Heart and Coronary Artery Disease
Votes
Answered By AOPA

It appears from the July 1, 2020 "Back To Basics"  that I will never fly again.  I had a stent placed in 2002, but in the 2 years following the procedure I got free of all medications and activity restrictions through changes to diet and exercise.  I've had no problems in two recent trips to the Himalayas involving moderate activity at altitude, nor do I have any cardio-pulmonary restrictions in my daily life.  But reading that article seems to be saying I will have to undergo the stress echo and nuclear stress tests and angiogram every year (which insurance won't pay for) to obtain and maintain the right to fly (exercised prior to 2000 on 3rd class medical for private pilot SEL complex -IFR privileges).

I recently went through both the stress echo and nuclear stress tests as a "precaution" during investigation of an incident of acid reflux I stupidly mentioned during a physical.  The tests indicated there "might be a small spot of ischemia at the tip of the heart muscle" but it didn't appear worth further investigation since all other factors appeared "normal". 

However, based on the article, it appears the FAA would override my doctors and deem me unfit to fly.  Is this about right?
Is anybody going through this coronary "Special Issuance" procedure?  How much does it cost?  How long does it take after going through the tests? 
wmc

5 Replies
Votes
AOPA Staff Answer
Hi Wayne,
Below you will find a link to the AOPA web page that discusses reporting a stent placement to the FAA. You will see by the information that depending on what type of medical certificate you wish to obtain, the testing requirements will differ. Once the pilot has shown that they meet the FAA requirements then a medical certificate along with a Special Issuance is issued. Yes the Special Issuance will require yearly updates to the FAA, however these updates are not necessarily the same as those items listed when first applying for the medical certificate. The process can be lengthy, taking several months to review and process; and yes it can be expensive, not all of the tests are covered by insurance. The costs of these tests will vary depending on your location in the U.S.  and your physicians fees. However, like Bruce had mentioned, once a medical certificate has been issued the pilot does reserve the right to move over to Basic Med. Under Basic Med there are no Special Issuances, hence no need to provide the FAA with yearly updates.
https://www.aopa.org/go-fly/medical-resources/health-conditions/heart-and-circulatory-system/angina-angioplasty-bypass-cad-heart-attack-stent
 
Votes
Wayne Cole:

But reading that article seems to be saying I will have to undergo the stress echo and nuclear stress tests and angiogram every year (which insurance won't pay for) to obtain and maintain the right to fly...

No doubt Bruce Chien will be around with the medical answers.  But please remember that flying is a privilege which requires a license, not a "right" guaranteed by the Constitution or any law. Demonstration of the knowledge, skill, and fitness necessary to fly safely is a requirement to obtain and maintain that privilege, whether we like that or not.

Votes
You only have to beat the 3rd class once, Wayne, then you go to Basic Med for ship at 6,000 lbs or less and not flying into Canada.
What matters is the anatomy of the cath in 2001, and how large the ischemic area is, and under what load.
 
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Vampiress At AOPA:
However, like Bruce had mentioned, once a medical certificate has been issued the pilot does reserve the right to move over to Basic Med. Under Basic Med there are no Special Issuances, hence no need to provide the FAA with yearly updates.
https://www.aopa.org/go-fly/medical-resources/health-conditions/heart-and-circulatory-system/angina-angioplasty-bypass-cad-heart-attack-stent
 

Just to be clear, with cardiac conditions like this, you do have to get an SI Medical Certificate issued once after the surgery before you can go Basic Med.  But then, you're good to go without any more SI's as long as the physician signing your Basic Med paperwork is satisfied and no new conditions arise.

Votes
Ron and "Vampires...",
Y'all are mind-readers in that you answered other questions I had about Basic Med that I didn't think about when I made my original post.
When the entire Basic Med thing came up, I just assumed that anything that required a special issuance would be covered on the questionnaire(s) and be disqualifying requiring either a class medical or semi-annual / annual physicals / testing to maintain a special issuance paper as part of "legal to fly" credentials.

Anyway. thanks again to both for the solid info and giving me a little hope that I might be able to putter about the skies again in future.