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Old 14th Oct 2003, 19:29   #1 (permalink)
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Join Date: May 2003
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Flat T wave

Not a happy Obs cop now,

Just had word from CAA that my recent ECG contained an abnormality. Namely that a flat T wave was present in the anterior lateral and anterior septal leads.

Obviously I am now concerned as to 2 major issues.

Most importantly, what kind of abnormality causes the flat T wave. I am a afirly fit 29 year old with no previous heart problems, no family history of heart problems and apart from the flat T wave, no other signs or symptoms.

Secondly, is this likely to affect my class 1 medical and if so how?

Any advice gratefully received.

Obs cop
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Old 14th Oct 2003, 21:44   #2 (permalink)
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number one - go see your GP, if there's any problem with your heart itself, best get to it ASAP.
I just did a google on "Flat T wave" and came up with a few things, namely thiroid abnormalities, as well as the more alarming stuff. But as you're young, fairly fit etc (smoker?, drinker?, how's your diet?), it's probably entirely treatable.
Not that I'm qualified in any way of course, but when I was 16, and in the Scouts, I took part in a raft race, part of which involved carrying the raft for about a mile. I wasn't that fit, pushed myself too far, and ended up damaging my heart, or rather its firing sequence mechanism. It was rather scary at the time, not least for my parents, and I ended up learning quite a lot about cardiology. All perfectly healthy and normal now.

Don't panic.

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Old 14th Oct 2003, 23:23   #3 (permalink)
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Very non-specific abnormality and in your case -- i.e. fit 29 year old with no known medical problems or symptoms -- very unlikely to be of significance. Go and see a cardiologist, but I wouldn't sweat overmuch at this stage.

If you do enough ECGs on normal people you pick up some vague abnormalities. That's the down side of any screening test and ECGs are no different.

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Old 15th Oct 2003, 00:21   #4 (permalink)
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Funny coincidence.

I have noticed an irregular heartbeat, or arrythmia, over the last month or so. Saw the quack and they plugged me in for an ECG. Yesterday I went for the results and he said that whilst there was some electrical abnormality this is normal in many cases.

He's referred me to a cardiologist to see if it's worth having a 24 hour ECG to really isolate what the problem (if any) is.

He also said that if it was a single arrythmia, i.e one beat a few times a day they don't even treat it.

I am 36, non smoker. I gave up caffeine about two weeks ago to see if that makes a difference.

With regard to flying, the flight safety foundation produced a paper on arrythmia in pilots which covers the rgulatory aspects, here's a link.


You have to register for publications but they are free. It's in the human factors, most recent publication, but if you can't find it pm me and I'll send you a pdf.

I've always taken my health for granted and it's a bit of a downer when you find out something may be wrong. However from what I can find out this is quite a common condition.

All the best,

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Old 15th Oct 2003, 01:34   #5 (permalink)

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About two weeks after my medical 3 years ago, I had a phone call from the doc at around 7.30 one night. He said that the CAA had concerns over my ECG print out because it showed a flat "T" wave and that I shouldnt fly. He asked had I experienced chest pains? I hadnt, but ran round the block just to be sure!!! Next thing is that I attend the local cardiac unit, they wire me up to televisions and computers, make me breath so rapidly that I nearly pass out. Then they put me on a running machine that gradually gets faster and faster and tips steeper and steeper until I fall backwards off the thing exhausted. About a week later I get a phone call to say all is well and that the flat T wave was not a problem and that I can fly again. The chest pains came later tho' when I got the bill from the cardiac unit!

What seems to have happened is that the ECG machines have got a lot more sophisticated in recent times and now flag up automatically if any sort of irregularity is detected. Additionally, ECG traces are sent to the CAA and a Cardiologist examines them. I understand that T wave irregularities are often detected and that a flat "T" wave is "normal" in some people although there is no heart defect as such. The last medical I had, the machimne actually printed "Flat "T" wave" on the print out but nothing was said by the CAA when the printout reached them.

Don't panic, all may be well!
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Old 15th Oct 2003, 03:14   #6 (permalink)
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Sensible says.....
< What seems to have happened is that the ECG machines have got a lot more sophisticated in recent times and now flag up automatically if any sort of irregularity is detected. Additionally, ECG traces are sent to the CAA and a Cardiologist examines them. I understand that T wave irregularities are often detected and that a flat "T" wave is "normal" in some people although there is no heart defect as such. The last medical I had, the machimne actually printed "Flat "T" wave" on the print out but nothing was said by the CAA when the printout reached them.

Don't panic, all may be well!>

Aviate 1138 replies.....
A few points..... cardiologists do not all agree. Were you in the USA they probably wouldn't even question the situation. The CAA is Paranoid about heart situations. And have you had a Thyroid level check? Does funny things to heart rythyms sometimes if it's on the low side.
Each advance in technology produces people who have justify the expense involved. Will we ever be rid of red tape?
Somehow I doubt it.

