Supraventricular tachycardia

[Unregistered]

Older male, overweight, active, non-smoker, non-drinker.
Mar 09 one episode of tachycardia. No trigger correlation. Occurred at rest. 3 minutes, bpm 120, stopped spontaneously. No recurrence. Reported it to doctor and AME, who says don't quit flying. Got thallium dipyridamole stress test (didn't know FAA prefers tread mill. Referring doctor thought my arthritis precluded treadmill, didn't ask me [it doesn't - I can do treadmill]). Interpreting resident says, "Study is probably within normal limits". My doctors says, "...the results of the stress test was normal." My AME says, ????? but is not concerned.
Class 2 runs out Feb 10, decided to let it slip but AME suggests Holter anyway. Have had no symptoms except my typical occasional skipped heartbeat. Took Holter Jan 2010 and felt fine. Interpretation:
"1.) Occasional ectopy (premature ventricular complexes, premature atrial complexes, couplets and bigeminy).
2.) Short runs of supraventricular tachycardia (heart rate around 110 beats per minute)."
I haven't heard from my family doctor yet. Haven't seen the Holter trace. Don't know what the length or frequency of the "short runs" is. I'm interested from my own health perspective and am following up with my doc today but figure if it was serious they'd have contacted me. Still feel fine.
Looking at Guide for Aviation Medical Examiners it appears to me that the FAA will do an SI, will want to see traces, history, GTX for reissue of medical. Does that sound right? Also looks like there is no waiting period like there is with a heart attack or cardio cath?

I'll follow up with my doc for health, but in the meantime is there any cause for concern about sport pilot if I decide the FAA hassle is just not worth it? I'm at the stage where I've talked about slowing down flying, anyway,and light sport is acceptable.

 

[poadeleted20]

Dr. Bruce is busy at the hospital right now, but I'll bet he checks in this evening and answers your questions.

 

[Doggtyred]

I will give you some info from a heart health perspective. This may or may not be the same information Dr BB Chien will follow up with ( MD, Senior AME) that also covers what the FAA looks for from a medical perspective.

Think of your heart as an electric pump.

Stress tests (treadmill, chemical) are primarily PLUMBING tests. They test your heart under load to see if you have signs of inadequate blood flow to portions of the heart muscle. Its this bloodflow that gives the muscle the nutrition and oxygen it needs to do its job. Stress Tests do little to nothing to diagnose irregular rhythms unless its CAUSED by inadequate bloodflow (as a result of said blockages).

With regards to the ELECTRICAL SIDE... the hearts internal wiring...
The holter monitor captured several irregularities, some of which can be expected. Premature atrial and ventricular beats can happen spontaneously, and can occur with increasing frequency as one ages. When someone gets to be over 65 we tend to expect to see one from time to time.

However, a PVC (Premature ventricular Contraction) has less "cardiac output" than a normal beat.. usually 30% less, sometimes more. The greater the number of premature beats in a given amount of time, the greater chance of you having symptoms related to that lowered output (dizziness, for instance). If you aren't having symptoms other than feeling the skipped beats, thats great. Dont get excited over it.

The Supraventricular Tachycardia that you described, which appears to be "self limiting" in your case can be caused by several things. Stress, drugs, or in cases where its literally on then off at the flip of a switch - by electrical defects in the conduction system.

The term, in a purist sense, is.. rapid heart rate triggered/mediated by the top half of the heart (above the ventricles) but not triggered by the sinus node, which is the normal natural electric pacemaking center of the heart (hence the name Normal SINUS rhythm when medical folks are talking about EKGS and heart rhythms).

I work in a cardiac cath lab now, and electrophysiology lab, where I deal with hearts day in and out as a nurse. One very likely cause for your tachycardia, in the manner you are describing on your tests... is the result of one of your PVC's falling in just the right spot... to trigger an alternate pathway/short circuit in your heart that keeps tripping itself over and over...

Treatment for this involves evaluation by an electrophysiologist (a cardiologist trained on the electrical side of the heart, rather than the plumbing side of things). We perform testing in the cath lab to try and cause the tachycardia with a temporary pacemaker, and if we trigger the SVT, then evaluate its characteristics, we can then "fix" it by running a microwave tip catheter across the short circuit, burn it with a few watts of power and typically have a cure.

The medical condition I am suspecting is called AVNRT. The heart rate you are describing falls outside of the traditionally accepted values for what people consider SVT, but the only way to definitively know for sure is to do the Electrophysiology (EP) study and watch where the current goes. We've evaluated and treated patients with slow rates such as yours, and any EP trained doc will be able to perform such a study.

As with all things in medicine, nothing is foolproof. We had a case the other day that looked "simple", but in the course of getting the short circuit we inadverdently got the main circuit too.... resulting in a pacemaker having to be implanted. That is a rare (first one in two years), but real, risk. Doc Bruce would have to say if an ablation is a grounding event... but I'm pretty sure a pacemaker implant is a big red flag for the FAA.

Biggest thing to consider is.. is the SVT causing you problems? Chest Pain? Dizziness? funny feeling in your chest? If its bothersome, you may want to pursue medical management by your cardiologist with meds (which may or may not be on the OK list) that make the SVT less likely, consider an electrophysiology referral to see if your SVT is amenable to ablation, or if its not bothering you then consider the risks/benefits of leaving it be.

Once again. None of this is advice regarding your medical cert. Just giving you info that you SHOULD have gotten from your cardiologist..

 

[bbchien]

Paroxysmal supraventricular tachycardia is not an obstacle to certification provided that: (1)Coronary disease is excluded, and (2) no changes to consciousness or brain function occur during the spell(s). (3) PSVT has to be proven to be just that and not Vent. Tachycardia. If you got a positive on #2, see Dave's post, you need to consider getting the re-entrant electical pathway RadioFrequency blocked, or chronic meds.

Thus the requirement of the Holter monitor (24 hour recording ) as in #3. (1) is satisfied by the treadmill. They REALLY REALLY HATE the dipyridamole scan esp. when trying to exclude CAD, because in males, Dipyrid. Thal's weakest suit is just that. But if you went to a heart rate of 0.9*(220-YourAge) and >8 minutes, and your tracings are good, you have it.

Please know that the thallium images must be negative. You have gone beyond required treadmill screening, but any additional data gets considered, positive or negative, 'cause that's no longer screening, that's added FACTS (It's screening if you are a SECOND CLASS or FISRT CLASS airman). So if these nonrequired images are fishy, you have a problem despite the treadmill.

There is always a waiting period unless you have an AME with a good line either to a proactive RFS (Chicago region, fuggedaboudit) or OK City. If he calls, and describes the studies to a co-operative examiner, and THAT GUY KNOWS THE AME AND TRUSTS HIM, he will give authority to issue year at a time.

That will require yearly holter monitors and cardiac current status letters to maintain the medical. Assuming this is third class, your treadmill runs will be every 3 or six years. If the tracings are BARELY negative, you will have to run each and every year.