Acceptable CAD

[Anon]

"Acceptable" CAD

I have been operating since 1997 with a SI for Class I. In March of 05 I had a stent placed in a cardiac artery the doc claimed was 90% closed. In Sep 05 I started recertification process for my class I under SI considerations. I have already done my echo, my nuclear stress test, and blood tests. I have an angiogram set for this Thursday and am concerned as to the amount of CAD that may be allowed. Somehow 50% sticks in my mind though I can't remember where I heard that number from. I don't think the cardiologist doing the cath will stent at 50%, and would like to know what is acceptable to the FAA. Does anyone have the answer?
Thanks,
Anon

 

[bbchien]

Re: "Acceptable" CAD

I have been operating since 1997 with a SI for Class I. In March of 05 I had a stent placed in a cardiac artery the doc claimed was 90% closed. In Sep 05 I started recertification process for my class I under SI considerations. I have already done my echo, my nuclear stress test, and blood tests. I have an angiogram set for this Thursday and am concerned as to the amount of CAD that may be allowed. Somehow 50% sticks in my mind though I can't remember where I heard that number from. I don't think the cardiologist doing the cath will stent at 50%, and would like to know what is acceptable to the FAA. Does anyone have the answer?
Thanks,
Anon

The term "acceptable" is misleading. 50% diameter stenosis is rarely hemodynamically significant- that is, you can sustain a 50% loss of diameter in say the left anterior descending coronary artery and still have plenty of flow distal to the obstruction to feed everything downstream. Not so at 65%.

What is acceptable to the FAA is (1) prove that you have plenty of flow to feed downstream, e.g, the thallium nuclear stress test to Vmax (225-age) heart rate without scan evidence of blood supply deficiency. FAA does NOT peg "acceptability" on fixed images of narrowing or lack of images of narrowing. They want to know about adequacy of flow.

So, approach the cath from the point of view of the Docs deciding what's best for you (irrespective of FAA), and you probably already have enough information from the nuclear stress to tell if you are recertifiable.

The threshold for third class is determined by treadmill stress which has a different set of precision(s).

 

[Unregistered]

Re: "Acceptable" CAD

Thank you Dr. BC. But why is the FAA so insistant on a followup heart cath?
The cardiologist says I did fine on the nuclear stress test. The FAA allows for a restricted second class if one elects not to have the follow up cath as you no doubt are aware. What are they looking for if the stress shows no ischemia?
In the meantime, thank you very much for your friendly advice.
Anon

 

[bbchien]

Re: "Acceptable" CAD

Thank you Dr. BC. But why is the FAA so insistant on a followup heart cath?
The cardiologist says I did fine on the nuclear stress test. The FAA allows for a restricted second class if one elects not to have the follow up cath as you no doubt are aware. What are they looking for if the stress shows no ischemia?
In the meantime, thank you very much for your friendly advice.
Anon

Because after many years of known coronary disease, small vessel disease (smaller than the size that is stentable) becomes an issue. At that point the disease progresses much more quickly and is very hard to treat and forestall. Just hope you haven't got "ratty small vessels". There are some other ones- 50% narrowing in the left main coronary artery is problemmatic, it's the only location where 50% may NOT be benign (Lots of flow right at the head of the faucet).

Micro ischemia is how heart rhythms get disorganized, which means you suddenly need defibrillation. Not a good thing for the PIC.

PS. There is no CAD that is acceptable to the FAA. There is only CAD for which you have convinced the administrator's designee, Dr. John Jordan (the federal air surgeon) that you have near equivalent operational safety, and that constitutes a Special Issuance.

 

[Unregistered]

Re: "Acceptable" CAD

Thank you for the advice.

 

[bbchien]

Re: "Acceptable" CAD

Thank you for the advice.

Of course . If it gets to the point where you're not going to requal for a Class 1, call me up (email me - my email here works, I'll send you back the office phone #) and I'll discuss the limiting endorsements ("Valid for class 1 only when exercised as member of a part 121 crew") and the like...which might buy you a tad more breathing room....

It's never nice when a pilot is realizing he may not be able to continue.