves using RF energy to kill the nerve cells using a wire introduced into the heart via a vein.

[HotDog]

I have been diagnosed with Atrial Flutter 12 months ago. Normal resting pulse of 60bpm shot up to 120. The only way they could reset the sinus rythm was with Electro Cardioversion. All OK for 12 months and the condition has re occured. I'm booked into hospital next Monday for a Cardiac Ablation procedure. Needless to say, license is suspended.:{