Right Bundle Branch Block (RBBB)

[Whirlybird]

I just went for my medical and the ECG indicated RBBB....and suddenly I was grounded, at least temporarily :{

For those who are wondering, this means there is a blockage of some of the electrical impulses within the heart muscle, though I daresay a medic could explain it far better. Anyway, I'm hoping an AME or similar can answer some of my questions...

1) The AME who did my medical sent the ECG off to the CAA and said they might say it was fine. My reading of the CAA's website on this indicates they won't. It looks like I'll HAVE to have an exercise ECG, 24 hour ECG, and echocardiogram to find out if all is well or someting else is wrong. Is that the case?

2) My reading of the CAA website suggests that I can continue to fly on a Class 2 while the tests are being done. My AME didn't say that. Again, who's right?

3) If the test show nothing else wrong, will I get my Class 1 back. Again, my reading suggests that for a year I'll have to fly with a safety pilot...is that what 'OML' means? That's not great news for an instructor, so I hope I've got it wrong.

4) How much are these tests likely to cost, and is there any possibility of getting them done on the NHS, bearing in mind that for a Class 1 I think they have to be done by a CAA approved cardiologist.

5) Will I get any answers if I phone the CAA medical bods?

All advice - or comments from anyone with experience of this - very gratefully received! I was cutting back on instructing, but I didn't plan to give up entirely. :{:{:{

[Jarvy]

Sorry to hear this Whirlbird, I have had heart problems for about 5 years now so understand some of the problems.
I have a CPL(H) and sometimes a Class 1 (OML) medical.
1 The CAA will look at your ECG and WILL confirm this. They will ask for the exercise ECG to the Bruce protocol, a 24 houlter and an echocardiogram.

2 If your AME has grounded you subject to the CAA looking at your ECG then I'm sorry but you cannot fly at all as pilot in command. (same as if you had no medical)

3 If the CAA decide you have RBBB then a class 1 (oml) may be allowed. This counts as a class 2 and allows you to fly as P1 with a qualified P2 or as a P2 commercial. So not much good for instructing.

4 Its best that the CAA do the first tests at Gatwick. The prices are on the website. You may get them done on the NHS (I have had them done at the CAA, privately and on the NHS) but it is alot slower.

5 It is very difficult to get answers from the CAA and I have 5 years of practice. Best way is by e-mail.

Sorry for all the bad news.
If you have any more questions or just want to talk about this please contact me.

Jarvy

[Lister Noble]

Whirls,
I had exactly same as you but on a class 2 medical for PPL.
Then had a 24 h ECGr,stress test and echocardiogram.
All OK,but cost me around £650,this was 3 yrs ago,got my PPL licence back after 3 weeks.
I had to do it privately at Norwich University Hospital,tried the NHS but no luck.
Then March this year I got total heart block and had a pacemaker installed.
Got licence back after 6 weeks as PPL but flying on NPPL privileges,can fly up to three passengers anywhere in UK.
I could get my class 2 medical back after 3 months and fly PPL,but I thought why bother with the cost and hassle?
I spoke to the bods at CAA and they were most helpful.
A bit different for you,but anyway you should be OK and good luck.
Lister:)

[Fratemate]

G'day Whirls,

I wouldn't go retiring just yet as I've had it on almost every medical I've ever had. On joining one employer, the doc thought it was 'interesting', despite me telling him I'd seen it all before, as had my AME. Anyway, he emailed the results to a cardiologist who sent the result back almost immediately, saying there's no snags. So far I've had my ECGs looked at by English, American, Japanese and Australian docs and they've all begrudgingly given me Class 1 certs :ok:

Don't know the answers to your other questions but hopefully the Belgrano will give you the 'all clear' and you won't need the other questions answered :)

[BoeingMEL]

... but wish you all the best..... it DOES look as if (from other posts) things could well turn out fine for you. Fingers crossed. bm :ok:

[AgentOrange]

Whirlbird, had the same myself,

Firsy, go see your GP, he knows you best and probably knows a decent cardiologist. If you're really lucky you may get the first one on the NHS.

For class 2 med you have to undergo the three tests you mentioned, these are fairly routine provided your heart is structurally sound.

For class 1 med you need to undergo the three tests twice at least 12months apart then periodically thereafter.

