Cardiolite

[Unregistered]

I'm supposed to have a test called Cardiolite later this month. My physcian says he wants to check due to my family history and age. Is this something I should be worried about as a pilot ? If nothing abnormal is found, do I have to specifically report having it done even if it's a part of my annual physical ?

 

[bbchien]

This is one of the hard questions in Aviation Medicine. If you have a positive result you wil be disqualified until a catheterization proves/unproves that you have the disease. If you have the disease, you will need to show you can run 12 minutes on the "Bruce" protocol treadmill without echo/EKG changes of ischemia to fly, every year on a special issuance.

My suggestion is just tell him you'll do the treadmill. But whatever the outcome, you have to report it. Better to just modify your risk factors, run every morning, lose weight, eat correctly and not do the tests.

 

[Ghery]

If you have the disease, you will need to show you can run 12 minutes on the "Bruce" protocol treadmill without echo/EKG changes of ischemia to fly, every year on a special issuance.

Bruce, that brings up an interesting question. I'm not worried about having to take the test, but I do need more exercise. However, running is out of the question and has been for years due to an ankle injury. Just can't do it for more than a real short sprint, and then there had better be a good reason. As a result, I know I'm out of shape. Just what would be a good exercise regimine (sans running) for someone who really ought to do more to get his HDL up and triglycerides down, not to mention better overall shape (I know, round is a shape, just not the one I want).

 

[Bill]

Just what would be a good exercise regimine (sans running) for someone who really ought to do more to get his HDL up and triglycerides down, not to mention better overall shape (I know, round is a shape, just not the one I want).

Can you ride a bike without ankle pain? Biking is a good low impact aerobic activity. If not, do you have access to a pool?

 

[bbchien]

Just what would be a good exercise regimine (sans running) for someone who really ought to do more to get his HDL up and triglycerides down, not to mention better overall shape (I know, round is a shape, just not the one I want).

Swim! Zero impact highly aerobic-intense.

 

[BobS]

I used to run 40 miles a week right through my 40's. Then arthritis got the best of me and I stopped running and gained 15 pounds within two years. I started swimming, which helped my heart no doubt but I didn't lose the weight. I had hip replacement surgery, lost some weight, and am now walking a lot more but I'm back up to swimming 6-8,000 yards a week and feel better than I have in years. Swimming is great exercise, but I rarely see poor swimmers stick with it. If you're not a comfortable distance swimmer join one of the water aerobics classes at you local YMCA, but do something to keep the muscle in your chest pumping!

 

[jdwatson]

Better to just modify your risk factors, run every morning, lose weight, eat correctly and not do the tests.

Isn't this sort of playing Ostrich ? Let's presume that if "unregistered" took the cardiolite thing and it showed he had a blockage. Without the test "unregistered" might not have known about it until a heart-attack. And that would be a bad thing to have happen in-flight.

Lowering the risk factors wouldn't make the blockage go away, could it ? Is exercise and diet enough to stablize one's condition ? I'm just curious. I've stated in this forum before my Pop had a 5-way bypass and I'd like to avoid his fate. To that end, I'm exercising, losing weight, eating nearly vegetarian... Is it enough to offset genetics ?

 

[jdwatson]

A follow-up question:
Can a pilot be PIC after a heart-attack ? I would think that having the test is worth the risk especially if it reveals something that's fixable now. Am I not thinking correctly ?

 

[Earthroamer]

You might also try eliptical machines. Sorry if that is not how you spell it. I had back surgery long ago and use them b/c they are low impact on my back and legs. However, they will really get your heart rate up.

Brent Bradford

 

[jdwatson]

If you have the disease, you will need to show you can run 12 minutes on the "Bruce" protocol treadmill without echo/EKG changes of ischemia to fly, every year on a special issuance.

Dr. Chien, I remember reading a post you made (I can't find it now, otherwise I wouldn't be asking) that to pass the Bruce protocol for the FAA the pilot has to get to their max heart rate. I was talking some non-flying friends and they said that it's dangerous to exercise at 100% of one's max. None of them are doctors but they are avid runners/marathoners.

