the EKG

lbfjrmd

lbfjrmd

Line Up and Wait
Joined
Nov 13, 2015
Messages
923
Location
pensacola
Display Name
Senior AME/ATC AME
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pns
When it rains, it pours. I have 3 airmen I have had to ground because of abnormal ekg:

one with hypertensive changes - with treatment he will be ok.
on with a heart block and a half - she should do well with lifestyle modifications
one with 2 blocks (bifascicular) - he is being sent to cardiology and is deferred to the FAA

And these can happen suddenly ... after a string of normals!
 
My biggest problem with the EKG is getting my heart rate down enough to take the test (my resting heart rate is fine). The above post is exactly the reason why.

Having decent LTD (or a solid plan B) is nice to have in your back pocket when the ability to put food on the table depends on this test.
 
pilots hate that I find this - but these are cases of the life of the airman wagging the flying dog!
 
FatherPilot said:
As an almost 50 year old, seemingly healthy so far, this is what freaks me out about trying for another 3rd class versus going for Basic Med.
Click to expand...

No EKG for 3rd Class, but BasicMed is worth it’s weight in gold. To paraphrase one of our AMEs here, why certify for a class of medical that your type of operations doesn’t require?
 
Stewartb said:
Why ignore a potentially life threatening heart issue? The sad part of the original story is that the patients hadn’t had these conditions identified by their PCPs.
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I think the thing pilots hate most about this is NOT KNOWING what is going to be found on the EKG, (ahead of the EKG....of course, which is why they are gotten).

Secondary is the loss of pay while waiting to get into our congested healthcare system...
 
I think it’s common knowledge that pilots delay and/or ignore good health exams due to fear of the FAA. That makes AMEs an enforcement tool for regulations, not health care practitioners. That’s one of my biggest disappointments in the aeromedical system.
 
The advice given to aspiring pilots is to do a medical consult first before diving into a Class _ medical and filling out MedXpress.

I think that advice should apply to everyone prior to every medical (6 mos, 1 yr, 2 yrs) so that there are no surprises. That does seem excessive, and maybe infeasible, but it’s the only way in the current system for a pilot to be able to manage his/her health AND career so that there are no surprises to either.

Does Class 2 require EKG also? If going for your commercial cert to be a CFI only, might as well NOT do the Class 2 if EKG surprise might occur.
 
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455 Bravo Uniform said:
The advice given to aspiring pilots is to do a medical consult first before diving into a Class _ medical and filling out MedXpress.

I think that advice should apply to everyone prior to every medical (6 mos, 1 yr, 2 yrs) so that there are no surprises. That does seem excessive, and maybe infeasible, but it’s the only way in the current system for a pilot to be able to manage his/her health AND career so that there are no surprises to either.

Does Class 2 require EKG also? If going for your commercial cert to be a CFI only, might as well NOT do the Class 2 if EKG surprise might occur.
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No EKG for Class 2. Only Class I and military pilot long form require it.
 
I’ve got one of those home Kardia EKGs. Kinda wonder how accurate they are. Always states “normal sinus rhythm.”
 
About 2 months ago I had my annual visit with my cardiologist. She's a pilot with two airplanes so we always talk about flying as much as my health. Even with a built-in EKG machine in my left shoulder I've had a required cardiologist sign-off and three EKGs for orthopedic surgeries in the past three years and mentioned how I appreciate knowing what's happening inside my chest. She agreed, and suggested I do a stress echo to fill in any blanks. It's on the schedule for October and I look forward to getting the results. I'm not concerned but I wasn't concerned the first time a cardiac issue grounded me, either. Life first. Flying second. I won't take either for granted.
 
Stewartb said:
The sad part of the original story is that the patients hadn’t had these conditions identified by their PCPs.
Click to expand...

Conversely, maybe this is the happy part of the story, for the pilot's own health, that the condition was detected after a string of normal results. Aside from FAA medicals, aren't EKGs seldom ordered, unless a patient has symptoms?
 
NoHeat said:
Aside from FAA medicals, aren't EKGs seldom ordered, unless a patient has symptoms?
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I don’t know how common it is, but my PCP does an EKG in his office every year at my regular exam, along with a chest X-ray and a complete set of labs. The labs get repeated at 6 months.
 
