Ugh. Minor cardiac anomaly turns into mess
 

I recently got my class 1 renewed and there was a minor electrical anomaly on my ekg. The doctor still issued the class 1 but he said to expect a letter from the FAA requiring additional testing. He assured me that the issue never grounded a pilot, but that the FAA would likely require some additional testing and that I should not worry.

I went for the initial additional testing and during the heart stress test, right as I hit my peak heart rate they found an abnormality. The cardiologist now wants to do an imaging test. I have no symptoms and am in excellent physical condition; however, the abnormality either points to just a variance in my own personal physiology at peak heart rate or it could point to a blockage -- which is why they want to do imagery. I didn't even get to see the doctor, but the go-between said worst case is if there is a blockage they'd have to put in a heart stent or possibly accomplish bypass.

Should it be the absolute worst, is this something I can recover from and regain my class 1 physical or is it time to find another line of work?

yes u can come back ... may be some hoops to jump through ... but your life is most important.

Thank you for the reply. The cardiologist office I use is very busy and I never even saw a doctor on this visit, just had the bad news conveyed through the test administrator who I presume was a nurse. I had a couple follow-up questions if you don't mind answering.

As I was cooling down from the test, the nurse noted that my left leg and left arm limb leads were reversed and swapped them. The tech tried to cover her mistake by saying 'oh, I've seen this before and the doctor says it doesn't matter'. Is this a true statement or could this have affected the outcome of my test? If it helps: The "positive" on my test occurred at the 11th minute of the stress test exactly when my heart rate hit 100% effort. The nurse showed me the EKG and (I may relate this poorly, this is not my language) said that the portion of the graph between heartbeats dropped below the resting level-line when I hit my maximum heart rate which could be indicative of a blockage.

If there is any blockage at all, will the FAA require I do some kind of surgery to correct it, or will I just be able to change diet/exercise plan and continue to monitor?

Just a question of office protocol, but since the tech screwed up the lead placement I'm a little concerned. She dry shaved my chest and I have no idea if the blade was new or sterile. The tech was on loan from another office and didn't know where anything was. Prior to placing the lead she couldn't find a razor and left the room. When she came back she had a razor in her hand, I didn't think about it at the time but after I left I realized I had no idea if the blade was clean or had been previously used on another patient. Since she dry shaved me I have mild abrasions on my chest and am concerned she could have spread a disease or bacteria. Is this a concern?

Finally, is it normal to deliver bad news through a go-between? I've got all these questions and I never even saw a doctor. No sleep at all last night wondering what's going on, I'm really frustrated.

Thanks and sorry for the fairly long and rambling post.

First thing's first: relax. Deep breath. It seems like a mess now but it probably isn't as bad as you think. The FAA is pretty progressive with cardiac issues. As the good Doctor before me said, you may have to jump through some hoops (but thats where AOPA or AMAS comes in handy). That being said, my first recommendation would be to contact AOPA or ALPA medical (AMAS) if you have the ability.

I would also demand to speak with your cardiologist (not a go between) or contact a different cardiologist and have your records reviewed by their office. If it's a rhythm issue, perhaps a referral to an electrophysiologist would be appropriate. Yes you may spend some dough, but better to rule out serious issues now.

I'm not sure what kind of abnormality was shown? Was it a Premature Ventricular Contraction (PVC), or Premature Atrial Contraction (PAC?) The FAA has steps to address these diagnoses. Take one step at a time, but take care of yourself first.

Thanks WhisperJet.

My anomaly is WPW syndrome. I passed the treadmill stress test for WPW with flying colors but (un)fortunately they found a potential blockage instead. I say (un)fortunately because obviously I'd like to have had a perfect stress test, but if there is a problem my life is more important that my job and it's best I find out sooner than later.

I spoke with the cardiologist on the phone today and he clearly spelled out the various paths this could go down, so I feel somewhat better now than I did last night. Right now we're at inconclusive and I've got to do a nuclear stress test for my next step. Hopefully that test is negative and I'll be good to go, if not then I believe he said the next step would be an angiogram.

Go to the Cleveland Clinic web site for cardiology. Their web site has been most informative for me.

I'm dealing with a hypertrophic cardiomyopathy misdiagnosis. The staff at the Cleveland Clinic is excellent and the cardiologist who reversed the previous diagnosis is well known and highly regarded. Now I'm waiting on a decision from Washington.

Good luck!

Thanks for the advice and good luck on your up and coming decision.

At first I thought it would be great if the doc told me no blockages, just a thick heart muscle until I started researching and discovered that little gem HCM. The bulletin I found was a bit old and at the time the FAA wouldn't issue a class 1. I found out from a subsequent conversation with the Colorado doctor ALPA contracts with that it is now possible to get a class 1 even with HCM under certain circumstances but I was still really nervous going into my nuclear stress test.

Anyway, the nuclear stress test went as well as it could have. My WPW didn't even show up on the initial resting EKG (if only I'd had the same EKG 2 weeks ago, none of this follow-up mess would have ever even happened), I made it to 14 minutes on the stress test until I hit 100% effort, but I still had the "drop" (can't remember the specifics, s-wave drop perhaps?) from between 165 and 175 heart rate. The pictures of my heart both pre and post exercise showed excellent blood flow. The cardiologist could not definitively determine what caused the unusual EKG at high heart rates but based on how well I did on the stress test and how quickly I recovered he said it is likely that's just my own personal physiology and there is nothing wrong at all. I'm now just waiting on the results of my halter monitor, and barring any crazy unexpected requests from the FAA I should be good to go! To say I'm a bit relieved would be a gross understatement.