Watch out for CAAs record keeping, its ****, ie:? obtain hard copies of everything and take the name of anybody you communicate with at LGW.

Hope this helps,

AO

[oscar1850]

Dear Mr Whirlybird


I was diagnosed with RBBB in the early 90s at the age of 35. I carried out a 24 hour ecg test etc etc with the CAA and have held a full unrestricted ATPL ever since. At each medical my doctor mentions the thing but it has never been of any consequence. I underatand that RBBB is a common symptom of having suffered a heart attack, however it can occur naturally and may be heriditary(as in my case). If this is the case it does not appear to be any problem whatever.
The only way you can resolve this is to contact the CAA and do whatever they say!! Good Luck.

[Saab Dastard]

Commiserations Whirls,

I hope that it works out well, and quickly!

Best,

SD

[HEATHROW DIRECTOR]

Ex-colleague of mine, Heathrow ATCO, had this problem but CAA Medics were soon happy that it was no problem and he went on to hold a Class 1 for many, many years until he retired.

[frieghtdog2000]

Had this 2 years ago - found by the CAA on ECG review - they put an OML on my Class 1. Did all the tests - 24hour ECG monitor, Exercise ECG, and Echocardiogram. Then further exercise ECG after 1 year - OML removed. Speak to CAA - they have a protocol. If you live in the South speak with Professor Joy at Nuffield Hospital in Woking - he is one of the approved consultants.

[gingernut]

It's more than likely that what was found was an "artefact." ie of no significance to you medically.

The AME is, however, duty bound to investigate further, due to the nature of your activities. The tests you suggest sound reasonable, I'm not sure about pricing, but about 3-400 quid for each one sounds about right. (Including interpretation).

You may be able to convince your GP for an NHS opinion, but he may find it hard justifying it-and as you may have gathered, communication at the interface isn't one of the NHS strong points.



The important thing is that is unlikely to kill you, and you should, hopefully be in the air again soon- keep us posted.:)

[Whirlybird]

Thanks everyone. I've been on the phone to my AME and the CAA medical bods, and the above all sounds about right. It sounds like I'm even allowed to fly on a Class 2 while they do the investigations...and I found that on the CAA website. Anyway, I'll keep you posted.

[tigermagicjohn]

I Have To Say One Thing, The Uk Ame's And Uk Caa Are Sometimes Completly Clueless Of This.
This Based On Personal Experience And £1200 Wasted For Nothing.

I Took My Class 2 With Ame Uk, "he Discovered Something He Thought Was A Problem"

Sent Report To Caa Uk. After Several Weeks They Required Further Investigation.

I Went To Medical Cardiologist, Spent £1200 - Test Was Fine, Abnormal To A Certain Degree - But = Nothing Of Importance.

Now Few Weeks Later I Went To Denmark For Class 1 Medical, They Did Their Own Ecg, And Told Me All Was 100% Fine, They Did Not Even Care About The Extra Tests The Uk Caa Had Made Me Do For My Class 2 Medical.

They Told Me Basicly That The Uk Caa Had Requested Something That Was Not Required, As My Ecg Was 100% Fine.

So Initally I Would Not Worry To Much, But I Guess It Is A Nice Way To Make Sure Doctors Make Some More Money In These Hard Times.

[FlyingVisit]

Whirlybird,

Good luck. Hope it all turns out OK!

[Bad medicine]

Gday Whirlybird,

As has been said above, in the vast majority of cases RBBB is perfectly compatible with a long and successful career. The investigations at the moment are to rule out nasty, but uncommon causes. Remember that you are lucky to get regular comprehensive medicals and most conditions are found early in pilots, allowing treatment at an early stage.

All the best,

BM

[HEATHROW DIRECTOR]

tigermagicjohn... I think you have a very unfortunate attitude towards the medics. Maybe Denmark, maybe Outer Mongolia, maybe Timbuktu medics would have a different opionion to CAA... but CAA has every right in the world to ensure that things are OK when they issue a certificate.

I know of two ex-colleagues who had their lives saved by things AMEs found so I have the utmost regard for them..

[99jolegg]

I had my initial Class 1 at Gatwick where this (RBBB) was picked up - the nurse said it wouldn't be a problem, and their cardiologist signed it off the same day leaving me with an unrestricted Class 1 - it all seemed like a bit of a non-event from start to finish.

