AOPA Pilot Magazine - August 2021 - 28

FLIGHT MD
Better tests,
better future
Let's modernize the first class FAA ECG
BY DR. BRENT BLUE
I HAVE A RECOMMENDATION for how the FAA can modernize first class
medicals. Instead of resting ECGs (electrocardiogram), do stress
ECGs or nuclear stress ECGs. Now hear me out before shouting.
First class medicals are the least common medical that AOPA
members obtain, but the association has a bunch of airline pilots
who are members and who have a lot more fun flying small aircraft
than the big iron tubes.
At age 35 and annually after age 40, the FAA requires first
class medical applicants undergo a resting ECG. Resting ECGs
are a tracing of the electrical activity of the heart and mainly
show the rhythm of the heart. The ECG also shows how the electrical
impulse travels through the heart.
The ECG rhythm demonstrates irregularities such as atrial
fibrillation and normal skipped beats like premature ventricular
contractions (PVCs)-both of which can usually be indicated by
Most important, ECGs have almost zero predictive
value for sudden incapacitation, which is the FAA's
persistent concern.
listening to the heart with a stethoscope or feeling a pulse. Other
more esoteric rhythms can be detected as well.
The tracing of the electrical impulse can show tissue that
has been damaged in the past by a heart attack or other past illnesses.
If a person is experiencing acute symptoms, which is
not the case in most flight physicals, it can show an acute evolving
heart attack.
Most important, ECGs have almost zero predictive value for
sudden incapacitation, which is the FAA's persistent concern.
ECGs are old technology and there are far better methods that
also give predictive information, which is not only important to
the FAA but of substantial importance to the pilot as well.
Stress ECGs are heart electrical tracings that are performed
while a person is on a treadmill or a pedaling a stationary bike.
The science behind the stress test is, that as a person exerts
energy on a standardized scale, their heart rate, blood pressure,
and electrical activity should follow a fairly specific pattern. If
the person's results do not follow that standard pattern or shows
28
AOPA PILOT / August 2021
sign of a blockage of their coronary arteries through the electrical
wave forms, additional testing might be indicated. However,
if the test is negative, it means there is an excellent chance the
pilot does not have any coronary artery blockage and will not,
statistically, over the next five years.
There are some caveats to a stress ECG. There are some false
positives as well as false negatives but far fewer than a resting
ECG. In addition, the blood pressure response to the standardized
workload is recorded. Many times, a hypertensive response
to exercise is discovered and treatment with a medicine can prevent
serious problems as a person ages.
A nuclear stress test (also known as a myocardial perfusion
scan, Thallium, Sestamibi, and other names) is an even better
test. In addition to the stress test, a dye is injected during maximal
stress and again at rest. This dye is visualized on a special
camera that shows the distribution in the heart, which should
be increased during the high exercise portion. An analogy would
be like watering your garden with a hose. If the hose had a kink
in it, you might not notice. But when the house catches fire, you
turn the spigot all the way up and no more water comes out, you
know there is a problem. A nuclear stress test is essentially the
same physical concept.
Now the tough part-cost. A stress ECG is about five times
more expensive than a resting ECG. What I propose is the FAA
give pilots the option to take a stress test every five years in lieu
of an annual ECG. That essentially evens out the overall five-year
costs. Although a nuclear stress test is significantly more expensive,
about twice a non-nuclear stress test depending on in which
geographic location it is done, it may be worth the pilot opting
for it. It really is far better than a regular stress test and exponentially
better than a resting ECG.
These tests are more than just about flying. They can help
prevent progression of coronary
artery disease by early
discovery of heart disease
before damage is done. The
FAA could do something
really positive for pilots by
adopting this straightforward
proposal.
BRENT BLUE, MD, is a
senior AME who practices
medicine in Jackson Hole,
Wyoming. He is ATP
rated and flies a Noorduyn
Norseman out of Driggs,
Idaho.

AOPA Pilot Magazine - August 2021

Table of Contents for the Digital Edition of AOPA Pilot Magazine - August 2021

Contents
AOPA Pilot Magazine - August 2021 - Intro
AOPA Pilot Magazine - August 2021 - BB1
AOPA Pilot Magazine - August 2021 - BB2
AOPA Pilot Magazine - August 2021 - Cover1
AOPA Pilot Magazine - August 2021 - Cover2
AOPA Pilot Magazine - August 2021 - Contents
AOPA Pilot Magazine - August 2021 - 2
AOPA Pilot Magazine - August 2021 - 3
AOPA Pilot Magazine - August 2021 - 4
AOPA Pilot Magazine - August 2021 - 5
AOPA Pilot Magazine - August 2021 - 6
AOPA Pilot Magazine - August 2021 - 7
AOPA Pilot Magazine - August 2021 - 8
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AOPA Pilot Magazine - August 2021 - Cover3
AOPA Pilot Magazine - August 2021 - Cover4
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