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! :))

The only thing that worries me is your AME grounded you whilst awating the review of your ECG by the CAA. As far as I am aware this also covers your class 2 untill a cardiologist at the CAA has looked at your ECG readout.If he says its nothing then he will contact you and say so.
May I sugest you contact the CAA by phone or e-mail to clarify this and not rely on the website or hearsay.
Sorry about this but I have been there a number of times.
Jarvy

Whirls,
Just check that the quote is for the whole job.
I got a bill from the consultant for £300 ,I thought great!
Two days later got a bill for another £300 plus for use of hospital equipment and staff!
Hope your one is for total cost.
Lister:)

Jarvy,
I have clarified this with the CAA medical dept by phone. I said I'd read it on their website, and was it correct; I was told it was.

Lister,
This was a quote from the AME who is a CAA approved cardiologist...also the one I should have gone to see in the first place, but...long story....

Gordon Bennett, how I miss the common sense approach of primary care.:)

You can do it on the NHS, but will take long time.

Private for the test to be done will cost more then £300 with aviation cardiologist. I do not recall all the details, I belive just the letter (report from the doctor cost £220 - the consulation)
Then you pay for each of the tests you need to do, Echocardiogram was £375, exercise Electrocardiography was £280, + the 24 hour Holte test, do not have the cost of that, but would probably be another £200 - £300.

This was by an aviation cardiologist - no way will you get away with all those tests private for much less. I could have got all trough NHS, but GP had to refer you, and by that time and you get appointment, it can already have passed 3 - 4 months.

I bit the bullet, and then I am told I did not need to be investigated. Anyway best of luck, but at least budget with around £1000, I phoned several of CAA's doctors, and it was all more or less the same price.

Dear Ms Whirly.

My (probably imperfect) understanding on this is that LBBB is bad news(very), RBBB shouldn't be. The issue with ECGs seems to be when they show a change. Mine was diagnosed on my first ever ECG (RAF Biggin Hill 1976) and has shown on every one since. 23 years of mil aviation and 9 of civ later I guess it's still there.

Hope this helps - good luck

DH

Hi Whirlybird.

I've sent you a private message - please read !

hi there, an RBBB is not that big a deal. but if you have a left bundle branch block, then you need a pacemaker and I guess you'd not be deemed fit to fly.

I myself have an incomplete RBBB and am Class I fit n flying ! :ok:

I have sometime LBBB and at no time had or likely to need a pacemaker. As has been said before the heart has a built in back up system in place should it detect either LBBB or RBBB.

Class 2 priviledges
 

Whirly,

I have copied this from a Caa document which offers guidance as to the meaning of any of the limitations which can be placed against medical certificates.

SSL/FIL Limitation
Flight Instruction Using a JAA Class 2 Certificate to Validate a PPL (H)
In the UK it is possible to instruct on helicopters with a Flying Instructor (FI) rating and a PPL (Helicopters). Unrestricted Class 2 certification is usually considered as being compatible with a Class 1/OML certificate and this is the level of certification that is considered appropriate for a flying instructor. If a PPL (H) wishes to exercise the privileges of a FI rating but has a medical condition that would warrant an OML if he held a Class 1 certificate, he should be advised that he should not instruct ab-initio students. The AMS should be informed and the following limitation will be applied to his Class 2 certificate:
SSL/FIL “Flight Instruction Limitation”
No flight instruction prior to student's first solo cross-country flight.

I think its quite interesting as written, because you are a Cpl exercising your Class 2 priviledges with out pay! Not a PPL (Fi) Hope it helps

cab 3707,

Thank you; that's exactly what I needed to know! Last time I phoned he CAA medical dept they told me I couldn't instruct ab-initio students, but I hadn't read it anywhere and thought they were making up the rules as they went along. It's not what I wanted to hear, but at least means everyone is being consistent. Please could you post - or pm me - the link to that document.

Extra tests now booked for early September...I'll let you all know what happens.

Class 2 / OML
 

Hi Cab 3707 and Ms Whirlybird

Really interested in your topic as I'm in a similar position also. Had artery problems leading to angioplasty last august and have had to give up my beloved HEMS job in S.Wales as a result. I've had lots of contact with the CAA who have been very helpful and sympathetic but no chance of Class1 unresticted being re-instated. I was thinking of getting back into instructing with a Class 2 but obviously would not be able to make a living that way but then I saw Cab's post so perhaps there's a possibility after all. I have passed all the requirements on the CAA coronary algorhythm chart (except for perfusion scan , which I don't think will be a problem ) so think I will be able to get Class 1 OML / Class 2 unrestricted and then revalidate my FI ticket.

So, like Whirlybird I would also like to get a copy of the CAA document that was posted by Cab, so if you are about mate, please post a link or a p.m. so that we can go to the CAA with as much info as possible - it would be very much appreciated and thank you.

