Get your medical back after a heart attack

In January, a 66-year-old airline transport rated pilot went to the ER for chest pain. He was evaluated for a myocardial infarction (heart attack). The enzymes that we do when people enter the ER were negative for heart damage and his EKG was within normal range. However, his chest pain persisted.

He stayed overnight in the hospital and was set up for an angiogram to check out his coronary arteries the following morning. The angiogram revealed that he had mild to moderate heart disease. He had 50% blockage in one artery and 40% in two other arteries (the FAA won’t accept 75% or greater). However, on his treadmill EKG, it was found that he had no ischemia (insufficient blood supply) upon exercise. Since he had high lipids (fats) in the blood and also had an elevated blood pressure, he was placed on medications, including Crestor, Toprol-XL, a baby aspirin and Pavix, to help thin the blood. Because of the EKG, chest pain and hypertension, we needed to notify the FAA.

A diagnosis of coronary artery disease requiring treatment is a denial by FAA standards. Both the airman and I were upset with the ruling, but it is one of the things set in stone at the FAA.

But I don’t give up. I thought the initial doctor probably should not have used the diagnosis “coronary artery disease requiring treatment.” The truth is that the pilot has mild to moderate coronary artery disease, but he also is being treated for hypertension and high blood fats.

This patient has very few risk factors. He has continued to take his medications, is just slightly overweight, does not smoke and his family history is negative for either hypertension or coronary artery disease. I decided to send him to be reevaluated by a cardiovascular specialist. He was given a stress echocardiogram using the Bruce protocol, a standardized treadmill test used to assess cardiovascular health. He went in excess of nine minutes and reached his maximum heart rate of 160 beats per minute — 100% of his predicted maximum heart rate — which is required by the FAA. His blood pressure was within normal limits throughout the exercise. They also did a Thallium stress test, which is a nuclear imaging method done by injection that provides a view of blood flow into the heart. The FAA does not ordinarily like readings in the 40s or below. This airman’s ejection fraction, or percent of blood pumped out of the heart with each contraction, was 65%, which is quite good.

As we approached six months from the airman’s initial hospital visit, I reevaluated him. He had made lifestyle changes that improved his health. He started exercising, lost weight and followed a low-fat diet.

With the help of the FAA, he got a second class medical that is time limited for a year. At the one-year exam he will need a stress test, lab tests and current status report.

When emergencies come up, such as a coronary event, go to the ER, be treated, get well and contact your AME to help get your medical back.

Dr. Guy Baldwin is a Senior AME in Tulsa, Okla. A member of the EAA Aeromedical Council, he has more than 4,000 hours. He owns a Harvard T-6, a Cessna 210 and an Extra 300, in which he flies in airshows and aerobatic contests. He can be reached at 918-437-4993.

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