Can I get my FAA medical after a heart attack? If you are asking this question, there is hope for you, as there are many pilots who are able to reestablish eligibility for a FAA medical after a heart attack. The protocols for consideration of your medical eligibility following a heart attack are a bit nuanced, however, and don’t always correlate to clinical practices. In other words, after a heart attack, the FAA’s risk mitigation protocol can often be different from what your treating physician may consider clinically significant or relevant. The FAA’s standards and practices are designed for assessing and mitigating the risk for sudden incapacitation within the National Airspace System. As a result, there is often a disconnect between what your doctor would require from you in the normal course of treatment and what the FAA may require for mitigation of risk to aviation safety. This article will discuss some of these nuances and how you can get your FAA medical after a heart attack.
Having a medical history or clinical diagnosis of myocardial infarction or “heart attack” is a specifically disqualifying condition for airman medical certification pursuant to the Federal Aviation Regulations. See 14 C.F.R. §§ 67.111(a)(1), 67.211(a)(1), and 67.311(a)(1). What’s more (and significant to the process for showing the FAA that you are eligible for a medical after a heart attack) is that the regulations also identify the following, disqualifying condition: “coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant.” See 14 C.F.R. §§ 67.111(a)(3), 67.211(a)(3), and 67.311(a)(3). It is important to look at these two “conditions” together for FAA medical certification purposes. Why? Well, because these conditions are identified in the regulations as being specifically disqualifying for FAA medical certification, you will require a special issuance authorization (waiver) in order to be issued a FAA medical certificate. During the process of evaluating your medical history for purposes of special issuance authorization consideration, the FAA will consider whether you have coronary artery disease which remains untreated following your heart attack. Typically, this is where we see a disconnect between clinical medicine and regulatory medicine. For example, we typically see cases where an airman’s treating physician may not believe that an artery occlusion may not be significant enough for treatment; however, the FAA might believe that for purposes of risk mitigation, the very same artery occlusion should be treated with a stent or some other form of treatment. More often than not, it has been the experience of our practice that it is not a heart attack which will cause an airman to be denied a FAA medical certificate, but rather, it is the coronary artery disease which is left untreated and exposed to the FAA as a result of the heart attack.
So, what will the FAA look for after a heart attack? At the “heart” of the issue, is whether your heart attack or remaining coronary artery disease, if any, puts you at risk for prolonged physical deficiencies or risk for repeat heart attack/sudden incapacitation. The FAA’s assessment of your application will depend on the type of treatment you received for your heart attack, as well as what class FAA medical certificate you apply for.
There are four broad categories in which the FAA triages coronary artery disease, whether you have had a heart attack, or not. These categories include the following:
Category One: open revascularization of any coronary artery(s) and left main artery stenting;
- According to the FAA, this is considered “open revascularization includes coronary artery bypass grafting (CABG; on- or off-pump), minimally invasive procedures by incision, and robot operations. Left main coronary artery stenting carries the same risk of future cardiac events as CABG, thus it is treated the same for certification or qualification purposes.”
Category Two: percutaneous intervention;
- According to the FAA, this is considered “angioplasty (PTCA) and bare metal or drug-eluting stents.”
Category Three: myocardial infarction without any open or percutaneous intervention; and,
- This is a situation in which there has been no treatment for your heart attack.
Category Four: myocardial infarction from non-coronary artery disease causes.
- According to the FAA, these are situations in which a heart attack may be caused by something other than coronary artery disease such as “epinephrine injection, cardiac trauma, complications of catheterization, blood clotting disorders (e.g. PT/PTT, Protein S and C, Factor V Leiden), etc.”
| FIRST CLASS MEDICAL | SECOND CLASS MEDICAL | THIRD CLASS MEDICAL |
| 6-Month Observation PeriodCategory One Situations 3-Month Observation PeriodCategories Two, Three, and Four Situations | 6-Month Observation PeriodCategory One Situations 3-Month Observation PeriodCategories Two, Three, and Four Situations | Observation Not Required |
Once your situation has been categorized, the FAA will determine what observation period post heart attack/treatment will be required and what level of testing/documentation will be required for FAA review. Both the observation/recovery period and testing will be different based on you the category of your situation (from above) and the class medical you have applied for. These requirements are as follows:
Once you’ve achieved the required observation period, the FAA will require you to provide records regarding your heart attack, as well as your current function. Again, this is where there may be a disconnect between what your treating physician and the FAA may believe to be reasonable. In many cases, but not all cases, we experience treating cardiologists disagreeing with the necessity of repeat or redundant testing, as required by the FAA. Nevertheless, the FAA’s requirements, generally, are as follow:
- Required documentation for all pilots with MI due to non-coronary artery disease:
- Current status report from the treating physician
- Copies of all medical records (inpatient and outpatient) pertaining to the event, including all labs, tests, or study results and reports.
- Required documentation for all pilots with any of the remaining conditions above:
- The required documentation, including GXT and cardiac catheterization, must be accomplished no sooner than either 6 months or 3 months post-event, depending on the underlying condition as listed in Paragraph A. above
- Copies of all medical records (inpatient and outpatient) pertaining to the event, including all labs, tests, or study results and reports.
- Current status report from the treating cardiologist (cardiovascular evaluation (CVE)) including:
- Personal and family medical history assessment; clinical cardiac and general physical examination; assessment and statement regarding the applicant’s functional capacity and prognosis for incapacitation
- Documentation of counselling on modifiable cardiovascular risk factors
- All medications and side-effects, if any
- Labs (lipids, blood glucose)
- Current Bruce Protocol Stress Test (GXT):
- Third-class airmen – maximal plain GXT
- First and unlimited second-class airmen require maximal radionuclide GXT.
- For specific GXT requirements see Guidelines for GXT
- Additional required documentation for first and unlimited* second – class airmen
- For conditions requiring 6-month recovery:
- 6-month post event cardiac catheterization
- 6-month post event maximal radionuclide GXT (see above)
- For conditions requiring 3-month recovery:
- 3-month post event cardiac catheterization
- 3-month post event maximal radionuclide GXT (see above)
- The applicant should indicate if a lower class medical certificate is acceptable (if they are found ineligible for the class sought)
- For conditions requiring 6-month recovery:
- Additional required documentation for percutaneous coronary intervention:The applicant must provide the operative or post procedure report. If a STENT was placed, the report must include make of STENT, implant location(s), and the length and diameter of each STENT.
A SPECT myocardial perfusion exercise stress test using technetium agents and/or thallium may be required for consideration for any class if clinically indicated or if the exercise stress test is abnormal by any of the usual parameters. The interpretive report and all SPECT images, preferably in black and white, must be submitted.
Note: If cardiac catheterization and/or coronary angiography have been performed, all reports and actual films (if films are requested) must be submitted for review. Copies should be made of all films to safeguard against loss. Films should be labeled with the applicant’s name and return address.
* Limited second-class medical certificate refers to a second-class certificate with a functional limitation such as “Not Valid for Carrying Passengers for Compensation or Hire,” “Not Valid for Pilot in Command, Valid Only When Serving as a Pilot Member of a Fully Qualified Two-Pilot Crew,” etc.
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