JAR Class 1 Medical - Heart Murmur

[FlexGate]

Hi guys, i've been reading through these forums for quite a well now and thought it was time to finally sign up and post a few questions that I have. Basically, im 22 years old and have had no health issues what so ever in my life apart from a heart murmur that got found by my GP a few years ago. Subsequently, I was told to go to the local Hospital and get an ECG done. I was told that I have:

Very mild mitral regurgitation / Floppy MV with Mild Prolapse

This has got me worried as im planning on obtaining my JAR Class 1 Medical and I am worried if I will pass the ECG test. The doctor however told me that it is very common and that there is nothing to be worried about. I have since gone to my second hospital ECG scan and have been told that there has been no detoriation of this condition.
I have performed a search on pprune and various other websites through google and people have posted that they have this problem, but not if it has prevented them obtaining a JAR Class 1 medical. I know a guy that had this problem but he obtained an FAA Class 1 medical, which from my understanding is more lenient than the JAR/CAA medical.

I have also looked at:
http://www.caa.co.uk/docs/49/SRG_Med-Mitral_regurgitation-Feb_06.pdf

This has split the different grades of murmurs into three; Minor regurgitation orMitral valve prolapse only, Moderate regurgitation and Severe regurgitation. If I just look at my condition and base it on this document, I should be okay to pass the ECG right? Or can you have a Very mild mitral regurgitation / Floppy MV with Mild Prolapse and exceed the limits of the Severe regurgitation as stated in that document?

Any help would be appreciated :)

[ricky4892]

Hey FlexGate, I'm sure you will be fine. If the hospital said your fine then you should pass the ECG with no problems whatsoever.
I got really worried too during my class 2 medical as I have something called Dextrocardia which means my heart is on the right hand side of my body (pretty weird, yes I know) but I still passed my ECG (although they had to swap all the wires around haha) and I sent a letter from my cardiologist to the CAA and they were happy with it!
:ok:

[HEATHROW DIRECTOR]

<<although they had to swap all the wires around haha>>

Bet that caused some fun!! An ex-colleague of mine went for his medical and they got some wires mixed up on the ECG. He went into the quack, who said: "Well, Mr XXX, according to your ECG, you're dead"!!!!

[pulse1]

I have had a similar murmur for years. Through ten years of annual Class 2 medicals my AME has not mentioned it. Wretched travel insurance companies on the other hand............:{

[FlexGate]

Thanks for the response guys, i'm looking to book an initial Class 1 in the next few months or so. Will also seek to get additional information on this from various AME's.

[AIRWAY]

Greetings fellow prooners,

How does CAA Medical dept view heart murmurs when issuing Class 1 Medicals?

I shall try and explain the story briefly.

When I was young I was diagnosed with an ASD, a small one this was 21 years ago, at the time the doctor said to my parents that the hole in the heart should close when I am older and advised us to return for a check up few years down the line.

Now years passed, I moved to UK and completely forgot about the ASD until my 3 year old was diagnosed with one and also a PAPVC, he had heart surgery everything went well and he is doing very good, no problems watsoever.

7 years ago I did a class 2 medical just before I started my PPL all was fine and a class 2 was issued.

Recently I went to the GP to have my heart checked he referred me to have some blood tests and an ECG and pending the results of these maybe an Eco at a later date.

He did hear my heart sounds and found a little murmur, hopefully nothing serious.

If nothing more than a little murmur is it an automatic bar for issuing a class 1medical?

Kind Regards.

[gingernut]

Try a search, as this has been covered before.

From memory, you'll need an echo to have a look at the flow of blood and the structure of your heart. (A simple procedure).

The CAA will probably want a cardiology opinion before they let you near a shiny plane.

[AIRWAY]

Thanks for the post gingernut.

Having bloods and an ECG first shortly, hope it is nothing serious, unsure how I would take it not being able to fly. :(

[AIRWAY]

Hi Flexgate,

Let us know how you do in your Class 1 medical.

My GP recently found out a small murmur so I Am doing bloods and an ECG shortly, hope it is nothing serious I am keen to return to flying asap.

