AOPA Pilot Magazine - July 2013 - 28

FLY WELL

BY DR. JONATHAN M. SACKIER

The grim reaper versus $49
Tests to keep your heart beating

DR. JONATHAN
SACKIER will

present
health-related
seminars at the
2013 AOPA
Aviation Summit in
Fort Worth, Texas,
October 10-12.

28 | AOPA PILOT July 2013

WHAT WILL LIKELY kill you? Heart disease—the most
common cause of death in America. “But I eat well,
exercise, and don’t smoke, so I’m OK, right?” That ain’t
necessarily so.
Your heart pumps blood to the lungs, where oxygen
is collected and carbon dioxide (CO2) dumped. Upon
returning, it is squirted to every finger and toe, organ
and tissue delivering nutrients and oxygen, collecting
refuse and CO2, the cycle repeating 72 times a minute.
The first, freshest, friskiest blood flows through coronary arteries, tubes supplying the heart muscle with fuel
required to do its important work.
Bad genes, cigarettes, fatty diets, obesity, and sedentary lifestyle cause arterial gumming up with atheroma
(“porridge tumor”) limiting blood flow, like plumbing blocked with hard water deposits. Such atheroma
plaques cause cardiovascular (heart vessel) disease
impairing downstream organ function. If seriously
compromised, heart tissue dies—myocardial infarction
or heart attack. Eventually plaques harden as calcium
is deposited causing vessel walls to become rigid and
non-compliant.
Clues that disease is present include family history, high blood pressure, chest pain, or breathlessness
on exertion. In some tragic cases there are absolutely
no symptoms—and then, sudden death. As patients,
our responsibility is to live a healthy lifestyle and have
regular checkups. If symptoms appear, seek prompt
medical attention. Doctors, suspecting clogged arteries, will perform a history, physical examination, and
tests to include chest X-ray, electrocardiogram (ECG)
to review cardiac rhythm, and blood tests to measure
blood fats and cardiac muscle damage.
After prescribing medication to control blood pressure, heart rhythm, and raised cholesterol, a stress test
may be required; heart rhythm and blood pressure are
measured as heart rate is raised either by exercising on
a treadmill or by injecting a drug to increase heart rate
(the FAA usually prefers the former). ECG changes may
reveal not enough blood is bathing heart muscle, implying coronary artery disease. An angiogram might ensue,
whereby a catheter is maneuvered from a small groin
incision up into the heart and a chemical is injected,
which shows up on X-ray. This creates a coronary artery
map, identifying narrow or occluded areas which can

then be expanded with balloons, propped open with a
stent, or require a surgical bypass.
What if none of this applies to you—the 53-year-old
nonsmoker? You work out and eat well, blood pressure
and lipids are normal, but your uncle died of a heart
attack. Look at the first sentence again—heart disease
is the most likely source of your demise. Telling your
doctor you merely have concerns about heart disease,
it is unlikely you will qualify for insurance coverage for
a stress test—and even if you do have one it may well be
normal. But widowmaker plaques could be lurking
inside your chest, causing no symptoms until the day
one becomes inflamed, ulcerates, pops up, and blocks
the artery with dire consequences—two column inches
in the local paper and six feet of undesirable real estate.
The U.S. Preventive Services Task Force may state
that screening for heart disease probably makes no economic sense—which I find baffling in this country, land
of the free and home of the brave. Talk to your doctor
about whether you should undergo a CT heart scan,
which looks for calcification in the coronary arteries.
It is not covered by insurance, but takes five minutes
and costs around $49. The radiation dose is miniscule,
and if the result shows you have little or no calcium,
your risk of heart disease is far lower. Of course, if calcium is seen, this might lead to more tests. As with any
medical test there are false positives and negatives, but
I had this examination as a sensible precaution given
the consequences of missing a diagnosis.
At St. Vincent Heart Center of Indiana, Dr. Joseph
George, a radiologist with special expertise in this
modality, told me that they have screened countless
first responders—many fit young men in their 30s—
and “although the yield of bad disease is low, wouldn’t
you want to know?” He also talked of other advances
that will change how we diagnose and treat this heartfelt killer. For pilots having this test? The FAA does not
recognize CT heart scans for aeromedical purposes and
if calcium is seen, third class certificate holders need a
Bruce stress test; second class, a maximal test. If negative, report it at your next flight physical. A pain in the
neck, I know, but better than a pain in the chest; keeping your heart beating beats the alternative.
AOPA
EMAIL jonathan.sackier@aopa.org

AOPA Pilot Magazine - July 2013

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