Stress ECG ?

[kotakota]

Can anyone enlighten me as to what exactly to expect on a Stress ECG ?
Fast walking ? Jogging ? Slope ? Duration ? Target pulse ? Recovery rate ?
Have just been advised to expect one as I turn 60 , in addition to normal requirements . Would like to do some prep / practice.
FYI this si not a CAA medical ?

[gingernut]

More info here... http://www.patient.co.uk/reference/E...CG_Testing.htm

Most (UK) reports I've seen follow the protocol described above.

Some techie stuff here... http://www.gpnotebook.co.uk/simplepage.cfm?ID=926220294


It's a pretty good test for diagnosing ischaemic heart disease, (usually used to confirm angina).



If you've not got symptoms of heart disease, the value of exercise tesing is controversial- do you mind me asking, are they testing you as part of a screening program, or are you having symptoms?

(I'm not sure how predictive it's use is-but I guess commercial pilots may be a special case.)

[mrloop]

The previous poster gave some references to the treadmill test . I recently underwent an exercise ECG in Germany where they used an exercise bike with stepped increase in resistance during the test protocol. I found out that I can just about produce 200 W. So a couple of light bulbs worth of power...

[kotakota]

Thanks for that info .
No , I am not symptomatic , I do not have any probs - ECG fine , BP ok , could just do with being fitter and shedding a few kgs.
Its just the way of doing things where I am now for 60 year olds !

[AMEandPPL]

almost the same here . . . . . . .

Its just the way of doing things where I am now for 60 year olds !

So just where is "too far from the equator" then ? !

Situation is actually similar here in the UK (and presumably other JAR countries also). But the relevant age threshold is 65, not 60 years.

Any pilot in the UK who is maintaining a JAR class 1 as they reach their 65th birthday gets a letter soon afterwards from the CAA Medical Department at the "Belgrano". The first paragraph of the letter reads:

"It is a requirement under European Joint Aviation Standards for professional pilots over the age of 65 to undergo a cardiological review, to include an exercise ECG, every four years."

In my experience this situation most commonly arises in instructors. There are very few actual airline employees who have not been retired by their companies by the age of 65 !
Anyone who elects NOT to have this extra test done is allowed to continue flying, but only with class 2 (PPL) privileges.

[gingernut]

Intersting AME. 'spose the question is, "does it stop planes falling out of the sky."

Does it pick up any asymptomatic cases?

[AMEandPPL]

it sure does . . . . . . . .

does it stop planes falling out of the sky ?

YES is the answer, quite unequivocally !

Most recent example was in about March this year. Instructor at my own club, all medicals hitherto, including resting ECG's, entirely normal.
Reached 65, got the invite from the Belgrano.

Had his triple by-pass op in May . . . . . . . now convalescing very nicely, thank you !

The alternative scenario is that he could have been airborne with a twenty year old student flying for the very first time. Does not even bear thinking about.

[point8six]

I was " invited " to attend the "Belgrano" some years back , to discuss an anomaly on my latest ECG offering. The discussion only took place after agreeing to a stress ECG (since the resting ECG showed no such anomaly). After being briefed about the recovery facilities should I be unfortunate to suffer 'an event' during testing (!) (there are none at the centre, except very basic care), I proceeded to the treadmill. The exercise took 12 minutes and consisted of 4 x 3 minutes walking. After each interval the slope and pace was increased until I was virtually running for the last 3 minutes, all the time being wired up.
It took all of the morning, but the discussion took less than 5 minutes! A week later I received a letter apologising for having to call me in at all, and a copy of all my previous ECGs (maybe I should frame it?). That was 11 years ago and I still have a JAA class 1.
Good luck with it - worrying is counterproductive for a ECG!

[AMEandPPL]

"better safe than sorry" . . . . . . . . . . . .

A week later I received a letter apologising for having to call me in at all

Of course, this is what happens nine times out of ten, if not more.

But the view taken at the Belgrano is that it's better to put a few innocent and healthy bodies to a little minor inconvenience, than risk missing something more catastrophic - especially if there might be two hundred fare-paying punters sitting down at the back !

[point8six]

Point taken Doc (AMEandPPL), but the minor inconvenience related to a lot of stress regarding the possible outcome!
KOTAKOTA - if it really is necessary, check that the recovery facilities, where you take the ECG, are adequate!
The choice I was given was either agree to the stress ECG, or have my medical suspended pending invasive investigation. That was more stressful that the actual treadmill!
A former colleague who was feeling "under the weather", requested a stress ECG after his resting one was declared satisfactory. This also proved to be satisfactory, so he demanded further investigation. A year later, after a "triple", he regained his class one and continued to retirement as a Captain with a major airline. I'm sure there are pros and cons to ECGs, whether resting or exercise, and just because you get that precious certificate in your hands after taking the test, it doesn't mean that you will have a healthy heart until the expiry date. Perhaps it is just quicker and a lot more convenient than an invasive investigation! (Sorry I can't remember the medical term).

[sollas]

The stess ECG I had was on a tredmill.

You have sticky pads and leads put on, then your heart rate and blood pressure are taken in resting, then you go on the tredmill. The speed and incline increase periodically, your blood pressure is taken at set intervals. You basically have to keep going until you can't do anymore, then your heart rate/ blood pressure is taken and they monitor the time it takes to get back to your resting rate. They used the bruce method i think.

Hope that helps, good luck for it.