I didn't have to have a Holter monitor or stress echo. Nothing more has been said about it.

Viral pericarditis is another battle entirely, though :suspect:

[tigermagicjohn]

"HEATHROW DIRECTOR" -
My view of medics is balanced - now explain me this, class 2 had a stricer policy then Danish Class 1 medical?

Furthermore Prof Joy who I visited for the additional tests, confirmed it was non issue - he also told me this was non issue even for class 1.

Now I visited Danish CAA for class 1, they did not even consider there was anything to investigate.

Now Denmark is a far more developed country then Mongolia and Timbuktu, and UK vs Denmark, I would believe UK would not consider Denmark as a 3.rd world country, as it seems you associate them with.

I was made to wait 2 months, worried, not sufficent information by the AME, I splashed the cash for a specialist - Prof Joy - who was excellent. However later to discover I should not have needed to either have the worry or splash the cash.

CAA evaluated AME's primary test result, and demanded further tests before they could issue class 2 medical.
Only to discover later that the result of the tests did not show any issues. In fact the AME checked me for about 10 minutes, CAA class 2 initial, and FAA class 1 - when looking at the ECG, did not really seem he knew what he was looking at.

Going to the Danish CAA class 1, was also initial, and lasted the whole day, and the doctors there actually did proper tests, I am sure the same at Gatwick, dont get me wrong.

However maybe I was just unlucky with my choice of AME.

I do not have an attitude against medics, I just explained what was my experience - and the facts which eventually came out.
The AME even sent the report to the FAA, temporary blocking my FAA Class 1 medical, that took me around 4 - 5 months to have cleared - and guess what?

Again they did not even require any more additional information or tests - it was all fine with them too.

If the doctor wants to say something about my health, he should first know what he is speaking about - referring to the expert is all very fine, but I want to know more from the AME, instead I was left believing for the following 2 months, I might have a heartattack - because the AME did not make clear the situation in a satisfactory manner for me.
My experience - not my attitude to medics.

My FAA and JAA class 1 medical renewal will of course be with a different AME next time. But £300 for a 10 minute consulation is not bad!

[JohnRayner]

RBBB can indeed be a normal variant in young otherwise healthy people. If the RBBB is a new finding when compared to previous ECG's taken then that indicates a potential change in the function of the heart then as such needs to be taken further.

So, young healthy dude with RBBB and no previous= no worries

Older, still healthy dude with new RBBB and previous normal ECG's = risk stratification for e.g. Ischaemic heart diseae.

Hence I suspect some of the variation in the stories I've read here.

Good luck Whirls, though I'm sure it'll all boil away to nothing

JR

[Whirlybird]

Thanks a lot, people.

I've now had a quote for all the tests for £380 for the lot, which doesn't seem too bad....compared to some quotes given here anyway! I'm going to wait till I actually hear officially from the CAA before I set things in motion, just in case their cardiologist decides there's nothing wrong on the ECG...one can live in hope.

NEW QUESTION....

While investigations are going on, and if nothing turns out to be wrong, I can fly on a Class 2 medical (or a Class 1 as multi-crew, but that's no use to an R22 instructor). Now, you can instruct UNPAID without a CPL. If I instruct unpaid, can I do it with a Class 2 medical? That way I could keep my currency and hours up for the next year. I seem to remember you can do this, but it's not in Lasors, and I'm not certain. Maybe I'll need to ask on the Instructors forum, but perhaps someone here knows, to save me starting another thread.

If you do know, please give me a link to the info if possible, as I'm wary of doing anything without proof in writing.

Thanks a million!

Whirly (who is female by the way, so not MR Whirlybird! :))

[Jarvy]

The only thing that worries me is your AME grounded you whilst awating the review of your ECG by the CAA. As far as I am aware this also covers your class 2 untill a cardiologist at the CAA has looked at your ECG readout.If he says its nothing then he will contact you and say so.
May I sugest you contact the CAA by phone or e-mail to clarify this and not rely on the website or hearsay.
Sorry about this but I have been there a number of times.
Jarvy

[Lister Noble]

Whirls,
Just check that the quote is for the whole job.
I got a bill from the consultant for £300 ,I thought great!
Two days later got a bill for another £300 plus for use of hospital equipment and staff!
Hope your one is for total cost.
Lister:)

[Whirlybird]

Jarvy,
I have clarified this with the CAA medical dept by phone. I said I'd read it on their website, and was it correct; I was told it was.