Two questions:
1) Does the test require that you get your heart rate to 220-age ?
2) Does the aforementioned CardioLite test use the Bruce Protocol ? (google didn't answer this question )

 

[bbchien]

Dr. Chien, I remember reading a post you made (I can't find it now, otherwise I wouldn't be asking) that to pass the Bruce protocol for the FAA the pilot has to get to their max heart rate. I was talking some non-flying friends and they said that it's dangerous to exercise at 100% of one's max. None of them are doctors but they are avid runners/marathoners.

Two questions:
1) Does the test require that you get your heart rate to 220-age ?
2) Does the aforementioned CardioLite test use the Bruce Protocol ? (google didn't answer this question )

I have had some get certified that reached 90% as long as they went the whole 9 minutes to 12 METS of oxygen consumption.

Yes, it's the Bruce protocol, which if you get to 12 METS accurately predicts a less than 1% incidence of another cardiac event in 5 years, which is why that datapoint exists. In practical reality, since beta-blockade (the "-olols") has been shown to prlong survival, many cardiologists refuse to run someone without the "governor" in place. That leads to long discussions with OKC.

One of AOPA's regional counsels was just recertified in my office folowing an MI a year ago. He was re-stented because his first go didn't get it all; he made the treadmill run and now has a third class. Unfortunately his difficulty was that he got an extra nucleotide scan....

 

[Ken Ibold]

Meanwhile, think Sport Pilot. If your medical won't be renewed, don't TRY to get it renewed (or go through the special issuance once) and then self-certify as a sport pilot afterward.

 

[jdwatson]

I have had some get certified that reached 90% as long as they went the whole 9 minutes to 12 METS of oxygen consumption.

Thanks for the explaination. When I go running with these "nuts" I frequently stay in the 90-95% for a lot longer than 9 minutes. On yesterday's run, I got up to 174 (my max is 177) on the long hill. It's not my normal training, but it's fun to go out and stretch my abilities with the greyhounds.

 

[Unregistered]

I'm supposed to have a test called Cardiolite later this month. My physcian says he wants to check due to my family history and age. Is this something I should be worried about as a pilot ? If nothing abnormal is found, do I have to specifically report having it done even if it's a part of my annual physical ?

Well, the results are in and they are good. I got 97% of my heart-rate. I could have gotten to 100% but my doctor said it wasn't necessary. 14.2 METs on the Bruce protocol.

Test status: normal (stress) normal (rest)
Rhythm: normal (stress) normal (rest)
IV Conduction: normal (stress) normal (rest)
Arrhythmias: none (stress) none (rest)
ST response: normal
Repolarization: normal

Myocardial perfusion was normal
Scan Significance: normal & indicates a very low risk for hard cardiac events

LAD: 0% (stress) 0% (rest) 0% (Ischemic)
LCx: 0% (stress) 0% (rest) 0% (Ischemic)
RCA: 0% (stress) 0% (rest) 0% (Ischemic)
% of LV: 0% (stress) 0% (rest) 0% (Ischemic)

Ejection Fraction: 72%
ED volume, EDv Index: 91ml, 40 ml/m*m
ES Volume, ESx Index: 26ml, 11 ml/m*m
Cardiac Output: 4.9 l/min
Myocardial Mass: 139g
Summed WTHK score: 23
Summed WMOT score: 5

Global function: normal
LV Volume: normal
Regional function: normal
Stress/Rest LV volume ratio: 0.73, normal

Summary:
Stress was judged to be excellent. Stress had a hypertensive blood pressure response. Stress had normal ST response. Chest pain did not occur.

LV myocardial perfusion was normal. LV myocardial perfusion was consistent with 0 vessel disease. Global LV functions was normal. LV regional wall motion was normal.

RV perfusion was normal. RV volume was normal. RV regional wall motion was normal.

Scan significance was normal and indicates a very low risk for hard cardiac events. LV dilation was normal.