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Question re: Class 2 Medical

Old 1st Sep 2009, 15:12
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Question re: Class 2 Medical

First post, so please play nice

Just had a question about something that CASA's asked me to do as part of their assessment of me for a class 2 medical - basically, due to certain body metrics of mine, I have been told to get, among other things, a report from a cardiologist which includes a 'Symptom Free Stress ECG (Bruce Protocol)'.

I'm aware that this involves me running (walking?) on a treadmill while hooked up on an ECG to see if I have any cardiac conditions that might exist. But, I'm unsure about the actual intensity (read above) of the test and what kind of minimum standards, other than having a normal ECG, do I need to reach in order to 'pass' (such as a level in a beep test).

This question is probably more directed at those who have/had got their class 1 medicals, as I believe you have to go through something like this as a SOP?

But, if anyone could shed any light as to what occurs in the test, that would be much appreciated!
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Old 1st Sep 2009, 21:22
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Stress Test

Theflyinggeek

You may have been selected for a stress ECG for a number of reasons,
obviously because you triggered a cardiac risk assessment.

the following help qualify you.

BMI, body mass index, generally means you're not tall enough for your body weight.

Combined risk factors, smoking, family history, sedentary lifestyle.

Age, 50 or over then 55, 60 after that annually.

If you are reasonably fit it is no big deal.

you will be wired up as for a normal ecg, you will be advised that the test may induce a heart attack,
but you normally will be tested in a cardiac unit of a hospital anyway so help is near by.

then you start walking on a treadmill.

The treadmill will increase speed every 3 minutes, you will need to last about 15 minutes.

This is designed to take you to your maximum heart rate (pulse) and your blood pressure will be constantly monitored.

It is a good idea to have a brisk walk daily for at least 30 mins in the weeks leading up to the test.
Also a good idea to go to a gym and have a go on a walker (treadmill) if you haven't been on one before. Helps familiarise you with the test environment.

On the day of the test, wear your normal walking gear including joggers or walking shoes, and take a towel, you will be perspiring afterwards.

If for some reason you cant walk fast enough on a walking machine due to hip or knee surgery etc you may be tested on an exercise bicycle.

Or you can be medically induced to a max heart rate for the test and do it statically.

eenjoy the jog, MF
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Old 1st Sep 2009, 22:57
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The bruce protocol involves a treadmill execise in which you are wired to an ECG monitor.

I have done them numerous times for medical renewals. It involves a minimum of 8 minutes but they may go longer.

You start off at slow walking pace and there is a series of increases in pace and incline. They take you to the stage of heavy breathing and workload depending on your fitness. After you finish you sit down and they monitor your heartrate returns to normal in a normal fashion.

You need to book in with a Cardiologist. It can be done in their rooms either privately or in a hospital. This is to monitor you in case of problems. Purely precautionary. The cardiologist provides a report for your DAME and CASA.

Check out the CASA medical handbook on their website. Also Google search Bruce Protocol for a detailed explanation of the timing and speed and incline parameters.

I did a practice run on a treadmill before my first one to gain an appreciation of what is involved.
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Old 2nd Sep 2009, 00:00
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I think they may have done it solely on BMI, as none of the other risk factors really applies to me (put it this way, I've only hit my 20s).

So it starts at a walking pace...how does it become a running pace at its maximum? Or does it stay relatively slow at its maximum (i.e., jogging pace). I did have a look at the Wikipedia article on the topic, but I'm just not quite sure what those speeds translate to in the real world.
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Old 2nd Sep 2009, 01:27
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bah, BMI is a bunch of bs anyway. its only looking at body mass, not body fat. therefore a person who works out in a gym, pumping iron, fit as a fiddle, will return a high BMI simply because they have alot of muscle mass, but a DAME is going to say that their overweight or obese. what they really should be doing are body fat tests, alot more accurate in checking for risk factors accociatated with weight issues
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Old 2nd Sep 2009, 01:45
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FG,
It is not a flat out run. Fast jog. It will knock you up, though.
The whole experience is a bit scary until you've done it.

They will be looking to get your rate up to around 170bpm.
Recovery rate is what they will also look at.

You should feel quite good afterwards, providing they don't turn up any problems.
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Old 2nd Sep 2009, 05:36
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They want to see your "maximum" heartrate. This is calculated as 220 minus your age. EG, if you're 24 it would be 196. This is set on the ECG machine, and away you go.

