Question chest pain issues class 2

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Chuck Akan

Filing Flight Plan
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Jan 10, 2026
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Chuck
It's now Jan 2026, I have a class 2 medical, contract pilot so it's my paycheck. Was on 50mg Losartan blood pressure meds for slightly elevated blood pressure for 1 year. High blood pressure spiked 2 months ago led to urgent hypertension ER visit and 2 nights in hospital, now on 50mg HTZC and 100 Losartan keeping it well under control. 1 month ago started feeling chest pain after exercise ER visit with diagnosis of either GERD (which I've been to ER about 4 times last 10 years) or musculoskeletal, no heart issues they say. Seeing cardiologist in 3 weeks. Lately after exercising I get chest pain which I'd call angina lasting 1-2 days. Wife thinks it's GERD and stress related, I go back in forth between GERD and actual heart issues and even stray to things like Gallbladder issues. Also wondering if my meds could be causing these issues? So question is: if stable angina, can they do a stent and can I keep my class 2, and how long after stent until cleared? Are companies required to allow me time off to recover and get class 2 passed or can they fire me for not being able to do my job?
 
Gall stones definitely present as excruciating chest pain. BTDT. Has anyone does an ultrasound to eliminate gall stones?
 
murphey said:
Gall stones definitely present as excruciating chest pain. BTDT. Has anyone does an ultrasound to eliminate gall stones?
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Would they have done that in the ER? I remember them doing ultrasounds, xrays and CT scans to my chest but they never said they were looking at the gallbalder.
 
Chuck Akan said:
Would they have done that in the ER? I remember them doing ultrasounds, xrays and CT scans to my chest but they never said they were looking at the gallbalder.
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Only they think of it as a differential diagnosis. My wife keeled over and got taken to a hospital with a big cardiac care center attached. They had her laid up for two days and sent for an angiogram to find out there's nothing wrong with her heart and turfed her. Two days later she was back at a different hospital and within hours her gall bladder was gone (completely crammed full of stones).
 
Chuck Akan said:
1 month ago started feeling chest pain after exercise ER visit with diagnosis of either GERD (which I've been to ER about 4 times last 10 years) or musculoskeletal, no heart issues they say. Seeing cardiologist in 3 weeks.
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Why a cardiologist and not a gastroenterologist?
 
Chuck Akan said:
I did see a gastroenterologist and got an upper scope, they saw nothing significant. That was several months ago. Just put me on 20mg Nexium.
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As a long-time, experienced Nexium user, 20mg did nothing for me. And if you're getting generics, some of them are just garbage. You might talk to your doc about antihistamines, or something stronger.
 
4CornerFlyer said:
So far the count is four people questioning the medical care from afar, and none answering the question asked.
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Man, good thing I didn't post my thoughts on his medical history-would have been 5...:rolleyes:

Anyway, if it is coronary artery disease and he ends up with a stent, the protocol is here...

FAA stent protocol

I actually did type up a long blurb on what it might be, but it sounded too much like medical advice. Suffice it to say the OP needs a very thorough cardiac evaluation. If that is negative, then yeah, march down the GERD/dysmotility/gallbladder pathway. How come no one goes to a seasoned internist anymore? Would have had an answer 6 months ago for less money...;)
 
4CornerFlyer said:
So far the count is four people questioning the medical care from afar, and none answering the question asked.
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Ok. If we're going to assume that the OP's self-diagnosis is more accurate than his wife's and his doctor's, then he's grounded now. The FAA considers both Angina and chest pain of unknown cause to be disqualifying. So if that's what the OP believes he has, no need to wait to be grounded by the stent.

Whether he qualifies for disability payments or FMLA leave will likely depend on a number of other factors.
 
Lindberg said:
Ok. If we're going to assume that the OP's self-diagnosis is more accurate than his wife's and his doctor's, then he's grounded now. The FAA considers both Angina and chest pain of unknown cause to be disqualifying. So if that's what the OP believes he has, no need to wait to be grounded by the stent
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THIS. Get the diagnosis figured out.
 
4CornerFlyer said:
So far the count is four people questioning the medical care from afar, and none answering the question asked.
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Because other than the 3 AMEs on this list, none of us are qualified to answer the original questions. Those are company policy or company insurance questions.
 
So chest pain yesterday led to ER visit, normal echo, normal nuclear stress test, atypical chest pain, not present during stress test, docs saying probably musculoskeltal. Do I go see my AME now, or after cardio follow up in 2 weeks followed by PCM 1 week later and see what next steps are?
 
Chuck Akan said:
So chest pain yesterday led to ER visit, normal echo, normal nuclear stress test, atypical chest pain, not present during stress test, docs saying probably musculoskeltal. Do I go see my AME now, or after cardio follow up in 2 weeks followed by PCM 1 week later and see what next steps are?
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If you believe you have coronary heart or coronary artery disease, you need to disclose that on medxpress, and self ground now. If you have chest pain that's caused by GERD or musculoskeletal pain, then you need to disclose that on medxpress. If you have chest pain of unknown cause, you need to disclose that on medxpress and self ground now. In any event, you should have a consult with your AME, with all your records, well prior to your exam.

Here's the flow for chest pain:

 
On the other hand, as a physician, I would never tell a patient his pain was musculoskeletal if I thought there was even a small possibility of heart disease. A normal echo and nuclear stress test go a long way in ruling out any significant cardiac disease. (Not 100% though. There are rare scenarios where a nuclear stress can look normal, but this is exceedingly uncommon.)

So does he have to self ground? I would just contact my AME, say, "Hey, I ended up in the ER with atypical chest pain. The workup, including an echo and nuclear stress was normal and the ER doc thought it was musculoskeletal. " And see what the AME says. This is an exceedingly common medical scenario. The goal on initial evaluation is just to rule out significant, that is, cardiovascular or lung disease. Once that's excluded, then statistically you're most likely to end up with "musculoskeletal," or a GI issue/GERD. Neither of which will cause you to abruptly keel over and die. And, more importantly, not slump over the controls while dying.

I suspect what might happen though, and it falls under the "when you have a hammer, everything is a nail," is that he might be offered a CT angiogram by the cardiologist. To be fair, it also depends on his risk factors and age.

And, well, insurance ;). Of course, after his cardiac workup, if the symptoms continue he'll be referred to a gastroenterologist for a scope. Then a rheumatologist for his "costrochondritis," then to mental health for his anxiety...sigh...
 
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