Basic med

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Tpg

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Not so familiar with the medical terminology, but does an infrarenal aortic dissection, that’s obviously being monitored, (for certain reasons the doctors felt no reason to do surgery and best to just let it wait with follow ups annually) count as a coronary heart disease?
The applicant had a third class that he let expire, and after it expired he experienced the dissection. (The question being, is infrarenal considered coronary)
 
Tpg said:
Not so familiar with the medical terminology, but does an infrarenal aortic dissection, that’s obviously being monitored, (for certain reasons the doctors felt no reason to do surgery and best to just let it wait with follow ups annually) count as a coronary heart disease?
The applicant had a third class that he let expire, and after it expired he experienced the dissection. (The question being, is infrarenal considered coronary)
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I don't know what the FAA would think, but no vascular surgeon would consider an infrarenal anything to be coronary.
 
This doesn't quite appear to be one of the listed cardiovascular conditions, all which involve the heart. The aorta, while feeding the heart, is not the heart itself.
 
Thank you for the answers. Just to clarify (because I realised I was a bit ambiguous in asking the actual question); the practical application is whether the pilot, if deemed safe by his doctor, can fly on basic med or would need to first abstain an SI.
 
From the NIH - Heart disease is a catch-all phrase for a variety of conditions that affect the heart’s structure and function. Coronary heart disease is a type of heart disease that develops when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. It is the leading cause of death in the United States.

my read is that IOD fits the above definition, which puts it into the category of things which can be disqualifying. If the IOD requires treatment, then the pilot is disqualified from Basic Med.

Beyond that - this is serious stuff. IOD is a tear on the internal lining of the aorta and can cause the aorta to come apart. Please communicate to the applicant that they need to take care of their health first. This is nothing to play with.
 
bflynn said:
From the NIH - Heart disease is a catch-all phrase for a variety of conditions that affect the heart’s structure and function. Coronary heart disease is a type of heart disease that develops when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. It is the leading cause of death in the United States.

my read is that IOD fits the above definition, which puts it into the category of things which can be disqualifying. If the IOD requires treatment, then the pilot is disqualified from Basic Med.

Beyond that - this is serious stuff. IOD is a tear on the internal lining of the aorta and can cause the aorta to come apart. Please communicate to the applicant that they need to take care of their health first. This is nothing to play with.
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has nothing to do with the heart or the coronary arteries. does not make a person more prone to cardiac disease.
 
Has to do with the aorta. Heart disease includes diseases of the aorta.

Regardless, it’s serious.
 
Thanks for the concern. Im not a doctor, but he seems to be on top of it. He gets a yearly scan with his yearly appointment at the vascular surgeon. It's been pretty stable since the dissection and has barely expanded at all. Obviously all of this would depend on the surgeon consent, but figured he should find out if its practically feasible from a legal standpoint at all for starters.
 
bflynn said:
my read is that IOD fits the above definition, which puts it into the category of things which can be disqualifying. If the IOD requires treatment, then the pilot is disqualified from Basic Med.
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You're going to have to defend that. The "coronary arteries" are definite things of which the AORTA is not a part.

Of the four bullet items on the basic med requirements for SI for cardiovascular disease, all are directly heart-related and not afflictions of other parts of the circulatory system.
 
Health first. Flying second. The chances of dying from this is abnormally high.

I agree, it’s a borderline case. Literally, this is on the border. It could be called either way.

regardless, no treatment has been required, so the pilot is not disqualified from BasicMed. Yet. However, from my brief reading, the most common treatment for aortic dissection requires open heart surgery to repair or rebuild the aorta, which is squarely in SI territory.
 
bflynn said:
However, from my brief reading, the most common treatment for aortic dissection requires open heart surgery to repair or rebuild the aorta, which is squarely in SI territory.
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No, open heart surgery is not required for repair of a dissection in the descending aorta.
 
flyingron said:
You're going to have to defend that. The "coronary arteries" are definite things of which the AORTA is not a part.
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The coronary arteries arise from the proximal aorta. It’s where they originate.
 
Fellas - when one has an Aortic dissection he has by definition, atherosclerotic vascular disease. FAA then requires that one demonstrate that he does not also have coronary atherosclerotic vascular disease.

one is a “marker” for the other....

so for basic med it all hangs on what the PCP thinks about this...
 
bbchien said:
Fellas - when one has an Aortic dissection he has by definition, atherosclerotic vascular disease..
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May be a common cause of the dissection, but I don’t understand how it is so by definition. Atherosclerotic means plaques with hardening and narrowing. Would one count the possible narrowing in a dissection that way?
 
PeterNSteinmetz said:
May be a common cause of the dissection, but I don’t understand how it is so by definition. Atherosclerotic means plaques with hardening and narrowing. Would one count the possible narrowing in a dissection that way?
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Plaques are part of the disease process, but not the only part. Friability of the inner lining of the artery (intima) means that it can fracture, exposing the medial layer to the pressure and flow in the artery. That's how a dissection starts. As the blood is forced between the inner layers of the artery, disaster can ensue. If it's in the proximal aorta (arch), it can involve the arteries to the brain and upper extremities, even dissect back to the coronary arteries. If it's in the distal aorta, it can dissect into the renal arteries, or can dissect downward into the lower extremities. Or it can dissect into the lower aorta, then just stop, which is maybe what happened to the OP (since he's still alive).

As mentioned, I don't know what the FAA thinks about it, but I think that any kind of dissection means I'd want to be careful about endorsing that patient getting into an airplane and flying it.
 
Agreed that plaques can lead to a dissection. But aren’t there other causes? Traumatic injury, high blood pressure, iatrogenic? If so, we don’t really know in the case of the OP.

Definitely a serious condition and it strikes me one would have to be very sure of cause and stability before thinking it safe to fly.
 
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