Cardiovascular Evaluation Specifications

Heart and Circulatory System—Cardiovascular Evaluation Specifications

Cardiovascular Evaluation Specifications

These specifications have been developed by the Federal Aviation Administration (FAA) to determine an applicant's eligibility for airman medical certification. Standardization of examination methods and reporting is essential to provide sufficient basis for making this determination and the prompt processing of applications. This cardiovascular evaluation, therefore, must be reported in sufficient detail to permit a clear and objective evaluation of the cardiovascular disorder(s) with emphasis on the degree of functional capacity, recovery and prognosis. Preferably, it should be performed by a physician specializing in internal medicine or cardiology. As a minimum, the evaluation must include:

  1. Medical History. Particular reference should be given to cardiovascular abnormalities (cerebral, visceral, and/or peripheral). A statement must be included as to whether medications are currently or have been recently used, and, if so, the type, purpose, dosage, duration of use, and other therapy is required. In addition, any history of hypertension must be fully developed, and if thiazide diuretics are being taken, values for serum potassium should be reported. A comment should be included on any important or unusual dietary programs.
  2. Family, Personal, and Social History. A statement of the ages and health status of parents and siblings is necessary; if deceased, age at death and cause should be included. Also, an indication of whether any near blood relative has had heart attacks, hypertension, diabetes, or known disorders of lipid metabolism must be provided. Smoking, drinking, and recreational habits of the applicant are pertinent, as well as whether a program of physical fitness is being maintained. Comments on the level of physical activities, functional limitations, and occupational and avocational pursuits are essential.
  3. Records of Previous Medical Care. If not previously furnished to the FAA, a copy of pertinent hospital records, as well as outpatient treatment records, with clinical data, x-ray and laboratory observations, and originals or good copies of all ECG tracings, should be provided. Detailed reports of surgical procedures, cerebral and coronary arteriography, and other diagnostic studies are necessary.
  4. General Physical Examination. A brief description of any comment-worthy personal characteristics: height; weight; representative blood pressure readings in both arms; funduscopic examination of retinal arteries; condition of peripheral arteries; carotid artery ascultation; heart size; rate, rhythm, and description of murmurs (location, intensity, timing, and opinion as to significance) and other substantive findings should be provided.
  5. Laboratory Data. As a minimum, must include actual values of:
    1. Routine urinalysis and complete blood count.  
    2. Blood chemistries (values of normal laboratory ranges).
      1. Serum cholesterol and triglycerides after 12-to-16 hour fast.
      2. Fasting blood sugar. If the fasting blood glucose is elevated, a report of hemoglobin A1C may be needed.
      3. Maximum acceptable values for blood testing include:
        1. Cholesterol - 300
        2. Triglycerides - 400
        3. HDL - none
        4. LDL - 180
        5. Glucose - 140
        6. Hgb A1C - 6.5%
    3. Electrocardiograms
      1. Resting tracing.
      2. Exercise stress test to 100% maximum predicted rate.
        1. State methodology used (Bruce protocol 12 lead).
        2. Provide blood pressure determinations at rest, hyperventilation, and post-exercise.
        3. Submit representative ECG tracings for the resting, hyperventilation, and post-exercise periods.
        4. Obtain recovery ECG tracings until there is a return to the control configuration and/or until the control level of heart rate has been achieved.

Note: The information obtained through a determination of current cardiovascular capacity and an evaluation of strain end points under the stress of rhythmic exercise is considered essential to the determination of fitness of any applicant with suspected or known cardiovascular disease. Current practice indicates that a stress test on a treadmill, using 12-lead Bruce or Balke protocol, is optimum in providing the desired performance data. A bicycle ergometer test that results in the same degree of work is acceptable.

Stress testing should be accomplished to no greater than 100% of maximum predicted heart rate, calculated by subtracting age from 220. In the presence of symptom limitations (fatigue, leg cramps, or shortness of breath), the test may be terminated if at least 85% of maximum predicted rate is attained.

All usual medical precautions should be followed in prescreening, election to test, actual testing, and follow-up on applicants who undergo exercise stress testing. The resting tracing should be reviewed by the examining physician for evidence of acute coronary insufficiency, recent myocardial infarction, or repolarization abnormalities. ECG evidence of recent, unsuspected myocardial change or infarction could contraindicate exercise testing. State the reasons why testing is contraindicated. If an exercise/rest thallium or cardiolite myocardial perfusion scan is required, it will be performed along with the treadmill stress test.

How/Where to Submit to the FAA

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Updated October 27, 2009