Starts at walking pace at 2.7km/hr and 10 degree gradient. Then increases every 3 minutes. Stage 2 is 4 km/hr and 12 degrees. Stage 3, 5.5 km/hr 14 degrees stage 4, 6.8 km/hr 16 degrees. And so on increasing each 3 minutes. As the pace and incline keep increasing so will your pace. Check out the Bruce Protocol for the parameters. You can watch the ECG machine beside the treadmill and watch your heartrate increasing. If you calculate your maximum rate beforehand you can see how you are going for time. The doctor is interested in the "squiggles" on the screen, and if problems occur there would be warnings on the screen for him or the nurse who are monitoring it.

If you are fit, it will take some jogging by the end to achieve the maximum rate. If you're an older or unfit person you may reach the required rate with fast walking.

Last edited by zube; 2nd Sep 2009 at 05:47.
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Old 2nd Sep 2009, 05:50
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I think you're right theflyinggeek, it is because of your BMI. Because a class 2 medical doesn't require a EKG, the CASA medical review board probably wants to ensure your ticker is ok because of your BMI. I'd take a stab and say that if it were a class 1 medical and CASA had those EKG results, they probably wouldn't have had to recommend you for the stress EKG.

Can only hope you're not going to upgrade next year to a class 1 and have to get a EKG done all over again....
 
Old 2nd Sep 2009, 06:39
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You are required to reach nine minutes on a 'stress ECG' using the 'Bruce protocol', otherwise you will be required to undergo further testing for ischaemic heart disease.

Source: DAME handbook section 2.2.6 (Cardiology) paragraph 2.
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Old 15th Sep 2009, 04:16
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Had the test today, mostly normal and reached 10.35 minutes at 100% predicted (200 bpm) heart rate...I hope that's good enough for CASA!

There was a minor hiccup, having a slight high resting rate and losing my shoelaces during the walk. But yeah, I was scared that it'd be a full on jog all the way - which it wasn't.

Thanks for the pointers all!
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Old 15th Sep 2009, 04:53
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tmpffisch
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mostly normal and reached 10.35 minutes at 100% predicted (200 bpm) heart rate...I hope that's good enough for CASA!
More to do with what your ticker was causing the squigly lines to do...all the best of luck...you should be fine! (unless of course you're not)
 
Old 15th Sep 2009, 07:33
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it works on a point system. I think from memory you're allowed 12 points.
If you are over 55 you lose 8 straight up, if you are a smoker you lose x amt if you are a drinker (which none of us are) you lose more, if your BMI is out of "normal" you lose points etc etc etc. However if your Blood pressure is over 150/80 you're up for a stress test straight up and if you're a CPL or above and your serum lipids (cholesterol, fats etc) is up then you're gone again as you would be if your lung capacity test was low.

My friend, hop on a treadmill for as long as you can until your appointment with the cardiologist. Increase the speed and incline gradually to obtain your MHR (max heart rate). If you haven't a treadmill or similar go for an hour walk preferrably to include walking up a steep hill every day. This will open up those arteries and lungs more than enough to pass the stress test. Walk at a pace as if you are late for an appointment.

The good side of all this s**t is that you will get fit cos youre probably out of condition now, the downside is the expense.
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Old 15th Sep 2009, 15:30
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tmppfisch - I did ask the doctor running the test what their opinion was (I'm not sure if she was a cardiologist, but it was a specialist cardiology practice - Heart Care Victoria). Her opinion was that it was pretty much normal, so that's something to hang on to at least.

Who knows what happens behind the closed doors at CASA though?

--

PA39 - interesting post. With the points system, is it the same for Class 1 and Class 2 applicants? I'm only applying for the Class 2 with not real intention of taking a Class 1 at this stage (as I will be flying recreationally only).

Just so you know, I'm in the 18-21 year old age bracket, non-smoker and non-drinker (these days; I'd say I've downgraded from social drinker).

I've already done the stress test and have an appointment next week with the cardiologist to review the results (although they've already given me a preliminary report which seems all clear with the actual ECG printouts for my GP).

Hopefully CASA won't ask me to do any further tests - it's already costing me a s**tload of money.
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Old 15th Sep 2009, 19:41
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It' s important to note a stress test will only show some possible problems. Last year my old man did one for his class 2 and passed with flying colours. He was fit as a fiddle and working in a physical job everyday. Two months later bang, acute coronary artery atherosclerosis ... a.k.a Massive heart attack, he was dead before he hit the ground....

His DAME was just as surprised as the rest of us....
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