Get referred to Prof. Duncan Dymond at Barts. Top man.

Above all don't start checking your pulse etc. Its called White Coat Paranoia. Your blood pressure skyrockets when a BP monitor is applied, drops as you walk out of the surgery!

Good luck

Aviate 1138
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Old 15th Oct 2003, 09:30   #7 (permalink)
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Thanks all for such a quick and positive response.

In some ways, I am fortunate that I have never had cause to really question my health before.

The CAA have referred me to a list of aviation related cardiologists which I have to be seen by within 2 months.

I shall let you know the outcome, but here's fingers crossed.

Thanks again

Obs cop
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Old 15th Oct 2003, 10:26   #8 (permalink)

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Sensible brought up the point that when you have a treadmill ecg they test you to apparent destruction.

I have done a few of these at Gatwick with the CAA and am becoming more and more suspicious of its use.

You are wired up and informed by the nurse that the "normal" time is nine minutes. This leads you to assume that if you stop at 8 minutes you will fail. It also kicks in the competitive nature of pilots in that we try to beat that (especially when you have just met a 72 year old in the waiting room who did 14 minutes as I did...)

So the treadmill gets faster and faster and steeper and steeper. I usually go for twelve minutes which last time got my heart rate up to 179. I am early fifiies, BMI 22 and jog 10k a week so I am vaguely fit.

I now read in the literature that it is very unwise to push your heart over the rate 220 minus your age. I also read that if you excercise to this rate and then stop without a cool down period "arrhythmias are common in the recovery phase." There is no cool down phase in the CAA test. Just stop and lie down.

So when, surprise surprise an arrhythmia showed in the cool down phase the cardiologist looked serious and asked me to come back next year. To keep his numbers up?

Next year I shall stop at nine minutes exactly.

Grizzle over.
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Old 18th Oct 2003, 18:22   #9 (permalink)
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Obs Cop, I too was shocked to be told about "Flat T waves" at around your age. I had to have another ECG and the nurse said it was quite common and would change by the minute and there was no reason to think the next ECG would be anything but normal... which it was: drama over - no mention of it for 7 odd years now.

Most likely no cause for alarm.
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Old 19th Oct 2003, 04:12   #10 (permalink)
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Hope I can replicate your experience,


Obs cop
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Old 21st Oct 2003, 19:16   #11 (permalink)
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Groundbased, That publication ref arrythmias is well out of date and whilst it gives basic information is about 15yrs behind current understanding and treatment, if necessary, of the problem.
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Old 3rd Jan 2004, 00:22   #12 (permalink)
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OK Obs Cop - How did you get on?

After my cheery post, I went for my next medical and have to see the cardiologist with flat T-Waves again!
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Old 3rd Jan 2004, 16:55   #13 (permalink)
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not much movement I'm afraid.

I have been referred to a consultant cardiologist and am due to complete an exercise aka treadmill based ecg.

I should know more once that is completed.

My fingers are now aching from being crossed so much.

Obs cop
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Old 8th Jan 2004, 05:38   #14 (permalink)
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Obs Cop.

Don't worry too much. I had a flat T wave throughout my career. (Retired a couple of months ago after holding a Class 1 for 37 years). Still hold a Class 2 for private flying.

I was never referred to a specialist for that problem and was given my initial medical by the RAF CMU, although was referred for a "Left Axial Deviation" Apparently the heart changes position in the chest cavity over time. Mine just changed slightly quicker than the average. When that was investigated I pointed out to the specialist (as I did to any new AME) that they would find the Flat T wave. It did not concern him at all and I was cleared with the Left Axial Deviation.

I have always been of stout girth. When I questioned the condition with one AME he sid it was pretty standard for large chaps. He then showed me the ECG trace of who he referred to as a skinny concorde pilot and the T wave was like Mont Blanc!!

The only interesting thing though was at one of my last medicals the doc said that had I been French and subject to their rules from the word go in the 60's I would not have got a French Medical.

Best wishes
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Old 9th Jan 2004, 08:49   #15 (permalink)

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Sheesh, if we queried every errant looking ECG, we'd have the cardiologists here flat out 24/7, but saying that, are a great diagnostic tool. They are able to pick up ischemia (dead and scarred tissue), abherrant activity or lack of electrial activity to the heart muscle.

Quick overview of an EGC....

It is a picture of the hearts electrical activity and can be "observed" from a number of different angles. Something like looking around the exterior of an aircraft on preflight. If you stand and look at the front, you cant see the tail, so to see it, you walk around the back, and so it is with reading ECG's. Each lead has a specific placment and in reference to other leads creates a line of electrical activity on the portion of cardiac muscle it is "looking" at.

Thus the multiple lines on the printout.

Hearts have four chambers, two atria up the top and two ventricals on the bottom. The left side is much thicker and larger than the right, as this is the pump that supplies the aorta and thus the blood supply to the body. The whole electrical supply to the heart tissue depends on an effective chemical reaction to take place. Left side thickening is common in athletes.