Question for the AMEs here - is there official guidance from the FAA on what the heart rate needs to be for the EKG to be accepted? I've had two different AMEs have me wait until my heart rate was below 90 before sending, which quite honestly isn't easy for me. It's like being told not to think of pink elephants. It jumps from 70 (my resting heart rate) to 95 as soon as the tech walks back in the room. I'm guessing the FAA is looking for tachycardia, but if my AME can easily see that my heart rate is normally fine, is it really that important to wait for my heart rate to decrease before pushing the button? They're not concerned at all about it, but I must admit that it's a bit embarrassing to have to sit there for an extra 5-10 minutes to get my heart rate down. Maybe I should take up meditation? :)
 
Velocity173 said:
I’ve got one of those home Kardia EKGs. Kinda wonder how accurate they are. Always states “normal sinus rhythm.”
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You really need a 12 lead ECG and someone qualified to interpret the results. An annual wellness physical should include it (at least after age 40 or so).
 
kayoh190 said:
Question for the AMEs here - is there official guidance from the FAA on what the heart rate needs to be for the EKG to be accepted? I've had two different AMEs have me wait until my heart rate was below 90 before sending, which quite honestly isn't easy for me. It's like being told not to think of pink elephants. It jumps from 70 (my resting heart rate) to 95 as soon as the tech walks back in the room. I'm guessing the FAA is looking for tachycardia, but if my AME can easily see that my heart rate is normally fine, is it really that important to wait for my heart rate to decrease before pushing the button? They're not concerned at all about it, but I must admit that it's a bit embarrassing to have to sit there for an extra 5-10 minutes to get my heart rate down. Maybe I should take up meditation? :)
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Not an AME, but I have the exact same issue. The cut off is 110. Below 110 is fine. Above not good. Exactly 110 depends on who you talk to, but technically I think 110 or above is not acceptable.
 
My resting pulse had been under 50 for years prior to my pacer. My cardiologist laughed that I had to jump through hoops to get an SI when they’d allowed me to fly sick for 15 years. Even when I saw an AME whose attitude was to save humanity from pilots, and grounded me for a very low dose of thyroid right when policy about it was changing. Not a word about my pulse. For somebody with a resting pulse of 110 bpm? Seek out a doctor to figure out why. You only get one chance at this life.
 
My brother-in-law having severe chest pain ER did 2 EKG's came back normal. Wasn't diagnosed until they got labs back with high troponin he got 3 stents put in.
 
lbfjrmd said:
When it rains, it pours. I have 3 airmen I have had to ground because of abnormal ekg:

one with hypertensive changes - with treatment he will be ok.
on with a heart block and a half - she should do well with lifestyle modifications
one with 2 blocks (bifascicular) - he is being sent to cardiology and is deferred to the FAA

And these can happen suddenly ... after a string of normals!
Click to expand...
What was the outcome with the individual with bifascicular block?
 
Half Fast said:
I don’t know how common it is, but my PCP does an EKG in his office every year at my regular exam, along with a chest X-ray and a complete set of labs. The labs get repeated at 6 months.
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Mine doesn't do the chest x-ray every year, but definitely the others. Also labs every 6 months due to family history. And it's a handy way to get another CMEC, just in case he decides to retire, I have a cushion to find another PCP.
 
An interesting and somewhat relevant aside. We had an AME as guest speaker at our EAA chapter meeting a few months ago. He's very much AGAINST Basic Med for CAP pilots (and pretty much everyone else) because he doesn't trust PCPs. Perhaps an EAA chapter was not the right venue for his opinion, when most of the members are on Basic Med. In our CAP squadron, I'd bet more than half the pilots are on Basic Med.
 
murphey said:
An interesting and somewhat relevant aside. We had an AME as guest speaker at our EAA chapter meeting a few months ago. He's very much AGAINST Basic Med for CAP pilots (and pretty much everyone else) because he doesn't trust PCPs. Perhaps an EAA chapter was not the right venue for his opinion, when most of the members are on Basic Med. In our CAP squadron, I'd bet more than half the pilots are on Basic Med.
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That guy is an idiot. MY PCP does a more thorough physical than any AME I have ever been to. I get EKGs at every physical and blood work. Since being on Basic Med I feel like I can go to and talk to Dr.s without fear. In the long run I think it is going to save lives.
 
DFH65 said:
That guy is an idiot. MY PCP does a more thorough physical than any AME I have ever been to. I get EKGs at every physical and blood work. Since being on Basic Med I feel like I can go to and talk to Dr.s without fear. In the long run I think it is going to save lives.
Click to expand...
I know of one AME that will issue if you have a pulse and a positive wallet biopsy. My primary, that administers my annual physical, is much more thorough and performs lab tests beyond urine glucose.
 
TCABM said:
No EKG for 3rd Class, but BasicMed is worth it’s weight in gold. To paraphrase one of our AMEs here, why certify for a class of medical that your type of operations doesn’t require?
Click to expand...

Velocity173 said:
No EKG for Class 2. Only Class I and military pilot long form require it.
Click to expand...


Funny...the 1st basic med exam I did, my then primary care doc wheeled out his ekg machine...
Brad Z said:
You really need a 12 lead ECG and someone qualified to interpret the results. An annual wellness physical should include it (at least after age 40 or so).
Click to expand...
and I'm not so sure he even knew what he was looking for...
especially because there was no requirement or guideline for it... he was just grasping and looking....giving a good ole college try to pulling together what seemed like a logical and thorough exam for flying without any good clear guidelines.... pulling mostly I think from his experience doing DOT physicals thinking it's about the same...
 
