Exceeded 100% of MPHR in First 6 Minutes

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CAPT34

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CAPT34
I'm a 64 year old male applying for my first 3d class medical in 16 years, and the hypertension protocol was required because I've been taking blood pressure medication for the last 10 years. The resting ECG indicated a complete Right Bundle Branch Block - RBBB, and the FAA followed up with a letter requiring a maximal exercise stress test, which I completed last week.

A summary of the results are that 116% of my MPHR (181 bpm) was achieved in the first 6 minutes, 7.20 METS, and maximum bp was 190/100. The report says that the test was terminated due to dyspnea and maximum heart rate achieved. The Cardiologist's conclusion was "negative maximal stress test for ischemia".

My question is: Will the FAA consider this test incomplete because the duration only lasted through the through 6 minutes/2 stages, instead of the full 9 minutes/3 stages?

I've conducted several online searches on this topic, and it seems as though the FAA is concerned that the applicant needs to achieve at least 85% of MPHR AND must continue for at least 9 minutes/3 stages; if both of these conditions are met and/or exceeded, it appears that the FAA may consider this as an acceptable result. However, I was unable to find anything definitive for the case where 100% of MPHR is EXCEEDED and the test is terminated in less that 9 minutes, and nothing abnormal is seen in the ECG.

I am hoping that any AME's that frequent the forum (or members with similar results to mine) might be able to weigh in on this topic. Thank you.
 
When someone reaches target heart rate at a relatively low level of exercise it usually means they are in poor physical condition from lack of exercise or obesity although in some cases it can be the result of a medical problem.
 
Interesting question, after you talk to Bruce, would you be so kind as to post the answer? Thanks.
 
Henning said:
Interesting question, after you talk to Bruce, would you be so kind as to post the answer? Thanks.
Click to expand...

Well, I haven't heard from Dr. Bruce yet, but I do have an answer.

On Monday I got a letter from the FAA requiring a radionuclide stress test because they thought the regular stress test had "inadequate exercise tolerance". This is what I thought might happen, so it got me to thinking about whether or not to press on. I wasn't worried about taking the test itself, but I was worried about the cost; since my cardiologist's conclusion was negative for ischemia it is certain the insurance company would cover none of it. So his fee and the hospital's would be entirely out of pocket. It could be thousands.

So I contacted the FAA regional flight surgeon with a question: "Would the FAA allow for a retake of the standard stress test, and consider the results for review as along as I met or exceeded the 100% heart rate and the 9 minutes of exercise?" He pulled up my file online and we discussed the chronology and the details of my application. Toward the end of the discussion, he asked me an unexpected question...:eek:

He asked me why I took a resting ECG for hypertension in the first place? I told him that the AME had gone through a reference binder in his bookcase, found a one page document labeled "Hypertension Protocol" and made a copy for me. He told me that within 14 days I needed to bring back all of the results - 3 days of blood pressure readings, the resting ECG and my physicians cardiovascular evaluation of all those test results, etc. I did all of these and he sent them to the FAA, which resulted in the letter requiring the standard stress test.

The flight surgeon uttered an audible sigh, and then told me that the hypertension protocol had been obsolete for over a year and that my AME should have used the "Hypertension Worksheet" that replaced it under the CACI program; all that requires, at most, is a note from my physician that finds my condition stable on the current regimen for 2 weeks, no changes recommended and no symptoms . He then said he'd call the right contact in Oklahoma City to discuss the case.

The flight surgeon called me back an hour later and said the FAA had decided to accept my cardiologist's conclusions, no additional tests would be required and I can expect to receive my 3d Class Certificate in the mail shortly!:goofy:

I don't know how heavily the CACI program changes influenced the decision or whether they just thought the stress test was close enough. However, I do think this might have presented them with a dilemma, because for the last year I'm sure they've received many applications under CACI that would have required the old protocol if the application would have been made beforehand. And in my case, they were reviewing documentation they never should have received had the AME dealt with hypertension the way he was supposed to.

The take away for me is that I will never again accept an external (to the exam) document requirement from an AME that originates from his bookcase. I will ask him to show me where the current requirement is on the FAA website, to explain it in detail and then to print it from the FAA website; if he won't do those things, I'll take my business elsewhere.
 
Not to hijack, but I had an issue with my 3rd class being deferred because my AME didn't do his job either. I had had some numbness in my arm last year and went to the doc. All that was required was the AME commenting that I had full range of motion and no symptoms. He didn't and I got deferred. I sent a letter from my treating doc to the FAA, faxed actually, and I got my cert. today in the mail. Less than two weeks. Some folks at the FAA are doing a great job!
 
Capt34 and Mike, good for the both of you. I had an AME mess up an EKG and it cost me almost $30,000 in medical bills to get it straightened out. All through the process the FAA was most accommodating, allowing me to extend deadlines due to me working in Alaska and not getting time off to get things done in a timely matter.

Needless to say, that AME is no longer an AME.

Capt34, thanks for the follow up.
 
Here's a link to the LATEST Federal Air Surgeon's Medical Bulletin:

https://www.faa.gov/other_visit/avi...ons/designee_types/ame/fasmb/media/201403.pdf

He's giving some statistics on how well the first 3 months of CACI went - from July 2013 through September 2013, so this is almost a year old, but I think it may be useful to the subject of Medical Topics. If you're interested, you'll find the relevant article on pages 2 and 3.:)
 
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