Lister,
This was a quote from the AME who is a CAA approved cardiologist...also the one I should have gone to see in the first place, but...long story....

[gingernut]

So, young healthy dude with RBBB and no previous= no worries

Older, still healthy dude with new RBBB and previous normal ECG's = risk stratification for e.g. Ischaemic heart diseae.

Gordon Bennett, how I miss the common sense approach of primary care.:)

[tigermagicjohn]

You can do it on the NHS, but will take long time.

Private for the test to be done will cost more then £300 with aviation cardiologist. I do not recall all the details, I belive just the letter (report from the doctor cost £220 - the consulation)
Then you pay for each of the tests you need to do, Echocardiogram was £375, exercise Electrocardiography was £280, + the 24 hour Holte test, do not have the cost of that, but would probably be another £200 - £300.

This was by an aviation cardiologist - no way will you get away with all those tests private for much less. I could have got all trough NHS, but GP had to refer you, and by that time and you get appointment, it can already have passed 3 - 4 months.

I bit the bullet, and then I am told I did not need to be investigated. Anyway best of luck, but at least budget with around £1000, I phoned several of CAA's doctors, and it was all more or less the same price.

[deltahotel]

Dear Ms Whirly.

My (probably imperfect) understanding on this is that LBBB is bad news(very), RBBB shouldn't be. The issue with ECGs seems to be when they show a change. Mine was diagnosed on my first ever ECG (RAF Biggin Hill 1976) and has shown on every one since. 23 years of mil aviation and 9 of civ later I guess it's still there.

Hope this helps - good luck

DH

[ariel]

Hi Whirlybird.

I've sent you a private message - please read !

[bad_attitude]

hi there, an RBBB is not that big a deal. but if you have a left bundle branch block, then you need a pacemaker and I guess you'd not be deemed fit to fly.

I myself have an incomplete RBBB and am Class I fit n flying ! :ok:

[Jarvy]

I have sometime LBBB and at no time had or likely to need a pacemaker. As has been said before the heart has a built in back up system in place should it detect either LBBB or RBBB.

[cab 3707]

Whirly,

I have copied this from a Caa document which offers guidance as to the meaning of any of the limitations which can be placed against medical certificates.

SSL/FIL Limitation
Flight Instruction Using a JAA Class 2 Certificate to Validate a PPL (H)
In the UK it is possible to instruct on helicopters with a Flying Instructor (FI) rating and a PPL (Helicopters). Unrestricted Class 2 certification is usually considered as being compatible with a Class 1/OML certificate and this is the level of certification that is considered appropriate for a flying instructor. If a PPL (H) wishes to exercise the privileges of a FI rating but has a medical condition that would warrant an OML if he held a Class 1 certificate, he should be advised that he should not instruct ab-initio students. The AMS should be informed and the following limitation will be applied to his Class 2 certificate:
SSL/FIL “Flight Instruction Limitation”
No flight instruction prior to student's first solo cross-country flight.

I think its quite interesting as written, because you are a Cpl exercising your Class 2 priviledges with out pay! Not a PPL (Fi) Hope it helps

[Whirlybird]

cab 3707,

Thank you; that's exactly what I needed to know! Last time I phoned he CAA medical dept they told me I couldn't instruct ab-initio students, but I hadn't read it anywhere and thought they were making up the rules as they went along. It's not what I wanted to hear, but at least means everyone is being consistent. Please could you post - or pm me - the link to that document.

Extra tests now booked for early September...I'll let you all know what happens.

[tgilson]

Hi Cab 3707 and Ms Whirlybird

Really interested in your topic as I'm in a similar position also. Had artery problems leading to angioplasty last august and have had to give up my beloved HEMS job in S.Wales as a result. I've had lots of contact with the CAA who have been very helpful and sympathetic but no chance of Class1 unresticted being re-instated. I was thinking of getting back into instructing with a Class 2 but obviously would not be able to make a living that way but then I saw Cab's post so perhaps there's a possibility after all. I have passed all the requirements on the CAA coronary algorhythm chart (except for perfusion scan , which I don't think will be a problem ) so think I will be able to get Class 1 OML / Class 2 unrestricted and then revalidate my FI ticket.

