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An MI in the Sky

By Tom Cruse
Reprinted with permission from Tom Cruse

'A week before this flight, my flight surgeon gave me a new 3rd-class medical certificate. This pain could not be a heart attack, even if it did read like a script from one of the many brochures I had read'.'

The first Thursday in August was a great day to fly. The early fall weather combined low humidity, gentle winds, and an infinite sky over Dayton, Ohio. My brother and I had agreed that I would pick him up in Greenwood, Indiana, a one-hour flight from home. I launched into that infinite sky on time with no other activity at Dayton-Wright Brothers Airport. The climb was smooth as l leveled off at 3500 feet, set the autopilot, and studied the many corn and grain fields below. Ohio is just one of the beautiful states to fly over that my wife and I have enjoyed over the years. But today, I was flying alone.

I monitored Dayton Approach, listening to the increasing pace of general aviation activity in our area. One pilot, after getting a good traffic call and contact, commented to the controller that, earlier, he had not been given warning of a much closer call. This controller commented that on a day like this, a lot of pilots were flying so they (we!) 'could touch the sky.' I felt a real bond with all those who, with me today, could say we were there to touch the sky.

Around the halfway point, I switched over to Indianapolis Approach for monitoring, as I would be approaching a field en-route that had a lot of pilot training.

Suddenly, the center of my chest felt as if a three-inch log was jamming into me. It started at a low level of pressure but rapidly grew to a very uncomfortable strain, and the pain now radiated outward to my shoulders.

While I do not fly with a cardiac checklist, it sure seemed like a heart attack, but how could this be? A few months earlier I had a significant set of tests, including the isotope stress test and the new calcium CT scan. By all accounts, my cardiovascular system was in great shape. I had been a smalltime jogger for many years and watched (rather, my wife did) the types of food I ate. That set of cardiology exams was accompanied by warnings that my marginal blood lipids results and slightly elevated blood pressure were warning signs. A week before this flight, my flight surgeon gave me a new 3rd-class medical certificate. This pain could not be a heart attack, even if it did read like a script from one of the many brochures I had read last fall.

The pain grew intense. I had to take my headset off and wipe the profuse sweat from my head. I was soaked from the waist up. I realized that I would have to do something, and soon, as the pain intensity continued to grow. The Connersville airport that I was just past abeam of was the obvious place to land. Among the now out-loud comments to myself that this could not be real, I started putting the Unicom frequency into the radio. I began to consider the next step of how I would get help when I landed.

Abruptly and completely, the pain ended and my sweating stopped. What happened? I asked, as I let the autopilot continue me toward Greenwood. I did not consider turning for home, even though the winds would favor the time for return over the continued flight. But, I reasoned, I was picking up my brother. But, I countered; I could not allow him to fly with me after this experience. The indecision carried me on for another several minutes and miles. The Indianapolis skyline appeared ahead and a bit north of my course.

The pain begins again. And I know that this really is a heart attack and I have to act now. I call the Greenwood Unicom saying I have a medical emergency and to summon EMT to meet my landing. Silence. Then, an aircraft just announcing his turn to final for Runway 01 at Greenwood speaks up, saying that he'll call 911 for me as soon as he can get to a phone. I respond with thanks.

Less than ten minutes out'it grows more intense. Concentrating on flying was getter harder. I am drenched again. Time for the landing checklist. I started a slow descent. I never asked myself how I could get on the ground faster. There was the structure of a thousand hours of flying and many approaches to uncontrolled fields. I announce that I'd be overflying on cross-wind to the downwind for 01. More pain and time continues.

My voice, now weaker, announces that 8NG is over the field and turning for downwind. Downwind now. Speed to 85 knots. Ten degrees of flaps. Trim. The numbers for 01 abeam now. Power to 1500 RPM. When to turn base. OK. 8NG turning base, landing 01, Greenwood'my voice not very strong'8NG final for 01.

Ahead is the most beautiful runway I have ever seen. It is very long.

Speed! I'm below 60 knots. Add some power'be patient. I'm starting to almost shout at myself to keep concentrating as my mind is nearly consumed by the pressure in the chest. Patience'let the speed drain off...let the aircraft settle...add some power for cushion'patience. The landing is smooth but a bit fast.

Left turn off the active, right turn on taxiway. I see Dave, the line man, just at the edge of the parking ramp, wands up, guiding me in. Next to him a fire department pumper and an ambulance with flashing lights. For me. Thank God. What a great sight! Switches off. Double-check systems are down. Now, I can open the door. Two EMTs pull me out. I am on the stretcher then into the ambulance. The EMTs are working on me, one on each side. They hook me to an IV on the right and an EKG setup on the left. The EMT on my left, a young woman - another angel - shouts, 'Hit it, we have a real heart attack!'

Five minutes later, I am in the E.R. of a very close and very new St. Francis hospital. The emergency team takes control of my situation. While they work, my clothes are removed, and my history is asked for and given. The cardiologist then speaks up, 'Folks, let's prep him for surgery.' This is followed rapidly by a catheter insertion at my groin into the right femoral artery. The cardiologist gets his angiogram indications of a 99% block due to stenosis in the left anterior descending heart artery, otherwise popularly known as the 'widow maker.'

I find out later in my Critical Care room that they deployed a stent at the key location and achieved 100% flow there.

Later, tests confirm that my heart has no permanent, measurable damage. My cardiologist says that, except for the one other, less critical location, my heart does not have significant arterial blockages. Finally, there is agreement with the earlier positive cardiology findings that I have healthy arteries and no systemic heart issues, and that tests can't always predict heart attacks.

Two days later, I am released from the hospital and my wife drives me home to Dayton. I am alive, and it is a beautiful day as I write this down. It is a day so wonderful; it makes you want to fly and 'touch the sky' again.

Requirements for any Class of Airman Medical Certification After Coronary Heart Disease

1. Recovery period: 6 months after angina, infarction, bypass surgery, angioplasty, stenting, rotoblation, or atherectomy.

2. Hospital discharge summary (history and physical), coronary catheterization report, and operative report regarding all cardiac events and procedures.

3. A current cardiovascular evaluation must include an assessment of personal and family medical history; a clinical cardiac and general physical examination; an assessment and statement regarding the applicant's medications (and any side effects), functional capacity, modifiable cardiovascular risk factors, motivation for any necessary change, prognosis for incapacitation; and blood chemistries (fasting blood sugar and current blood lipid profile to include total cholesterol, HDL, LDL, and triglycerides).

4. A current maximal Graded Exercise Stress Test

5. A SPECT myocardial perfusion exercise stress test using technetium agents and/or thallium may be required for consideration for any class if clinically indicated or the exercise stress test is abnormal by any of the usual parameters. The interpretive report and all SPECT images, preferably in black and white, must be submitted.

Note: If cardiac catheterization and/or coronary angiography have been performed, all reports and the actual films (if films are requested) must be submitted for review. Copies should be made of all films as a safeguard against loss. Films should be labeled with the name of the applicant and a return address.

About the author. Tom Cruse has been a private pilot since 1975. He is a semi-retired research Air Force consultant and previously was a professor of mechanical engineering at Vanderbilt. He now flies every two weeks with a flight instructor to stay IFR current and work toward a Commercial rating, which he plans to earn after getting his medical back.

(Source: excerpted from Guide for Aviation Medical Examiners online edition: www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide)