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The Road Back After Heart Problems

by Paul Engstrom, Aviation Writer and IFA Member

Aviators with an ailing heart may find solace in the words, 'Takes a licking and keeps on ticking,' to borrow from that ancient commercial for Timex watches.

However, a heart that simply ticks isn't good enough for the FAA, even if you've undergone a medical procedure to correct a problem or are in good physical health otherwise. To regain a third class medical certificate, you'll have to meet sky-high standards.

The good news is that many pilots do return to the cockpit after heart attack, angina, implantation of a pacemaker or stent, bypass surgery, angioplasty, valve replacement, or other therapy. Each year, the FAA recertifies more than 3,000 private pilots who've had a heart attack, for example, and more than 2,300 whose coronary arteries have been cleared by angioplasty.

But it takes intelligent planning, initiative, optimism and hard work to regain the FAA's blessing.

There are two courses of action after a certification denial. One is to apply for a special issuance certificate. This means undergoing additional and probably numerous medical tests to prove that, despite coronary ills, you wouldn't endanger public safety while flying an aircraft. A special issuance typically is valid for just six to 12 months and other flight restrictions may apply.

The second course is to disprove the diagnosis for which you were disqualified.

In either case, to re-apply for certification after a denial, you must wait until six months after the cardiac event. This gives your heart time to heal and reduces the likelihood of complications following treatment.

Experts inside and outside the FAA say private pilots are finding it easier now than ever to get or maintain discretionary medical certification. That's because new treatments and medical advances enable aviators to perform well regardless of disease, according to Stanley Mohler, MD, director of aerospace medicine at Wright State University School of Medicine in Dayton, Ohio.

Moreover, aviation medical examiners have considerable leeway to issue a medical certificate in cases of sub-par health as long as you provide the appropriate documentation.

Matters of the heart can get especially tricky when it comes to flying, as illustrated by the case of a private pilot who crashed near Camden, S.C., in 1997. The FAA had given him a special issuance certificate even though he was battling coronary artery disease, had had a heart attack years earlier and was taking Diltiazem (a prescription drug for chest pain) and Cimetidine (an over-the-counter antacid).

Investigators concluded that the combination of these two drugs and the pilot's otherwise stable heart condition caused him to lose consciousness during a high-bank, high-G-force turn. Both he and his passenger died.

The road back to flying after cardiac problems can be long and arduous, if only because the FAA wants to see detailed evidence of recovery. The FAA's Aeromedical Certification Division in Oklahoma City, Okla., requires:

  • A hospital admission summary (history and physical), coronary catheterization and surgical reports, and a discharge summary about your heart attack, angina, bypass operation or angioplasty.
  • A current cardiovascular evaluation covering everything from medications, functional capacity and risk factors that can be modified (such as poor diet, lack of exercise and smoking) to a blood lipid profile.
  • A treadmill stress test that demonstrates you've regained 100 percent of maximal predicted heart rate.

Fortunately, experts aside from your personal physician can help. But cardiovascular rehabilitation, which may entail a long road back to good health, is essential in many cases if you hope to achieve the minimum functional capacity to fly again, according to Jeffrey Dwyer of the Cardiac Rehabilitation Program at Kaiser Permanente Medical Center in Vallejo, California.

Among other things, Kaiser's rehab program for pilots launches them on a safe and effective exercise program, measures the outcome of that effort, documents tolerance to heart medications acceptable to the FAA, and prepares them for a passing score on the treadmill stress test.

Other commercial outfits, such as Aviation Medicine Advisory Service (, handle the red tape for you. For example, they review and assemble medical records, offer advice on reporting requirements, provide checklists and FAA forms, and communicate with the FAA and advocate on your behalf.

This assumes, of course, that you have the will, desire, and determination, not to mention the financial resources, to re-earn your flying privileges. But most pilots probably would agree it's well worth the price.

When he isn’t flying, Paul Engstrom writes and edits from Sebastopol, Calif.

The information contained herein is meant for informational purposes only. Neither IFA, nor Paul Engstrom assume any responsibility or liability for events that occur due to actions you or others on your behalf take based on the information given in this article. You are proceeding at your own risk. It is strongly advised that you seek the opinion and advice of a qualified aviation medical examiner and appropriate medical physician for any medical needs you may have.

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