So, like Whirlybird I would also like to get a copy of the CAA document that was posted by Cab, so if you are about mate, please post a link or a p.m. so that we can go to the CAA with as much info as possible - it would be very much appreciated and thank you.

Regards............Tony Gilson :ok:

[Whirlybird]

tgilson,

Cab 3707 may have contacted you already. If not, the paragraph he quotes is in a document called the "UK CAA Limitations Guidance document". I don't have the link to hand, bu a search should find it. It's guidance for AMEs on the limitations put on medicals.

Anyway, the last paragraph is the one quoted above. What it means, if I've understood correctly, is that with a Class 1 OML/Class 2 unrestricted, you can instruct, but NOT AB-INITIO STUDENTS. You also can't be paid unless you have a Class 1...or maybe you can, if you have a CPL, not 100% certain of that. Anyone know? I wouldn't have thought so, if you're instructing on the basis of your Class 2.

I now have my medical back with the restriction stated above.

[Phororhacos]

LASORS gives some information about what instruction can be given by a FI with with an oml.
Have a look at page 76 and 77 of this... http://www.caa.co.uk/docs/175/Section%20A%20-%20GENERAL%20INFORMATION%20(LASORS).pdf

Which is broadly similar to the entry above mentioned by cab3707 but I think the guidance documents on UK limitations refers to pre-JAR (ie pre 1999) CAA Class 1 medicals, not JAR class 1 medicals.


Edited to correct typos and clarify, (I hope).

[Bruce Wayne]

Whirlybird,

How did you get on with your RBBB ?

Was reading this thread last night and the future Mrs. Wayne was getting rather irritated by the situation concerning your RBB. the Future Mrs. Wayne works in cardiology so took a professional interest in your situation.

(copied to your PM)

[Whirlybird]

Extra tests being done today and tomorrow. I have my Class 1 medical back with an OML, which can also be used as a Class 2 unrestricted, so long as I get the tests done within two months. And after asking four people at the CAA, I finally have it in writing that I can instruct unpaid using my Class 2. If all is OK in a year, I get my Class 1 unrestricted back. Could be worse.

[Bruce Wayne]

Whirlybird..

this is from Ftr. Mrs. Wayne...


As a Cardiac Physiologist who does these tests daily, your situation seems ridiculous. First off, RBBB is a conduction abnormality which doesn't warrant any concern unless your ECG showed up other problems such as Left Axis Deviation. (If you have a problem with both the right and left sides of the heart this can be more serious but would need more factors again to make it of great concern.) However, to only have RBBB is not really a problem. On this side of the heart there are various other conduction pathways that can be used to make the heart contract.

With regards to the tests that they are asking you to do, I can't see the sense. A 24 hour ECG tape seems the most reasonable thing to do, yet this will just show a bundle branch block morphology, which we already know you have from your resting ECG. I can't imagine it showing up anything else if you are otherwise fit and healthy. Not sure how much you're being charged for this, my hospital charges 160 pounds to put it on and analyse the results as well. (though the cost varies regionally, I'm in Surrey)

The echo seems utterly pointless. This looks at the structure of the heart and having established you have an 'electrical fault' not a structural one, this won't give any info on the bbb. Lets hope nothing else structural is found though!

The Exercise test looks at ischemic heart disease. Again, this is structural (whether you have blocked coronary arteries) and they are also notoriously more difficult to do on someone that has RBBB as the morphology on the ECG is different anyway. So again, can't imagine they are going to find anything there. You should do about 9-12 mins (it's on a set protocol) and then that shows there is absolutely nothing wrong with you.

Can't believe how they are not giving you the full medical classs 1. RBBB is nothing to worry about and had you not had an ECG as a routine you probably would never have noticed anything was wrong with you!

GRRR!!!! :ugh:

[Whirlybird]

Thanks, Mrs Wayne!

Well, I had the tests done today, and FWIW, the cardiologist pretty much agreed with you. Apparently the RBBB hardly even showed on the ECG, but the computer said it was there, and once it's found, you have to jump through the CAA hoops. Everyone seems to agree that the CAA want to be seen to be checking everything out as carefully as possible. They didn't find anything, and all that happened was I came away £380 poorer, with aching knees from the exercise test (nearly 10 minutes, then I gave up; at 5ft 2ins I was running rather than walking as you're supposed to by that point; my legs weren't long enough!). But I still have an OML on my Class 1 (and an unrestricted Class 2) for a year.

Oh well, I make more money from writing about aviation than practising it anyway, so I'll instruct unpaid for a year to keep up my hours. Could be worse.

[air pig]

Hey Whirlybird,

Glad to know they have not grounded you permanently, but does the restriction mean you have to go through all this again next year, or will just lift the restriction without all the hoop jumping.

Aviation journo, in what field?

Congratulations anyway.

Regards.

Air pig.

[Whirlybird]

air pig, next year I just have to do another exercise ECG (yuck, I hate ******* treadmills) and my Class 1 medical. If all is well, that's it...for ever, as I understand it! Once RBBB has been proved to be nothing, the CAA won't bother about it again.

I write for several GA magazines, generally on helicopter related stuff, and I have a book on helicopter flying out too. But I call myself an aviation writer, not journalist!

[air pig]

Hey Whirlybird

I humbly apologise labelling you a journo, a more devastating slight I could not have bestowed upon you.

Having done an exercise test, I can vouch for it being a pain in the a**e, but thankfully not in the chest.

Air pig.

[bbrush]

Anyone had RBBB with the new European Class 3 for ATCO's, and is the procedure similar?

Cheers

[ILS RWY27L]

bbrush,

That's me. This thread has actually been an interesting read. Upon my initial UK Class 1/EU Class 3 at Gatwick about three weeks ago [ATCO Licence], 'Left Axis Deviation' was reported on my ECG reading.

I had to have a follow-up consultation and exercise ECG on Tuesday. The exercise ECG went very well and I got pleasing results, however during my consultation, the Cardiologist seemed to pick up a slight murmur and has requested that I undergo an Echocardiogram. Hugely frustrating as it means a longer wait of uncertainty, not to mention the £250.00 price tag attached.

Have considered going down the NHS route [free of charge], however this is likely to incur further delays so may well have to end up returning to the CAA to get the Echocardiogram carried out. No request of a 24-hour ECG though.

Cardiologist informed me that the CAA will 'normally' still issue me with a EU Class 3 certificate provided that the murmur [possibly caused by a minor leakage from a heart valve] isn't too major.


Those are my experiences thus far. Has anyone else been issued with a certificate upon a discovery of a heart murmur? I'm trying to remain positive, but can't help getting a little anxious.

[extreme P]

Same issue for me. First picked up in SE Asia during the four hour medical with one of the most competent physicians I have encountered. He mentioned the result and he was sure I was well aware but I was certainly not. My questions were ultimately met with it's no big deal, lots of pilots have it.

I was however advised that if I ended up in the hospital with a heart attack the ECG would be useless unless the staff knew of the condition.

[HEATHROW DIRECTOR]

<<not to mention the £250.00 price tag attached.>>

Surely if you are a Heathrow ATCO you would not have to pay that?

[ILS RWY27L]

Surely if you are a Heathrow ATCO you would not have to pay that?


It's an initial Medical, HD; I'm not an ATCO just yet! NATS only pay for initial Medicals but nothing to cover any additional costs during this initial phase. 'EGLL' refers to my nearest major Airport, not my occupational base unfortunately! :ok:

Received news from my GP today that I would be looking at a three month wait, should I go down the NHS route. Would like to get things moving as soon as possible though, so I may have to end up forking out the money and return to the CAA. Given the fact that I need to get my certificate within twelve months of my conditional job offer, would encourage me to get things done quickly, so it looks to be the expensive route after all.

[HEATHROW DIRECTOR]

On the, thankfully, rare occasions when I have needed specialist examinations I have forked out for private treatment. With NHS it was 2-3 months of waiting and worrying but going private had the job done in a few days.

Good luck. Hope everything pans out OK.

[MadMurdock]

Can anyone tell me if this is a less significant form?
I've just had class 2 & had this picked up. AME told me one in five people have this & it's nothing to worry about, just needs to be reported. Also said won't affect me getting class 1 either.

[Whirlybird]

Yes, if it's incomplete there's no problem and you can get a Class 1. I found that out when doing some research. I think it's somewhere on the CAA website, but I can't remember where now.

[MadMurdock]

Cheers, Whirlybird.
I did have a quick search but never found it, however on looking again found it this time:
it's in JAR 3.145 (Subpart B) page 35

"Incomplete Right Bundle Branch
Block
This does not require investigation. The
RBBB algorithm only applies to
complete right bundle branch block."