All the best.

[FlexGate]

Airway,

Basically I decided to undergo a Class 2 Medical as I do not see myself start commercial flight training fairly soon with the current economic climate and the uncertainty of cadet jobs out there. However, I do wish to obtain a PPL as I would love to be able to fly for leisure. But if the market picks up for 200hr pilots, then I may go and do the ATPL, CPL, IR, etc through the modular route.

Now back to the heart murmur itself. When I had the Class 2 taken, everything was fine appart from the ECG, when the AME detected irregular patterns. But I had told him before the medical exam started that I had a Mitral valve prolapse with mild MR, so he wasn't that shocked by it. He couldn't issue me the medical there and then because he needed additional information about the murmur, so he asked me to get cardiology reports from the hospital.

And god bless the NHS, they took around 4 weeks for them to send me the reports after me posting my application form!!! However, I only have just received them last week and am hoping to recieve a letter from the CAA in the next 2 weeks or so about the results.

My Report came up with the following results:

REPORT (2009)
ECG: SR 80
Left Ventricle: Good LV function
Left Atrium: normal size
Aortic Valve: Tricuspid, opens well
Mitral Valve: Myxomatous floppy MV with prolapse of both leaflets, mild MR
Right Ventricle: Normal
Right Atrium: Normal
Tricuspid Valve: Normal
Pulmonary Valve: Normal

IVSd .852cm
LVIDd 5.16cm
LVPWd .969cm
LVIDs 2.19cm
Ao root diam 2.92cm
LA dimension 2.88cmThe Cardiology report also stated that my murmur was a grade 2. I'm not sure if they are within the parameters of the issue of a Class 2 medical, but I will have to wait and see. The AME also told me that the murmur parameters are basically the same as a Class 1 so if I can pass the Class 2 medical, I should have no problems with the Class 1 as everything else is in order (or seems to be at least), however there may be a restriction with the Class 1.

All the best to you as well, hope it all goes well.

[AIRWAY]

Hi FlexGate,

Thanks for your update.

I did my ECG recently and was advised that everything on the ECG was good/normal, but then again my GP heard a small murmur. Might ask to be referred to the cardiologist for an Eco to try and see the "full picture"... Maybe I am just worrying for nothing. :uhoh: But then again I would like to be sure on all counts before I fork out ££££ on a class 1 flying medical.

[gingernut]

I'm wondering if there is some confusion between the terms Electrocardiogram (ECG) and Echocardiogram ("Echo") in this thread:ooh:

Easilly done.

One Looks at the wiring, the other at (some) of the plumbing.:)

[AvMed.IN]

If in your case of ASD, there is nil/minimal valvular flow defect (Mitral regurgitation) on Echo and no conduction disorder on 24 Hr ambulatory ECG, a fit assessment, Class 1 OML, is likely. Regular cardiologist review shall continue to monitor for the same.
Your GP, probably wishes to establish the diagnosis, and thus the echo etc.
Hope it helps!

[AvMed.IN]

I do not wish to dampen your spirits, and the AME is the best judge, but please bear in mind that the presence of mitral regurgitation, due to a prolapsed leaflet, may put Class 1 OML restrictions.

[FlexGate]

I do not wish to dampen your spirits, and the AME is the best judge, but please bear in mind that the presence of mitral regurgitation, due to a prolapsed leaflet, may put Class 1 OML restrictions.

Is that a certainty about the prolapsed leaflet putting an OML? I know im clutching on straws here but aren't the parameters of my echo within the guidelines in the document below or am I looking at the wrong thing?

http://www.caa.co.uk/docs/49/SRG_Med...ion-Feb_06.pdf (http://www.caa.co.uk/docs/49/SRG_Med-Mitral_regurgitation-Feb_06.pdf)

Thanks for your answer

[AvMed.IN]

I agree there, as per the referred link, in case of "Minor regurgitation or Mitral valve prolapse only" you are fit Unrestricted Class 1/2.
ECG and Echo are the determining factors.

