Hypertrophic Cardiomyopathy - Class A detect it?

[Andy Rylance]

I have been told of a real tragedy recently. A PPL who was going for his CPL and ATPL was out running and died from a sudden heart attack caused by hypertrophic cardiomyopathy according to the post mortem. Only in this 30's.

The question has to be asked.

If he had the Class A medical as soon as he started training for his PPL, would this have been detected and treatment possible?

[gingernut]

Andy, that's terrible news.

I havn't the expertise to answer your question, but from what I gather, screening is only performed on those individuals at risk- (is there a family history?).

I had a delve here http://gpnotebook.com/simplepage.cfm?ID=-1617297364

From what I read, I doubt a physical exam would reveal much at all, I'm not sure of the value of the resting ecg performed at medicals- I guess this would depend on the "natural history" of his disease. (Perhaps this is where a specialist cardiological opinion could help).

From what I gather, the "extra's" performed at a class1 medical would have had no added benefit in predicting the outcome.

It's unlikely a 30 yr old would undego echocardiogram,as on the face of it, your friend would present as a fit young individual at medical.

[cats_five]

I have been told of a real tragedy recently. A PPL who was going for his CPL and ATPL was out running and died from a sudden heart attack caused by hypertrophic cardiomyopathy according to the post mortem. Only in this 30's.

The question has to be asked.

If he had the Class A medical as soon as he started training for his PPL, would this have been detected and treatment possible?

Very sorry to hear of this - it will be shocking for his family.

Not sure if the medical would have picked it up, but it's quite possible the guy had a family history of early heart problems, and HCM has an inherited component and in cats at least one responsible mutation has been found. If the genetics are the same in humans, it should be possible (IMHO) to test individuals with a suspicious family history for the mutation. However, it also looks like there is a second mutation producing some of the cases in cats, so gene testing won't pick it all up.

Not having ever done a class A medical I have no idea if it goes into family history, and the other thought is that although most genetic disease is inherited mutations do happen all the time, and they can also pop up out of the blue.

[Jarvy]

I developed cardiomyopathy that was only found by my AME following an ECG.
My GP claims that if I hadn't had a class 1 medical there is a good chance I would no longer be around.
Treated with drugs and now have a class 1 (oml).
Jarvy

[spInY nORmAn]

I was diagnosed with HCM 12 years ago at age 40. I had been symptomatic (shortness of breath and ocassional dizziness) for about two years prior but my GP could not provide an explantion/diagnosis. A new GP then discovered a murmur, this being one of the most common symptoms leading to further testing. Once identified by auscultation (listening with a stethoscope) the next test is usually an echocardiogram. This confirms the presence of HCM and the degree to which it is present. Genetic testing, as far as I understand, is rarely used. Once diagnosed, testing of immediate family is usually recommended and is done by echocardiogram.

If the thickened heart muscle causes a partial blockage of blood flowing from the left ventricle, it is called Hypertrophic Obstructive Cardiomyopathy (HOCM). The convential wisdom is that the later in life you are diagnosed, the better the prognosis i.e. if you've made it this far, things ain't too bad! HCM is often the cause of sudden death in young athletes that you often see reported in the media.

Treatment usually involved medication (for the rest of your life) to treat the symptoms. Severe cases may require surgery or most extremely - heart transplantation.

The bottom line is that initial diagnosis is either post-mortem, or by simply listening through a stethoscope. The prognosis is usually positive with ongoing care.

[RobertS975]

The diagnosis requires an echocardiogram at a minimum, and since the left ventricular outflow obstruction tends to occur only with high cardiac outputs and vigorous exercise, it may require a stress echo to really detect.

There is a finding called asymetric septal hypertrophy which can be seen on the echo study.

[Cricket23]

Andy,

Sorry to hear your news.

For what it's worth I think that his medical exam could have picked up a problem. I have HCM which was picked up via a company medical ECG. A few months later when having an ECG during my PPL medical the same pattern was picked up.

By this time, I'd been through the 'mill' as far as testing was concerned and was able to present the CAA with the necessary test results so I could get my licence.

Regards,

C23