JAA Class 2 Medical - ECG Problems!!

[ct8282]

Hi peeps.

I had my Class 2 medical ECG today (not the full medical which is next week). The ECG has come back with the following findings which understandably I'm very concerned about. I suspect some of you peeps have heard these statements before, and maybe had similar findings on your ECG so Iwas looking for some advice.

The 3 points are:

Sinus rhythm with sinus arrhythmia
Incomplete right bundle branch block
Borderline ECG

Now I have done some research via the trusty google searches and the info I turn up doesn't seem to suggest that any of these are major issues. The top one is apparently a common thing with most younger people which disappears with age.

The thing is I'm a very fit guy indeed. I train 5 times a week, running, weight lifting etc etc. I can easily run several miles without a problem and have never ever had any problems with my heart or general well being and fitness.

Do you think I should be concerned? Do any of you have any experience with these things. Most importantly, will these things stop me from achieving the class 2 medical??

[AvMed.IN]

Assuming you are working towards a class I medical in the long run, it can be safely assumed that you shall be fit, as far as ECG findings are concerned.
At the most CAA may seek an additional cardiological review, including exercise ECG, holter, echo and anything else, if required.
As for now, I would suggest, please do not worry about the findings, which are pretty normal in young people, including incomplete bundle branch block is found in 1-3%.
Cheers!

[LSC172]

JAR Med manual states:
---
Right bundle branch block [(RBBB)]
Incomplete right bundle branch block is seen in 2–3% of routine flight crew
electrocardiograms and appears to carry a normal prognosis in asymptomatic subjects. No special requirements are needed.
---

The above diagnoses were printed in the ECG printout? Those ECG machines sometimes make false diagnoses. The final diagnosis is made by the AME himself.

So no worries there. If someday the RBBB becomes complete, they might do some additional test. I would be suprised if they did any further testing at this point for class 2 medical.

[ct8282]

Thanks guys. Both re-assuring posts there which is what I needed at this stage as I'm really worrying about this.

I will post back on wednesday and let you know what the AME says.

[HEATHROW DIRECTOR]

Yes, ECG machine are fallible. A colleague of mine, another controller at Heathrow, went for his medical. Doc looked at his ECG readout and pronounced him dead!!

[homonculus]

LSC172 is absolutely spot on. The computer generated comments at the top of the sheet are total c@@@. No doctor would even look at them.

I am really surprised the person who gave you the print out did not explain this and gave you such angst. If they worked for me !!!!!!!!!

You need to ask the doctor, not the computer

[Flyin'Dutch']

Although it is possible to get some spurious 'diagnoses' the fact of the matter is that for the CAA there are 'acceptable' codes i.e. those 'diagnoses' which can be accepted for the purpose of medical certification.

Incomplete RBBB is a variant of normal which requires a phone call to Gatwick or a reading of the ECG by an approved Cardiologist but rarely more than that.

[homonculus]

Sorry Flying Dutch, you misunderstand.

The narrative printed out by the computer is normally WRONG. It uses a very simple algorythm and even a bit of movement can lead to life threatening diagnoses. The doctor, be it an AME or the CAA, will look at the actual waveforms and 'read' the ECG not the junk from the computer.

So I agree, if you are dead you probably wont pass the medical, but if the ECG says dead and you are alive you will.

[Flyin'Dutch']

Sorry homonuclus, you misunderstand.

The narrative can be wrong and therefore ultimately what matters is the trace itself as interpreted by a Cardiologist.

However the CAA allows ECGs which are either reported by the computer as normal or have an acceptable code can be accepted for certification purposes by AMEs who are not Cardiologists.

However if there is a different code that ECG needs to be interpreted by a Cardiologist acceptable to the CAA.

[LSC172]

So basically CAA trusts the ECG macines more than a non-cardiologist AME?

I am new to the field of aviation medicine but I find it hard to believe that this would be so. Have myself seen ECGs from even the latest machines with obvious ischaemic changes that the machine has interpreted as normal.

[Flyin'Dutch']

So basically CAA trusts the ECG macines more than a non-cardiologist AME?

If you were writing headlines for a tabloid you could put it like that.

The fact of the matter is that the CAA has looked into ECGs and obviously come to the conclusion that the predictive value of an ECG reported by the machines (only certain brands and models will do) is such that they are happy that when these codes appear on the ECG report that the chances of the patient having a cardiac problem is low enough for them to nail their colours to the mast.

Of course if the machine suggested that the ECG was normal and there were worrying signs on the trace it would be quite OK to comment on that; after all one has one's professional responsibility.

[LSC172]

Not trying to make catchy headlines.

I just find it surprising. Would even see it as a matter of trust. I would expect an AME to posess skills of ECG interpretation to the extent of knowing when to consult a cardiologist.

ECG interpretation is not an easy thing to do, especially if it is not part of someone's day to day. But as always one's professional resposibility is to know when to consult.

I do not argue that the CAA has looked into this. Once again, just surprises me.

[homonculus]

Surprises me too how many doctors cant read an ECG

My AME always uploads mine and I was told he needs it to be checked at Gatquick. I too would be horrified if the CAA relied on the computer says yes. I read several ECGs a day and as has been said it is not uncommon to pick up abnormailites where the print out says normal, although the opposite is far more common.

[ct8282]

Had my medical with the AME today. I passed everything but he says he will send my ECG scan to the CAA at Gatwick for their advice and so cannot issue me with my certificate until they have checked this over.

Apart from this he said I would pass a Class 1 on the basis that the ECG comes back ok.

The waiting and worrying continues.....:(

[homonculus]

Hang on - my AME sways this every time and my ECG is (or has been up to now!!!!!) absolutely noral - I always peep. So no hassle I suspect

[Tugnut]

My AME said the same to me. He looked at the trace and said "has anyone ever said right branch block to you" to which I replyed what's that! He then said it was probably due to the positioning of the leads and moved them around a bit. He then ran the machine again and it came back ECG normal!!! However I was assured by him that even if it was RBB it wasn't a problem. I did ****e my pants when he said it though :eek:

Tug

[ct8282]

That is very interesting indeed, and also worrying really. Are we really at the mercy of these machines that can be so inaccurate but play such a significant part in the decision making process for something so important!! Eeek