Idiopathic ventricular tachycardia

[should I be scared?]

I wanted to solicit some opinions on this. I'm not terribly concerned about passing the medical although perhaps I should be, more concerned about how I should present this and what hurdles I should expect to go through to appease the FAA.

I am 44, 6'-0", 180. In pretty good shape. No medication.

In 2010, I had some heart palpitations, saw my doctor, was referred to several specialists, wore a Halter for a week, etc. No one could really find anything. I was finally referred to an electrocardiologist that diagnosed me with Idiopathic ventricular tachycardia (sounds much worse than it is) and prescribed Verapamil and the palpitations cleared up almost immediately. The doctor said these things sometimes come and go so he wanted me to try the Verapamil for 90 days, go off the meds and see how things are. 90 days later, I went off the Verapamil, the palpitations were gone and never returned. I also made some positive life changes during that period of time that reduced the amount of stress I was under (new business related).

Completely unrelated but last year I was having some issues with a numb fingers in one of my hands. My physician referred me to a vascular specialist and a cardiologist who performed a full stress test, EKG, etc. All normal, no issues. I ended up with a diagnosis of a mild case of Reynauld's Syndrome. As long as I wear gloves when outdoors in the winter and stay warm, there aren't really any issues with it and when it does flare up or if I plan to be outdoors for a long time in winter, an electric hand warmer is all it takes to clear things up. Pretty odd and sometimes uncomfortable but not that big a deal I don't believe.

What do you guys think about all of this? That is basically my entire medical history and I'm due for my annual checkup soon and I plan to discuss all of this with my regular physician but she is not going to be familiar with the specifics of the FAA medical I don't believe.

Thanks.

 

[lbfjrmd]

The Raynaud's will likely not be a problem. The heart though will result in the FAA wanting records and possibly more from your cardiologist.

 

[DFH65]

Any reason you can't go basic med? If so I would think all this would just be a discussion with your PCP instead of possible mounds of paper work or even extra tests to prove what you already know.

 

[lbfjrmd]

Any reason you can't go basic med? If so I would think all this would just be a discussion with your PCP instead of possible mounds of paper work or even extra tests to prove what you already know.

The ventricular tachycardia alone precludes basic med!

 

[AggieMike88]

Are you asking because you will soon be going for a medical certificate the first time?

Or is this a renewal situation?

Either way, as Dr. Lou mentioned, the cardiac issue is your big thing. Working with the right AME to determine 1) what documentation is needed and 2) organizing it into proper sequence and format will be key items.

An application that is missing items and/or poorly organized will cause significant delays and might increase your cash requirements to reach the finish line. Not to mention create a big risk of ding denied a medical certificate. Being denied is something you need to avoid at all costs.

Hiring the right AME to be your advocate will be key.

 

[DFH65]

The ventricular tachycardia alone precludes basic med!

I am not a doctor but I guess I don't understand why? It doesn't fit the requirement for an SI or am I missing something?

III. Cardiovascular - A cardiovascular condition, limited to a one-time special issuance for each diagnosis of the following: • Myocardial infarction. • Coronary heart disease that has required treatment. • Cardiac valve replacement. • Heart replacement.

 

[lbfjrmd]

Arrhythmia - AOPA
https://www.aopa.org/go-fly/medical-resources/health-conditions/.../arrhythmia
The FAA grants special issuances for many types of arrhythmias. Atrial fibrillation, atrial flutter, or ventricular/supraventricular arrhythmias that are not associated ...

 

[idahoflier]

I am not a doctor but I guess I don't understand why? It doesn't fit the requirement for an SI or am I missing something?

III. Cardiovascular - A cardiovascular condition, limited to a one-time special issuance for each diagnosis of the following: • Myocardial infarction. • Coronary heart disease that has required treatment. • Cardiac valve replacement. • Heart replacement.

I think this would only be a concern if the OP has never had a medical certificate or hasn't had once since 2006, otherwise the OP should be good to go under BasicMed...

 

[OP Here]

OP here. This will be my first application and I’m just stating to get familiar with the process and have a lot of reading to do but I wanted to get some perspective on this as I get started.

There are no longer any physical manifestations. Stress test, EKG, etc. all normal. Basically it was a stress induced irregular heartbeat that has long since cleared up. If I hadn’t mentioned it to the cardiologist last year, he would have never known and everything is completely normal now. Hell, i even ran a marathon a few years ago.