Regards............Tony Gilson :ok:

tgilson,

Cab 3707 may have contacted you already. If not, the paragraph he quotes is in a document called the "UK CAA Limitations Guidance document". I don't have the link to hand, bu a search should find it. It's guidance for AMEs on the limitations put on medicals.

Anyway, the last paragraph is the one quoted above. What it means, if I've understood correctly, is that with a Class 1 OML/Class 2 unrestricted, you can instruct, but NOT AB-INITIO STUDENTS. You also can't be paid unless you have a Class 1...or maybe you can, if you have a CPL, not 100% certain of that. Anyone know? I wouldn't have thought so, if you're instructing on the basis of your Class 2.

I now have my medical back with the restriction stated above.

LASORS gives some information about what instruction can be given by a FI with with an oml.
Have a look at page 76 and 77 of this... http://www.caa.co.uk/docs/175/Sectio...20(LASORS).pdf

Which is broadly similar to the entry above mentioned by cab3707 but I think the guidance documents on UK limitations refers to pre-JAR (ie pre 1999) CAA Class 1 medicals, not JAR class 1 medicals.


Edited to correct typos and clarify, (I hope).

Whirlybird,

How did you get on with your RBBB ?

Was reading this thread last night and the future Mrs. Wayne was getting rather irritated by the situation concerning your RBB. the Future Mrs. Wayne works in cardiology so took a professional interest in your situation.

(copied to your PM)

Extra tests being done today and tomorrow. I have my Class 1 medical back with an OML, which can also be used as a Class 2 unrestricted, so long as I get the tests done within two months. And after asking four people at the CAA, I finally have it in writing that I can instruct unpaid using my Class 2. If all is OK in a year, I get my Class 1 unrestricted back. Could be worse.

Whirlybird..

this is from Ftr. Mrs. Wayne...


As a Cardiac Physiologist who does these tests daily, your situation seems ridiculous. First off, RBBB is a conduction abnormality which doesn't warrant any concern unless your ECG showed up other problems such as Left Axis Deviation. (If you have a problem with both the right and left sides of the heart this can be more serious but would need more factors again to make it of great concern.) However, to only have RBBB is not really a problem. On this side of the heart there are various other conduction pathways that can be used to make the heart contract.

With regards to the tests that they are asking you to do, I can't see the sense. A 24 hour ECG tape seems the most reasonable thing to do, yet this will just show a bundle branch block morphology, which we already know you have from your resting ECG. I can't imagine it showing up anything else if you are otherwise fit and healthy. Not sure how much you're being charged for this, my hospital charges 160 pounds to put it on and analyse the results as well. (though the cost varies regionally, I'm in Surrey)

The echo seems utterly pointless. This looks at the structure of the heart and having established you have an 'electrical fault' not a structural one, this won't give any info on the bbb. Lets hope nothing else structural is found though!

The Exercise test looks at ischemic heart disease. Again, this is structural (whether you have blocked coronary arteries) and they are also notoriously more difficult to do on someone that has RBBB as the morphology on the ECG is different anyway. So again, can't imagine they are going to find anything there. You should do about 9-12 mins (it's on a set protocol) and then that shows there is absolutely nothing wrong with you.

Can't believe how they are not giving you the full medical classs 1. RBBB is nothing to worry about and had you not had an ECG as a routine you probably would never have noticed anything was wrong with you!

GRRR!!!! :ugh:

Thanks, Mrs Wayne!

Well, I had the tests done today, and FWIW, the cardiologist pretty much agreed with you. Apparently the RBBB hardly even showed on the ECG, but the computer said it was there, and once it's found, you have to jump through the CAA hoops. Everyone seems to agree that the CAA want to be seen to be checking everything out as carefully as possible. They didn't find anything, and all that happened was I came away £380 poorer, with aching knees from the exercise test (nearly 10 minutes, then I gave up; at 5ft 2ins I was running rather than walking as you're supposed to by that point; my legs weren't long enough!). But I still have an OML on my Class 1 (and an unrestricted Class 2) for a year.

Oh well, I make more money from writing about aviation than practising it anyway, so I'll instruct unpaid for a year to keep up my hours. Could be worse.

RBBB
 

Hey Whirlybird,

Glad to know they have not grounded you permanently, but does the restriction mean you have to go through all this again next year, or will just lift the restriction without all the hoop jumping.

Aviation journo, in what field?

Congratulations anyway.

Regards.

Air pig.

air pig, next year I just have to do another exercise ECG (yuck, I hate ******* treadmills) and my Class 1 medical. If all is well, that's it...for ever, as I understand it! Once RBBB has been proved to be nothing, the CAA won't bother about it again.

I write for several GA magazines, generally on helicopter related stuff, and I have a book on helicopter flying out too. But I call myself an aviation writer, not journalist!