February 1, 2010
By Jonathan Sackier
“The heart is the only broken instrument that works,” said T.E. Kalem, former writer for Time magazine, and on Valentine’s Day, surrounded by images of love, we tend to focus on the emotional side of our biological fuel pump. But February is also Heart Health month, so let’s think about that.
As aviators, we have a love affair with engines—oh, those sweet, soothing, throbbing sounds from under the cowling! The astute pilot can detect the slightest aberration in that steady beat, but what of the reassurance of a dependable “lub-dup” from your chest cowling? What is the TBO for your heart? The organ system most likely to transfer you from the cockpit to a rather more confined, permanent container is your ticker and its associated pipes—the cardiovascular system.
If your aviation medical examiner (AME) and personal physician are separate people, it is important to note that the AME requirements may not be the same as your personal physician’s. The former determines whether you have a license to fly, the latter, a license to live! This article should be read in the context of what the FAA demands and what your doctor recommends.
The heart pumps oxygen-rich blood to all organs and returns depleted blood to the lungs to exhaust the carbon dioxide and refuel with more oxygen. In coronary artery disease, the tubes that supply blood to the heart muscle become blocked by atherosclerosis. If this subsequently ruptures, the artery becomes blocked, which can cause erratic heartbeats or death of heart muscle—a heart attack. This is our nation’s number-one killer and often the first sign is a revoked license to live and a couple of column inches in the local newspaper.
Many heart attacks occur in the absence of obvious risk factors and normal cholesterol levels that result in a “normal” flight physical, electrocardiogram, or exercise stress test—common methods of looking for coronary artery disease.
Other ways to find developing blockage prior to permanent damage are worth exploring given how dangerous and asymptomatic this disease can be. One such test is a five-minute noninvasive specialized scan with an Electron Beam CT (EBCT). Dr. Jim Ehrlich, an expert on disease screening and prevention, said, “These ultrafast CT scanners detect and measure the amount of calcified plaque years or decades before there may be a heart attack and precisely identify individuals at risk for future disease.”
Conventional cholesterol tests evaluate total, “good” and “bad” circulating lipids. A comprehensive and accurate analysis, the VAP test, identifies hidden heart disease, allowing doctors to make important therapeutic decisions to help prevent a first heart attack. Many insurance companies do not cover these tests so check with your doctor to see if they are right for you.
The systolic and diastolic blood pressure measurements relate to the contraction and filling of the heart. Both are expressed in millimeters of mercury but there the similarity to weather systems deviates. High pressure recorded by the barometer suggests fair weather, but noted on the unpronounceable sphygmomanometer it is a harbinger of turbulence ahead. There is a normal range, and it is as important to know your numbers as it is to know VNE. Simply put, have your blood pressure checked regularly.
On occasion one of the four heart valves can become either stiff, thereby restricting blood flow, or leaky, allowing reversed flow. AOPA’s chief pilot, Bill Ryan, knows this firsthand. “In 1981 I was informed that I had a heart murmur by my AME. I had a cardiovascular evaluation and was cleared for my first class physical by the FAA. I continued getting my first class [medical], but at age 53 I lost my nerve and had the operation.”
After a day of tests, including an angiogram to evaluate whether his coronary arteries needed attention—they were fine—Ryan was admitted to the hospital, underwent a replacement with a bovine valve, and was home on the fourth day. He was up and about quickly and thanks to AOPA medical staff’s expertise, back in the left seat with a special issuance. With approximately 17,000 hours under his belt, Ryan confidently guides either the AOPA Cessna CJ3 or Caravan all over the United States. With his elective surgery behind him, Ryan summed it up: “How much better to have taken care of this in a planned manner rather than being rushed into the hospital as an emergency? Now I can focus on what I love to do—fly airplanes!”
High blood pressure and coronary artery disease are helped by keeping weight in check, not smoking, eating a sensible diet, and maintaining a regular exercise schedule. However, family history might conspire to interfere with your life expectancy so please consider having appropriate screening tests—if you find a problem, you can deal with it!
Further information can be obtained through the AOPA Medical Services Plan, which offers access to Worldoc, a remarkable online resource. Very soon, AOPA members and families will be able to obtain discounted EBCT and VAP testing, among other screening tests. Stay tuned for that.
Maybe it is fitting to close with another quotation— Confucius said, “Wherever you go, go with all your heart.” Ideally in perfect working order!
Dr. Jonathan Sackier is a U.K.-trained surgeon and active private pilot. E-mail the author at email@example.com.
Aviation Medical Examiner,
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