Right Bundle Branch Block (RBBB)
 

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. :{:{:{

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

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:)

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 :)

No cardiac expertise or experience here Whirls...
 

... 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:

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

oscar 1850
 

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.

Commiserations Whirls,

I hope that it works out well, and quickly!

Best,

SD

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.

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.

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.:)

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.

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.

Whirlybird,

Good luck. Hope it all turns out OK!

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

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..

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:

"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!

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

New question - please read!
 

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! :))