[FlexGate]

I have just got a letter back from the CAA today and it states the following...

Referring to the ECG done in 2009 at the hospital: "I note that you have a diagnosis of mitral valve prolapse and mitral regurgitation. The reports forwarded to us regarding this are satisfactory for an initial JAA Class 2 medical certification".

But then it goes on to say...

"At your initial JAA Class 2 medical examination, your ECG showed T-wave inversion in the inferior leads and non-specific T-wave changes in the lateral leads. This is likely to be benign finding, however as certificatory standards are high, if you wish to be considered for JAA Class 2 initial medical certification, we require you to undertake a clinical assessment with a local cardiologist to include an exercise ECG test".

Does anyone know how much it costs roughly for an exercise ECG?

Any help would be much appreciated.

[Kowboy72]

Cost is not much,

I had a similar issue going class 2 to class 1. They found a heart murmer and then off to the quack i went.
200hrs IFR started, commercial training on the way all up in smoke.....
Hyper Trophic Cardio Myopathy!!

So make sure its all good before you spend any more on training, casue my 50k is long gone!

But hey there is Recreational Flying in Aus !! 600kg MTOW, no pax and no fuel!!

[Kowboy72]

Repair for a hole in the heart is key hole and in and out in a day. If it is going to hold you back its not much of an issue to get it sorted. (without knowing anything more than what you have posted.) Partner works in cardiology!! :ok:

[AIRWAY]

Thank you all for the comments.

My GP said it is a "Soft systolic heart murmur"... Did ECG and the report was good, no problems, next step now is to do an Eco shortly.

So I am keeping my fingers crossed.

[FlexGate]

Just got back from the Aviation House at Gatwick. I had booked for an Exercise ECG with consultation which cost £195. It is one heck of a work out if you do not exercise regularly! My legs were on their last knockings when I had to inform the AME to stop it. My heart rate got up to 182bpm on the 4th stage, when the AME had set me a target of 198bpm before the test started. However, I managed to last over 12 minutes which was more than satisfactory. Then I got the good news that I have passed the Class 2, and was well within the limits and got the certificate issued!
However, the AME then informed me that if I wish to undergo for a Class 1 in the future, the current condition (MVP) should not be a problem providing it doesn't deteriorate that badly. So all in all, great news and I can now look forward to some PPL lessons. Thank you all for your support in this thread and PMs, it is much appreciated

[AvMed.IN]

Congratulations FlexGate. Now you could focus on your flying lessons rather than worrying about MVP and the licence.

[AIRWAY]

well done flexgate. :ok:

I still have to wait a while for my results (I hate waiting)... Doc heard a soft systolic murmur, ECG was good, now only ECO is outstanding... I am keeping a positive mind when the doc said it is "soft"... Hopefully wont be anything serious or barring when it comes to do the flying medical.

[FlexGate]

Thanks AvMed.In & Airway for the comments.

To Airway:

The AME basically said as long as there is not a lot of blood leakage from the Left Ventricle to the Left Atrium, certification should not be a problem. Have you undergone an Exercise ECG test yet? Because, before I undertook my exercise ECG, a few AME's had told me that it did not look likely for me to get medically certified but after the test, everything was clear and good.

[AIRWAY]

Hi flex,

I only did the standard ECG, which was a good result, next is an Eco on the 24th.
This waiting game is rather upsetting, whilst I want to start training ASAP (providing I am medical fit), I also would like to know If I don't have any major heart related problems... Time seems to drag itself. I am trying to be positive and do some theory reading, but then thoughts of what if I have this or that keeps resurfacing.

[AIRWAY]

Greetings,

Just got back home from my Eco.

I don't have official results in the sense of measurements, but the cardiac physiologist said my heart is working normally, everything is where it should be, and that there are no obvious abnormalities.

Because I had a small ASD when I was young, back then the doctor advised it should close by the time I am older. Now my GP heard a "soft" systolic murmur, and according to the Eco all seems to be fine.

The cardiac physiologist will write a report to my GP and then if further investigation is needed then she mentioned an exam called a Bubble Ecocardiagram.