Sollas

[homonculus]

The problem is false positives and false negatives. We DO NOT USE THIS TEST in medicine for asymptomatic people because of these risks. A false positive can easily lead you down the slippery slope to an angiogram and surgery, both of which can kill (1 to 4% for surgery). The reason is that many people have abnormalities on an angiogram and there is little evidence (with some very specific exceptions) that surgery prolongs your life.

False negatives is where your exercise ECG is normal and you drop down dead the next day which suggests to me the CAA is once again throwing tests around and grounding or restricting pilots on dodgy data - as shown by Evans v CAA

I would be interested to know what they do if the stress ECG is positive and the angiogram negative!

[kotakota]

Gentlemen ,

Thank you all very much for all your informative information and views on Stress ECGs - exactly what I was looking for , and exactly what pprune is all about when it comes to supporting and backing each other up.
I realise that the motives for demanding such procedures, and the methods employed , seem to vary somewhat , but I have been assured by the local AME ( somewhere warm ) that it is no biggy for someone remotely fit and , obviously , with no defects.
If you have a problem , then you will not fly again , especially after 60 .
Any smokers reading this , give yourselves half a chance , and quit ASAP .
If I had continued with smoking , which I gave up at 35 , I would seriously doubt my ability to be aviation-fit at 60.

Take care and thanks again

KK

[gingernut]

Thanks for the feedback Kotakota.....I've gotta say we've got to get things in perspective here.

As regards your forthcoming test, I'm pretty sure you've got nothing at all to worry about- I reckon your drive to the doc's will be the riskiest thing.

As we sometimes find, here on this forum, we (the health professionals,) look like we're falling out.

But actually we're not, we just thrive on academic debate. It's actually quite healthy, and it's why medicine (and nursing) is such fun- we love challenge and change.

The fundamental question you've raised is this: should we use exercise ecg as a screening tool in people who are well?

The evidence say's no, but the pilot population is something special.

Both sides of the argument have been well presented.

I'm a little biased, I reckon if you give a bloke in a white coat something to play with, he's gonna play with it The important question is: will it make you live longer and happier, or in your case, will it make your passengers live longer and happier. In all honesty, probably not.

[Agaricus bisporus]

Wired to the monitors they have you put on a constricting gasmask, walk on a running machine, then walk faster, then faster, and faster, and faster still. Not allowed to run, they keep you going until you simply can't do any more; stagger, walk or breathe. If you are going to have a heart attack, ever, it will happen here.

Hideous, and far, far more brutal than any fitness test I ever did in the military.

I was called in for one when some new gnome became head of the CAA medical division and set off a campaign (new broom syndrome) against everyone with an "inverted T Wave" on their ECG, something I had displayed, unremarked for the previous 15 years, as do many of us.



Just another hoop to jump through.

[homonculus]

Am I just an angry old doctor?

'Thanks for the feedback Kotakota.....I've gotta say we've got to get things in perspective here'.

We sure have and we need to get angry and question this.

A quick Google shows ONE IN FIVE women will have a false positive and for the general population it is TEN TO FORTY PERCENT

If you are sick you may need grounding, but the issue is that this test has not been proven to be of use. Up to 40% of us may be grounded unnecessarily but most worryingly a proportion of the false positives may be harmed and eventually someone will die unnecessarily..

If this were a study coming to my ethical committee, or if I tried to do this to my patients unrelated to the CAA, I would stopped.

I presume, to be air to the CAA, that there must be additional filters in the system but I would love to hear their defence.

[AMEandPPL]

suggest something better . . . . . . . . .

eventually someone will die unnecessarily

Yes, it's true that most things human being do are less than 100% perfect, and accidents and unintended consequences happen in ALL areas of human activities.

Do you ever hear the suggestion that CARS should be banned, just because several dozen of our population are killed by them every day ?
Or planes, or lifts, or motor sports, or alcohol ?

The regulatory authorities would DEARLY LOVE a simple harmless test which could, with 100% sensitivity and 100% specificity, identify those airmen who were likely to experience a cardiac event in the air and put passengers at risk. Such a test DOES NOT EXIST - fact !

So, if it doesn't exist, should we just close our eyes to the problem ?
Then, when the inevitable happens, and a professional pilot dies at the controls, it is headline and TV news with the question "how can the authorities permit this ? ".

Damned if we do ; damned if we don't.

If there is a better way, for pity's sake tell us what it is !
Until somebody does tell us, all we can do is the best we have.

[eastern wiseguy]

they have you put on a constricting gasmask

I do one annually (type 2 diabetes) and I have never had the mask. I wonder if I am just lucky........still my least favourite part of the year though.

[AMEandPPL]

by the way . . . . . . . . . .

I presume, to be fair to the CAA, that there must be additional filters in the system, but I would love to hear their defence.

I should just stress ( pun intended ! ! ) that in my last post I am NOT responding on behalf of, nor trying to defend, the CAA. Not my job.

Yes, there ARE additional parts to the system (anyone here heard of the Medical Advisory Panel ? probably very few), and I personally believe it is as fair as we can get at the present time, given the limitations of the technology we currently have at our disposal.

[AMEandPPL]

one more thing . . . . . . . .

Sorry if it looks as if I'm rather monopolising this thread today !

they have you put on a constricting gasmask

It is not my own experience, either, that ANY kind of mask is worn while carring out a standard exercise ECG to the Bruce protocol. Because of a relatively benign heart valve anomaly I, too, have to have an annual cardiac review to maintain my PPL class 2. That includes an echocardiogram and an exercise ECG. Fair's fair - even we in the the business are subject to the same rules as everyone else !

That'll be my lot for the day now !