Brad W said:
Funny...the 1st basic med exam I did, my then primary care doc wheeled out his ekg machine...

and I'm not so sure he even knew what he was looking for...
especially because there was no requirement or guideline for it... he was just grasping and looking....giving a good ole college try to pulling together what seemed like a logical and thorough exam for flying without any good clear guidelines.... pulling mostly I think from his experience doing DOT physicals thinking it's about the same...
Click to expand...
There's no requirements or standards established by the FAA for BasicMed exams. Presumably the Doc was using his best clinical judgment to determine if there was anything that would be problematic for signing the form. An ECG is pretty typical for annual wellness checks once you hit age 40 or so...
 
Q: What's an EKG?
A: Electrocardiogram
Q; Then what's an ECG?
A: Also an electrocardiogram
Q: What's an EEG?
A: Electroencephalogram
Q. Then what's an EGG?
A: An ovoid object with a shell and yolk.
 
DFH65 said:
That guy is an idiot. MY PCP does a more thorough physical than any AME I have ever been to. I get EKGs at every physical and blood work. Since being on Basic Med I feel like I can go to and talk to Dr.s without fear. In the long run I think it is going to save lives.
Click to expand...

robin ardoin said:
I know of one AME that will issue if you have a pulse and a positive wallet biopsy. My primary, that administers my annual physical, is much more thorough and performs lab tests beyond urine glucose.
Click to expand...

Yeah, you would HOPE your PCP is more thorough than your AME. After all, the purpose of an AME visit is not to provide you with a thorough checkup. It's not to dig deep and and see if anything is going to be a problem years down the road. It's not to diagnose or fix any existing ailments.

The purpose of your AME visit is solely to determine compliance with an existing set of medical standards. That's it. (And hopefully if you have problems meeting such standards, they'll be your advocate and advisor, yes, but I'd call that a little different than their function strictly as an AME.)
 
RussR said:
Yeah, you would HOPE your PCP is more thorough than your AME. After all, the purpose of an AME visit is not to provide you with a thorough checkup. It's not to dig deep and and see if anything is going to be a problem years down the road. It's not to diagnose or fix any existing ailments.

The purpose of your AME visit is solely to determine compliance with an existing set of medical standards. That's it. (And hopefully if you have problems meeting such standards, they'll be your advocate and advisor, yes, but I'd call that a little different than their function strictly as an AME.)
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Certainly understood by me. However, my statement is accurate. Great to have around if you desire a pencil whipped med cert.. A glorified coffee chat at best.
 
DFH65 said:
That guy is an idiot. MY PCP does a more thorough physical than any AME I have ever been to. I get EKGs at every physical and blood work. Since being on Basic Med I feel like I can go to and talk to Dr.s without fear. In the long run I think it is going to save lives.
Click to expand...
My PCP has been my doctor for over 24 years now. For the first 20 or so he was the doc hired by my employer to perform our Industrial Fire Brigade physicals. Very thorough regime there. I am no longer on the Fire Brigade, but I still use him. He has that long history with me and knows how well I performed on the cardiac stress tests, labs, and lung function checks and various other tests required by NFPA 1582. He had no problem signing my CMEC for BasicMed.
 
FatherPilot said:
As an almost 50 year old, seemingly healthy so far, this is what freaks me out about trying for another 3rd class versus going for Basic Med.
Click to expand...
Father, you need to find an AME who will review your application while is is not live, do the entire exam and then adivse you as to whether or not to "go live". This is very basic and elemental.
 
FatherPilot said:
As an almost 50 year old, seemingly healthy so far, this is what freaks me out about trying for another 3rd class versus going for Basic Med.
Click to expand...
Why not do both? Unless you need a class 1 or 2 medical (generally for commercial operations), Basic Med permits you operate as if you have a class 3 medical certificate. That way, you can continue to operate (at least in the U.S.) while you sort out your options for renewing an FAA medical certificate. In many cases you will continue to fly and save a LOT of money in the process, particularly if there is any kind of medical concern that threatens your ability to be certified with an AME..

I did both then went exclusively to Basic Med to avoid paying $5,000 out of pocket every year for a head and neck MRI to renew my Special Issuance. I don't hesitate to see my cardiologist, dermatologist or any other ologist regularly and as I see fit, and I'm not required to report any of those visits and will just self-ground whenever I need to in order to comply with the regulations. There's a reason that some 75,000 pilots are operating under Basic Med.
 
dbahn said:
I did both then went exclusively to Basic Med to avoid paying $5,000 out of pocket every year for a head and neck MRI to renew my Special Issuance.
Click to expand...

Ditto to avoid paying for an echo, CT, and nuclear Bruce every year.
 
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