Silent/Mild heart attach last week

Joe P

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Doing the preliminary research now but here are the details that are known:

Last Sat, I had a silent Heart Attach while mountain biking. Thought I had just worked too hard. Discomfort went away after I got home but came back Monday morning. To the ER I went where they did blood work, EKG, and chest x-ray. EKG and x-ray were normal. However, blood work showed elevated heart enzymes and the silent heart attack was diagnosis. Admitted to hospital.

Tues morning -- Cardiac Cath. 1 artery 100% blocked, 2nd artery was 90% blocked. 2 stents put in on the spot. They want to go back to check out a 3rd artery that appears to be 50% blocked but want to re-evaluate in 3-4 weeks. I was released from hospital Weds afternoon.

Pain -- No classic pain associated with this incident. No crushing chest gripping pain, no elephant sitting on the chest pain, no shortness of breath, and no sweats. Just an ache. Cardiologist tells me the 2 arteries we not major arteries and that is probably the reason for no classic signs but called them the culprits. Regardless, he said I made the right call in going to the ER.

All this known, here's the question(s). I am on basic med and obviously am self-grounded. I understand for me to get back in the air after all this is over and cardiologist clears me to return to normal activity, I will need to get a SI. Do I see the AME to just get an SI or do I need to go back to a 3rd class in order to get the SI? Not sure if I just stay with the Basic Med and go for the SI with an AME?

Any guidance will be greatly appreciated.
 
Pinging Doctor’s Lou and Bruce for their input. @lbfjrmd @bbchien


I have seen both of our resident AME’s comment that certification after a cardiac incident and stent implantation is possible. It just takes many steps and acquiring the correct documents to show the FAA details of what happened, treatment, and proving that the likelihood of reoccurrence is minimal.

Hopefully they will be along soon to provide guidance about the process
 
A SI has to be a SI of something. You need to apply for (at least) a third class medical and jump through the hoops to get (special) issuance.
 
Yes, because you have a condition listed in 14 CFR 68.9, you have to go back and get a third class medical issued with a SI for the MI. After that you can go back to basicmed.
 
Yes, because you have a condition listed in 14 CFR 68.9, you have to go back and get a third class medical issued with a SI for the MI. After that you can go back to basicmed.


Correct me if I'm wrong, but I believe if an airman's 3rd class also requires an SI for other conditions (say sleep apnea or diabetes, for example) that are not on the basic med list, he'll still need to have an SI for those as well. There's no way to get an SI 3rd class for just the cardio condition if other issues are also present.

Is that correct?
 
You need an SI and an SI is only issuable as part of a regular medical.
 
Correct me if I'm wrong, but I believe if an airman's 3rd class also requires an SI for other conditions (say sleep apnea or diabetes, for example) that are not on the basic med list, he'll still need to have an SI for those as well. There's no way to get an SI 3rd class for just the cardio condition if other issues are also present.

Is that correct?

That correct. A special issuance is a special issuance for a medical certificate. It is not a special issuance for a particular medical condition. A special issuance is granted in the context of the airman's complete medical profile. So yeah, if you developed diabetes after going BasicMed (which isn't a condition in 68.9), and then have a heart attack, you will need an SI to address both conditions.
 
This is going to be fun. Back when I had the 3rd class, I had SI for hypertension and a retained kidney stone. While on Basic Med, diagnosed with Obstructive Sleep Apnea. Now heat attack requiring stents (thank God not by-pass). FAA is going to think I'm a train wreck!!!!!!!
 
Do you know your “ejection fraction”? It has to be >40% to win an special issuance. The other showstopper is if you have any >69% lesion remaining ANYplace in the arterial system.....
 
This is going to be fun. Back when I had the 3rd class, I had SI for hypertension and a retained kidney stone. While on Basic Med, diagnosed with Obstructive Sleep Apnea. Now heat attack requiring stents (thank God not by-pass). FAA is going to think I'm a train wreck!!!!!!!

That's all pretty normal stuff for folks in the 75% age percentile of GA pilots. There are many threads here on OSA SIs.
 
Do you know your “ejection fraction”? It has to be >40% to win an special issuance. The other showstopper is if you have any >69% lesion remaining ANYplace in the arterial system.....
Ejection fraction is estimated to be 40-45%. Will that value increase with time for healing? Have to have one more cardiac cath on the 27th. After that, I will let you know the findings and based on your suggestions, I will go from there..
 
Also know that if ANY blood vessel remains with a 70% or more lesion, it's grounding.
If the LEFT main has a 60% or more, its' grounding and the reapplication time after that is treated, is 6 months, not 3 months.
 
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