February 26, 2009
By Jill W. Tallman
As American Heart Month draws to a close, it’s important to remember some good news about flying and heart disease. Fewer than 30 years ago, cardiovascular disease was a disqualifying condition for pilots. Heart attack? No more medical certificate.
That’s no longer the case. Today, some 12,000 pilots with heart disease are flying on all three medical certificate classes.
Larry Pennington of Suffolk, Va., is one of those pilots. Pennington, now 56, suffered a heart attack in 2003 while flying a Cessna 206 from Suffolk to Raleigh/Durham, N.C. Amazingly, he was able to maintain control of the aircraft—there was no autopilot—and land. He’d never felt such pain.
“It [was] like someone had a fish hook in my chest and was trying to pull my heart out of my chest,” Pennington says. He opened the 206’s roll-up door to get more oxygen, doused himself with water, descended from 6,500 to 2,000 feet, and focused on the instruments—airspeed, altitude, heading, attitude—until he landed at Raleigh-Durham. Doctors confirmed that he’d had a heart attack, and shortly thereafter Pennington underwent bypass surgery, in which healthy blood vessels are taken from the leg, arm, chest, or abdomen and connected to other arteries in the heart so that blood is “bypassed” around diseased or blocked areas.
Bypass surgery is one option to treat heart disease. Other artery-opening procedures include angioplasty, in which a catheter is inserted through an artery in the groin or arm, guided to the narrowed artery, and a balloon inflated to improve blood flow; and stenting, which involves placing a wire-mesh tube in the blocked area that expands to hold the artery open.
Physically fit and a non-smoker, Pennington nonetheless had a family history of heart disease. In fact, he’d taken a stress test and was scheduled to go over the results with his general practitioner on a Monday. The heart attack happened on a Sunday.
The FAA requires a six-month recovery and stabilizing period after a cardiac event or procedure such as bypass surgery or angioplasty. If you plan to request a special issuance medical certificate, you’ll need to assemble your medical records and obtain a cardiovascular evaluation. The evaluation must include an assessment of your personal and family medical history, a blood chemistry profile, a description of the medications you’re taking, and a treadmill stress test. These are just some of the requirements. There are several more; see the subject report on AOPA Online for additional information.
After his surgery, Pennington wanted to apply for a second-class special issuance medical certificate. A multiengine- and instrument-rated pilot with a commercial certificate, he owns and operates Skydive Suffolk Inc. The skydiving business operates a Cessna 206 as well as a PAC 750, a New Zealand-built low-wing turboprop that can carry up to 14 jumpers. Pennington also owns a Cessna 310 that he flies for the U.S. Coast Guard.
The FAA initially disallowed Pennington’s application for a special-issuance medical. He’d had a stent, which started the six-month recovery clock again; some disqualifying medications resulted in another denial--and the list goes on. Pennington asked AOPA’s Medical Certification Department for help. He wasn’t about to give up.
“After the procedure was done, I had never felt better,” he says. “I didn’t realize how bad I felt [before the heart attack]. I felt wonderful. I went back to running, which I hadn’t done in a long time…I haven’t had that much endurance since I was 19 or 20.”
All told, it took 18 months and frequent telephone calls to the FAA, but Pennington got his medical. He credits medical certification specialist JoAnn Wilson for making sometimes-daily telephone calls to Oklahoma City, Okla., on his behalf. “If it hadn’t been for AOPA, I wouldn’t be flying right now,” he says.
Pennington must undergo a treadmill stress test every six months; he also undergoes a nuclear perfusion scan yearly. The graded exercise stress test, using the FAA-favored Bruce protocol, is the primary tool for evaluating coronary artery disease, but the nuclear scan is often used by the FAA as a more sensitive study to detect compromised blood supply to the heart during exercise stress.
Throughout American Heart Month, we’ve shared success stories about pilots who overcame health problems and kept flying. The FAA has broadened its guidelines on obtaining a medical after coronary disease, but that doesn’t give you a free pass to ignore your heart health. Follow your doctor’s recommendations for lifestyle, diet, and exercise. And if you have questions about heart issues or any other health concerns, contact the medical certification experts in AOPA’s Pilot Information Center. Call 800/USA-AOPA weekdays from 8:30 a.m. to 6 p.m. Eastern Time, or send an e-mail.
AOPA Technical Editor Jill W. Tallman is an instrument-rated private pilot who owns a Piper Cherokee 140.
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