I haven’t really been concerned since it is such a non-issue now and don’t want to turn it into a bigger deal than it needs to be but don’t want to do anything unethical either. Now I’m startimg to get stressed!

 

[DFH65]

Arrhythmia - AOPA
https://www.aopa.org/go-fly/medical-resources/health-conditions/.../arrhythmia
The FAA grants special issuances for many types of arrhythmias. Atrial fibrillation, atrial flutter, or ventricular/supraventricular arrhythmias that are not associated ...

I feel out of place arguing with an AME and more than happy to learn if I am missing something.

My understanding was there are only 3 things you need an SI for (really the beauty of BM):
https://www.faa.gov/licenses_certificates/airmen_certification/basic_med/

Medical Conditions Requiring One Special Issuance Before Operating under BasicMed

• A mental health disorder, limited to an established medical history or clinical diagnosis of—
  • A personality disorder that is severe enough to have repeatedly manifested itself by overt acts;
  • A psychosis, defined as a case in which an individual —
    • Has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or
    • May reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis;
  • A bipolar disorder; or
  • A substance dependence within the previous 2 years, as defined in §67.307(a)(4) of 14 Code of Federal Regulations
• A neurological disorder, limited to an established medical history or clinical diagnosis of any of the following:
  • Epilepsy;
  • Disturbance of consciousness without satisfactory medical explanation of the cause; or
  • A transient loss of control of nervous system functions without satisfactory medical explanation of the cause.
• A cardiovascular condition, limited to a one-time special issuance for each diagnosis of the following:
  • Myocardial infarction;
  • Coronary heart disease that has required treatment;
  • Cardiac valve replacement; or
  • Heart replacement.

The FAA grants special issuances for diabetes, sleep apnea and arrythmias but I don't see where you need them under BM.

Don't mean to hijack. Just thinking this could be a possible option for the OP if his doctor agrees is healthy.

 

[lbfjrmd]

in the basic med, one has to say yes or no: see item g

:

 

[idahoflier]

I feel out of place arguing with an AME and more than happy to learn if I am missing something.

My understanding was there are only 3 things you need an SI for (really the beauty of BM):
https://www.faa.gov/licenses_certificates/airmen_certification/basic_med/


The FAA grants special issuances for diabetes, sleep apnea and arrythmias but I don't see where you need them under BM.

Don't mean to hijack. Just thinking this could be a possible option for the OP if his doctor agrees is healthy.

That's only true if you have already held a Medical Certificate after Feb/2006. If that's not the case then you will need to obtain at least a Third Class and that's where you are subject to ALL of the other medical criteria...

 

[DFH65]

That's only true if you have already held a Medical Certificate after Feb/2006. If that's not the case then you will need to obtain at least a Third Class and that's where you are subject to ALL of the other medical criteria...

Very true. He did not indicate if he already had a medical or not. Bad to assume.

 

[idahoflier]

in the basic med, one has to say yes or no: see item g

View attachment 65973 :

With respect, I believe you can check "Yes" on (g) and as long as it isn't one of the conditions DFH65 quoted above and you are under care for whatever item caused (g) to be checked "Yes" and you have had a valid medical certificate after 2/2006, you should be good to go with BasicMed...

 

[DFH65]

in the basic med, one has to say yes or no: see item g

View attachment 65973 :

That list also contains "high or low BP" lots of people are going to answer "Yes" to that discuss it with their doctor and move on.

From the form:

18. Medical History: Mark “Yes” if you have or had any of the following conditions at ANY TIME in your life. Explain when it occurred, the severity, how it was treated, and if you are currently taking any medication or having treatment for the condition or have to see a physician for the condition. Discuss any “Yes” responses with the physician doing this exam.

 

[azure]

With respect, I believe you can check "Yes" on (g) and as long as it isn't one of the conditions DFH65 quoted above and you are under care for whatever item caused (g) to be checked "Yes" and you have had a valid medical certificate after 2/2006, you should be good to go with BasicMed...

Of course, it is up to the physician conducting the BasicMed exam as well. My (layperson) understanding is that VT unless due to CAD does not mandate the one-time SI by regulation, and I wonder why Dr. Lou said otherwise. But regardless, the doctor has to sign you off and might be reluctant to do so with that history.