I was starting to wory reading this thread, thought I would need countless extra tests (& £££££'s). Should have trusted my AME!

Cheers MM

[ILS RWY27L]

Current algorithm for RBBB for a EU Class 3:
http://www.caa.co.uk/docs/1943/RBBB%20Algo0609.pdf

It's strange, I haven't been requested to do a 24-hour ECG. Instead, just an Echocardiogram.

Thanks, HD. Hopefully things will pan out okay. I'm looking to book an appointment with the CAA as soon as possible. Might be a slight wait of a week or two as their Cardiologists are not in every day.

[stationcalling]

At 63, I`ve just lost my Class 1 Medical having been diagnosed with Atrial Fibrillation. The CAA, remember the days when they used to be a non profit-making organisation, have grounded me and sent me a copy of their Protocol and a list of Consultants and standard fees.
Now out of work, and surviving on 2 small pensions from previous employers, I took the cheap way out.
I took my CAA letters, including the Protocol to my GP, who I have known for over 20 years. She logged on to the local NHS site was able to get me an appointment at my local Hospital the following week. I have completed all the tests, didn`t do well on the exercise ECG, being overweight didn`t help, but so far it hasn`t cost me anything.
I`m on tablets approved by the CAA and so will try and get another excercise ECG at a later date and if that is satisfactory will send the documents off to the CAA, with the appropriate fee of course, for them to read and pontificate.

[ILS RWY27L]

Received confirmation today that I have gained my EU Class 3 [UK Class 1] Medical!!

This was following on from my original Left Axis Deviation. It emerged that I have a slight heart murmur, however following on from my Echocardiogram, the murmur seems minor enough for the CAA Medics to grant me my certificate!

I'll have to have another Echocardiogram in three years time to make sure nothing has changed significantly, but aside from that, my ATCO career can begin! I am absolutely ecstatic!


All the best to anyone going through the medical process. Although it can be costly at the CAA, they do a fantastic job and I wholeheartedly recommend their expertise.

[HEATHROW DIRECTOR]

So glad all has panned out OK. My wife has a heart murmur, which was only found with an echo scan 2 years ago. She had it checked recently and it had not changed so she has to have her next check in 3 years.

If you have a UK Class 1 medical there ain't much wrong with you!!

Hope all goes well with the course...

[ILS RWY27L]

HD: Many thanks!!

If you have a UK Class 1 medical there ain't much wrong with you!!

Very true!

[Peeliewally]

I have been invited to attend the Stage 1 Selection Tests for the position of Trainee Air Traffic Controller. My medical history is as follows:
1985 - heart valve replacement surgery to correct congenital heart murmur
1985 - cardiac pacemaker inserted as a result of above surgery (heart block)
I take warfarin & atenolol on a daily basis

I am a fit and healthy person who leads a normal active life and the only things I should avoid are things like airport scanners, big magnets & playing rugby!!

I've not been able to get a definitive decision from NATS or CAA but I would like to know before I go any further with my application as I don't want to waste NATS time if there is no chance of me passing the medical. I've sent details to CAA Medical Division at Gatwick airport but I have not had a reply yet.

Any advice would be most welcome as I would love a change of career at this point in my life. Qualifying as an ATCO is what I have my mind set on but if the rules say no, then I can say I tried.

[Peeliewally]

Thanks for that. I think I would be classed as unfit going by the info in the cardiology link.

[HEATHROW DIRECTOR]

Peeliewally. Apart from the medical aspects, at 39 you would find ATC training gruelling and IMHO there would be a greater than 50% chance that you would not make it to validation.

However, it has happened so I wish you the very best of luck...

[Peeliewally]

Thanks for your advice. I don't think being 39 stands me at any disadvantage, possibly more advantageous. I currently have a very demanding job supporting some of the most advanced technologies in the broadcasting industry. I work unsociable shifts for the worlds most respected broadcaster and I'm regularly required to work alone for hours on end with no help from anyone else. I understand completely that it is very different from Air Traffic Control and that ATC is probably one of the most stressful jobs out there. I like working under pressure and I do it every time I'm on shift. If I get the ok from CAA Medical department I will grab this opportunity with both hands and hold on very tight and I wont let go. This is probably the most helpful forum I have joined and I have utmost respect for all it's members and their opinions. Thanks again. I'll keep you posted as I await the news.....

