Coronary artery diseases in pilots

By: Dr. Atli Einarsson. 

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Photo: Biotrofix.com

Coronary artery diseases are among the most common diseases that people suffer, and the mortality rates globally are quite high. The frequency of the disease rises as people get older and is rather rare in young people, although there are known cases, usually involving the presence of many risk factors. The main risk factors are a family history of such disease, i.e. a family member suffered from the disease before the age of 65, high blood pressure, high cholesterol levels, smoking and diabetes. There has been considerable progress in the treatment of the disease in recent years.

Certain rules apply to aircraft pilot as regards coronary artery diseases, and it is important that pilots inform their aeromedical examiner if they are diagnosed with the disease. Coronary artery stenosis may not exceed 30% in the left main branch and source of the left coronary artery. Stenosis elsewhere may not exceed 50% and may only be in two locations. If a pilot has been admitted to a hospital due to coronary stenosis, he must refrain from flying for 6 months. Once this period is complete, various tests must be carried out to assess the condition of the heart before the pilot is deemed fit to fly. These tests involve an exercise tolerance test and an echocardiogram and sometimes further tests such as an electrocardiogram spanning 24 hrs. Temporary or permanent restrictions are sometimes entered in pilot health certificates. Those who undergo angioplasty are off work for 6 months, as the risk of the return of stenosis is greatest during the first few months after the intervention. The requirement is made that there may not have been any significant loss of the heart’s contractility. As is the case with everyone, it is important to re-open coronary arteries that have become blocked as soon as possible.

Numerous medicinal products are used to slow down the advancement of the disease; often several different types are used. These include medications that lower blood pressure, lower cholesterol levels and anticoagulants. If a pilot has to undergo treatment with medications, the general rule is that the pilot in question refrain from flying for the first 2–3 weeks to see if the treatment is tolerated. It should also be noted that not all medicinal products are approved for pilot use, and pilots should verify whether the medicinal product is permitted.

It is important for pilots, as others, to know their risk factors in order to be able to respond appropriately. Their family history should be readily available in most cases, and a simple blood test can screen for cholesterol and sugar. Blood pressure measurements are easy to take, and a history of smoking is known if present. People can enter their own values into numerous risk assessment calculators that can be found on the Internet to calculate their risk. The symptoms of coronary heart disease can vary.

The classic symptoms are chest pains that occur during exercise and which disappear at rest. People often describe the pain as a heaviness or burning sensation travelling into the left arm or sometimes up to the jaw or the back. The symptoms are sometimes different, and 20–30% of coronary artery cases involve myocardial infarcts are silent, i.e. either there were no symptoms or the symptoms that did appear were believed to be something other than coronary artery disease. A person who has many of the risk factors and experiences any of the symptoms can seek the advice of his personal physician or a cardiac specialist who can assess the need for further investigation.

Atli Einarsson is a M.D,(medical doctor) AME,( Aeromedical examiner) and works at Vinnuvernd ehf.

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