All moot, since the OP has said that this is his first application. So BasicMed is off the table anyway.

 

[Op here]

Op here again.
I wanted to begin by thanking everyone who has contributed. It is really appreciated, thank you.

Due to these private post requiring moderator approval, my response to some early questions was buried a much of the coversation around Basic Med, while interesting and helpful to many, isn’t applicable to this situation unfortunty.

Could someone lump this into a general category:
1) forget it and save your money for something that won’t require a miracle.

2) You’re gonna have some hoops to jump through but if your health is now as you say, it shouldn’t be too difficult. Gonna probably cost you $x

3) Don’r sweat it. You’ll need x,y,z but not a big deal.

4) something else?

I have a Discovery flight scheduled this week and had planned to start lessons soon thereafter. I’m really confused now about the best coarse of action and how to proceed.

 

[DFH65]

Contact Dr. Bruce Chien http://www.aeromedicaldoc.com/ for a consultation.

He can tell you exactly what you need. It may just be a matter of getting all the documentation together. What you don't want to do is schedule an appointment with an AME for a medical until you KNOW FOR SURE you are going to get issued.

I would certainly hope with all the tests and Dr. consults you have had the FAA would issue you without too much added expense. If not you could always look into flying LSA.

 

[azure]

Agree with contacting Dr. Bruce, but my SGOTI opinion, based on what you said, is either 2 or 3 depending on what the "idiopathic VT" was in reality - were there runs of VT, or were they PVCs of a type that is considered a kind of VT, and was it the kind that arises in structurally normal hearts?

The reason I ask is that many many years ago I had a very annoying 6 weeks of persistent PVCs that were diagnosed by Holter as coming from the Right Ventricular Outflow Tract (RVOT). After an intensive workup including a cardiac MRI, the dx was "RVOT ventricular tachycardia". When I saw that I nearly flipped, since there were no runs of VT on my Holter. It's a technical diagnosis - that's what it's called, because ventricular ectopy coming from the RVOT can manifest in runs of VT and it's all considered the same phenomenon. It's a very common form of normal heart VT, i.e. unrelated to CAD or other structural heart disease. I was offered a choice between ablation and Verapamil and chose the Verapamil. Within a couple of weeks the PVCs were gone, never to return.

Once the PVCs were gone (followup Holter) I had a normal nuclear treadmill stress test, collected all of my reports and sent them to the FAA after a consult with a difficult case AME. Not only did the FAA not slap me with a request for more information, I was given a normal issuance 3rd class with the usual admonition to self-ground if symptoms returned. Go figure.

Now this was many years ago and the outcome may depend on who examines your file at OKC. But if your case is similar to mine (it sounds like it), I would expect, at most, a need for more testing and eventual issuance, maybe a SI but maybe not. Definitely consult a difficult case AME like Dr. Bruce before ANY interaction with FAA on this. If you post what state or part of the country you are in, someone here might be able to recommend such an AME close by.

Good luck!

 

[Op here]

Azure, it sounds very familiar actually, thank you for sharing that story.

We also had a discussion about ablation but the electrocardiologist seemed pretty confident it would not be necessary and recommended the Verapamil for at least a year before going down that route, for good reason in retrospect. I vaguely remember something about the left ventricle as well but don't quote me on that and I don't know how/if that adds anything to the discussion.

My understanding is that there was/is no underlying condition and my PCP doesn't seem very concerned, nor did the cardiologist that performed my nuclear last year. I don't see a cardiologist on a regular basis and my PCP and I have a pretty good relationship and they are relatively active in my healthcare decisions. Anyway, thanks again for sharing, it does ease my mind a bit.

I am in NYC btw. I will certainly reach out to Dr. Bruce or any other local AME's anyone can recommend when the time is right. There are a few other decisions that need to be made with my family before I can fully commit to this trajectory. LSA is certainly an option butif that were the only option available, I'd have some soul-searching to do before beginning.

 

[bbchien]

Vtach can be certified so long as you do not have coronary disease and have no symptoms. The prohibition on Basic med (requirement to win a special issuance first) is coronary disease so your obligation is to show you do not have CAD. A Stress echo treadmill run to 9 minutes and max heart rate = or greater than 90% of (220-YourAge), should do the job.

 

[Op here]

Thank you Dr. @bbchien.