[HEATHROW DIRECTOR]

I agree 100% that you should give it a whirl if the medics pass you. However, it is as well to be aware of the possible problems. My views are based on training controllers over a period of some 30-odd years, both at home and abroad. For example, radar control is a skill. Some can do it; others cannot. Unfortunately, in many cases, this does not become obvious until live training commences but it is easier the younger one is.

Good luck and keep us posted..

[belongins]

Whirls

Sorry I havent read all 4 pages of this thread but just to try and reduce any worry you have I too have got a RBBB and i am class 1 fit and flying:D

My mother had it really bad and had some ablative surgery and is now totally fine.
My bro (28) has is worse than me and not as bad as my mum and has some drugs from time to time.
I (36) havent had any issues (skips etc) since i last had mine looked at via the NHS circa 2007.

Via the NHS I followed the following route.
1995 GP referal - hospital, 24hr ECG and an ultrasound check out - all ok and nothing on he ECG.
Then in 2007
GP referral following an increase in the frequency of flutters from a skip here or there once every few months to several a day
Consultant referral
24 ECG
Numerous imaging including more ultrasound
Consultant check out - all fine. In fact he said dont let it stress you out hahaha

I then got the NHS records people (very helpful) to ship to me ALL of my records regarding my incomplete RBBB and hey presto handed them over to my Gatwick C1 examiner who was over joyed and has kept them on file....Yes i have my own copy to replace the ones they may loose:)

The C1 examiner praised the fact that i had compiled these records citing that if i come accross a difficult examiner in any furture C1 renewals i can just point to my records which all say I am fine.

I really hope this helps.
B

[Whirlybird]

Belongins,

Thanks, but that is actually irrelevant to my case. INCOMPLETE RBBB doesn't require any treatment or extra tests, and won't prevent you holding a Class 1. This is stated somewhere in the CAA protocol, which I think someone has given the link to forther back in this thread. COMPLETE RBBB, which I have, does need further tests. If you'd read the thread, you'd gather that my tests were all fine, and following another exercise ECG next August, I should get my unrestricted Class 1 back, with no other extra tests required, EVER.

Not meaning to sound critical of you, just giving the facts.

[DX Wombat]

Whirly, I was wondering how you were getting on but didn't like to ask. Glad to hear things seem to be going well for you. :)

[anotherthing]

I have a full RBBB.

It was investigated at OASC when I joined the RN to fly - I never even got told about it at the time and nevr knew I had one... it is so inconsequential.

The only reason I found out about it was when I went for an RN pre diving course medical several years later - the duty PMO came into the room to speak to me (he wasn't doing my medical but had been asked for advice on the ECG), because he said he thought he had recognised the ECG. Turns out he had done my initial medical at Haslar many moons ago.

Again, no problems with the fact I had a RBBB, so I was able to both fly and dive for the military.

Several years later at a loose end, joined NATS and as it was an initial issue of a CAA class 1 medical, I had to undergo a 24hr tape test. Again, it proved that it was 'just' a RBBB and there has been no problem ever since.

Every time I have an ECG, the RBBB shows (obviously), but it is never an issue as it is stated on my notes that I have RBBB.

The only reason it is investigated in the initial issue medical is to ensure that the abnormal ECG is only due to an RBBB and not masking anything else.

[Whirlybird]

And they don't like it if you've previously had normal ECGs and suddenly develop RBBB, in case it's indicative of something more serious. Mine doesn't appear to be, but they still insist on testing me again in a year to make sure.

[Whirlybird]

The year is up, and I just did another horrible exercise ECG. Nothing untoward was found; in fact, the RBBB this time was incomplete. The cardiologist has no explanation whatsoever for this as it should be impossible for it to reverse!!! However, once the CAA have see the results and all the paperwork is done, I should have my unrestricted Class 1 back again. I have no instructing work, but it's nice to know that if there is any I'm legal to do it again!

[air pig]

Hey Whirlybird,

Fantastic you aced the exercise test, b'stard things, useful only for torturing politiicans.

Good luck flying.

Regards.

Air pig:ok:

[allin121]

Hello,

nice to share the information which is important for me and others also to see.I hope that you will share that type of info in future also

thanks!!