coronary artery disease
 

Hi i am hoping that someone wil be able to give me more advice on this matter. I have been struggling to get my class 1 medical approved by the caa in South Africa. I am 30yrs old and they have noted irregularities in my ecg and now suspect that i might have coronary artery disease (cad). I have seen a few cardiologist about this and they are all happy with my results and can`t see that i am a risk for flying commercially. Surely if a specialist sees me as fit, why am i then not allowed to fly? Perhaps someone has had a simular experience and could advice me what i can do to get this medical passed.

Doctors look at individual patients and decide if they are ill, if there is any treatment, and the risk:benefit ratio of treatment

Aviation authorities look at risk to third parties and are concerned at the likelihood of sudden incapacitation in the future. If there is a doubt, they will err on the side of caution.

So it is important that the two liase so the two can agree pathology (if any) and risk. This may still result in you having no license but needing no treatment, and indeed being for all other purposes 'healthy', but it does optimise your chances of getting your medical

I think you'll find that your 'average' cardiologist/specialist can say whatever he wants, if he isn't approved by your CAA then you'll need to find one who is. Pressure your CAA into telling you exactly what needs to be done to licence you.

They will probably also tell you that they're merely a 'regulatory body' and they don't have a medical suggestion. If you tell them that if you'd had a heart attack they would come up with something-eg a stent on the affected artery-so how about a suggestion now. In all likelihood the will insist on an angiogram-the gold standard they'll tell you-before this. Don't waste your time ( and money) on exercise ECG's, blood tests etc, which (from experience) they may well describe as 'merely screening tools' unless they ask for them. Usually anything to do with the heart is of a high priority to the medical profession so you'll be seen quit equickly

I'm sure there is a way forward but you will have to take the ball and run with it. It's too easy for a CAA to say 'No' (Nyet!) and not to have any risk on their shoulders. They can then go home in the evening knowing that they've done a good job and kept aviation safer having denied you a licence. Meantime you're no nearer to the flight deck. Nine months is not a bad average time to jump through all the hoops but you'll have to do all the pushing for a result in that time. That would include a mandatory period grounded after an angiogram:ok:

S

Which issuing authority's Class 1? I don't think that the SA CAA would recognize anyone else's Class 1 Medical. They'd want you to pass theirs. While the British Class 1 only requires a resting ECG the South African Class 1 initial and certain age related renewals require a stress ECG.
By the way it is not actually the SA CAA that undertake the medical recognitions or authorisations. SA Class 1 medical applications and reports still go to MMI (Military Medical Institute) at Irene and it is in effect the military who have the final say over your SA civilian Class 1.

Cavorting
 

Yup, missed the first line. No other Jurisdiction (eg pan European) will accept another's Class 1 medical. So Singapore won't accept HongKong for example, and v v . UK/JAA won't accept HKG. You'll have to jump through the hoops with whatever CAA the aircraft you wish to fly is registered with. That doesn't mean you won't get a Class 1 Medical from someone but it might restrict your area of operation further down the line if it's somehow restricted. Also, unless you can solve the problem (see my earlier post) you're going to have problems moving around on the planet to get a job. Each CAA is going to have a good look at your problem-if not solved-and decide whether to issue a Class 1 or not.

S

Thank you all for your advice on this i will certainly persist with this and hopefully finally manage to get my medical passed. I will certainly let you know how my progress is going (or not). :sad: If any of you might have some more advice for me please let me know.

Many thanks anyway.

Try to get your Cardiologist to put you forward for a high resolution Cardiac MR scan. not as invasive as an angiogram and may show things an angio will not show.

Thanks air pig i`ll try that.

Has anyone got advice about frequent Ventricular Ectopic beats, what is the attitude in aviation and what are the limits, I have been told %2 and what have people done to try to fix this problem.

Alfisti, from what I've read on here, it would be difficult to gain an initial Class 1 with established Ischaemic Heart Disease.

Having said that, it sounds like the diagnosis hasn't been established. It's very rare (but not impossible) in a 30 year old, and irregularities in an ecg is an unreliable marker.

The treadmill test, and those tests mentioned on here, are pretty reliable at excluding IHD.

Toruk Macto: My advice having been on the receiving end for the last few years is to see a cardiologist who is also an AME. That way he will practice what the CAA preaches and there will be continuity in paperwork between them.
Each knows and understands the other.

There are PAC's, PVT's, NSVT's, AF's etc etc.
You need to understand where the CAA are coming from before applying any of these labels to yourself.

From the high street run of the mill arrythmia (PAC/PVC) the CAA limit you to less than 3% over a 24hr holter monitor readout.
[I believe the average john smith has 86400bp day and the monitor mustn't show up more than 3000 irregular beats, from memory. A 'run' of beats mustn't exceed 3 seconds is another limit they look more closely at too.

25% of the population experience irregular heart beats. Approx 30% don't even know about it!!!