The electrial heart function is a chemical reaction and very basically involves Calcium, Potassium and Sodium. Any abnormality such as dehydration, too much or too little potassium or changes in calcium levels will affect the conductivity of the heart. This is where the thyroid changes or kidney disease can affect heart activity.
Other major and common factors involve lack of effective oxygen to the cells, and either too high or too low blood glucose levels. Oxygen and glucose supply the energy that the cell needs to function. Water is a mediator - a transport agent if you will.

The initial electrical activity seen in the wave form is the Sino-atrial node activating all the excitable cardiac cells which in turn contracts the atria. There is then a short pause while the atria fill the ventricals. This is then followed by a triggering of the Atrio-ventricular node a short time later as the electrical wave hits it. This in turn fires down the septum of the heart (the layer of muscle between the ventrials) creating the QRS complex, then after the electrical activity has gone down the septum and continued around the outside of the ventrical thus contracting them, they repolarise creating the T wave, after another short pause as the ventricals empty and the atria refil. This is then followed by a longer pause, and the process starts again.

Any one of the cells has the capability of self firing if required, without the stimulation of the node initialising an electrical "wave". If the cells bellow a damaged area dont get a stimuli, they fire off by themselves, usually at a different rate than the nodes firing rate, thus the electrical activity looks different to the standard norm.

For example if the sino atrial node does fire but the area around the atrio-ventricular node is damaged, the ventricals will fire off after waiting for the message and without the required stimulation, thus creating a lag between electrical activity and hopefully an effective contraction of the ventricals. If the damage is extensive enough large portions may fail to fire, or fire at abnormal rates causing abnormal rhythms. This is one of the results of heart disease leading to heart failure.

This is great in one respect, our pump has three ways of continuing operation if one of the nodes or bundles fail. Good for human survival, bad when the doc sees the ECG. Some misfiring can be caused by chemical imbalances, some by heart muscle damage, others can be genetic and so on. Some folks will be completely assymptomatic. (no obvious symptoms)

The normal wave structure the Docs are looking for is a nice P wave (atrial contraction), QRS complex (the ventricals contracting and the atria repolarise at this point as well, but cannot usually be seen as the electrial conductivity of the ventricals is much stronger) and a T wave (the ventricular repolarisation phase). Each segment is broken down into time lapses for which a standard has been developed.

One good indicator of heart disease is abnormalities within the various segments of the wave form.

Some anormalities occur simply with dehydration, stress, weight if the patient is carrying heaps up top, any sweating, deviation in the placement of the leads, electrical activity within the vicinity, movement etc and the list goes on...

The diagnostic facility in most 12 lead ECG's is brilliant and is designed to bring attention to what may be entirely normal for that patient. Any changes to ECGs from the patients norm are usually investigated fairly thoroughly, especially if associated with chest or thorasic back pain, left shoulder pain, or shortness of breath either during exercise or at rest.

Hope I havent bored everyone, apart from flying, ECG's are a pet topic.....

Last edited by Northern Chique; 9th Jan 2004 at 09:15.
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Old 10th Jan 2004, 00:40   #16 (permalink)
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I was told ages ago that I have an inverted T wave. Don't know if that is relevant to this posting. My class 1 renewal doc and the CAA aren't concerned, they say it is normal for some people!!
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Old 25th Mar 2004, 20:56   #17 (permalink)
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Good news!!!! ish?

Great in fact, the flat T wave was not apparent in either a normal or exercise ECG done by my consultant.

Basically, he thinks the leads on my first ECG may have been slightly misplaced giving an incorrect reading. He could find no way of replicating the readings. He did find an anomally (spelling?) in one of the waves (different to the first one!) but it was unaffected by the exercise test and therefore he was satisfied that combined with my age and general fitness it has probably been present since birth and is of no consequence.

So my class 1 is retained. Wohoooooooo.

Thanks to all for the advice support and help.

One of the best things about PPRuNe is just such support.

Obs cop
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Old 25th Mar 2004, 21:18   #18 (permalink)
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Nice one ! Congratulations... I can only hope to be that lucky when i go in for mine.

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Old 30th Mar 2004, 10:50   #19 (permalink)
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i was diagnosed with inverted t waves in v5/6 ten years ago. it sparked off a series of tests (all proved there was nothing wrong) and caa parnoia that still dogs me today. Any new doc has a fit when they see it and the caa albeit under pressure from my ame have agreed only to review me every 5 years .Quite annoying when i'm fit healthy and sitting next to a hugely overweight colleague who has never done a days exercise, smokes and drinks. Just because i have a non normal indication i get hounded by bullshit and this chap cruises his medical. Ame standardization springs to mind.
As to the original post , dont sweat it mate, as individuals the caa staff will try to do all they can to help.I never had my medical withdrawn. Just beware of the system lurking behind the individuals.

good luck
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