As I had mentioned in that earlier article, the two main indications for performing an EKG on an airman are as a requirement for first-class airmen when one turns age 40 and every year following, and for the “initial” packet in a pilot who is reporting treatment for high blood pressure for the first time. It is the responsibility of the AME to interpret the EKG and if it is abnormal to have you undergo certain testing and evaluations to make sure that you don't have a medical condition that could be suddenly incapacitating. If the AME feels uncomfortable reading the EKG, then he or she should get someone who is comfortable to interpret it before releasing you from the office with a medical certificate in hand. Most EKG machines these days have self-interpretation capability, and the FAA has given the AMEs a list of what are called “normal variants. These are findings on electrocardiograms that have been found not to be aeromedically significant.
The FAA places online what is called the Federal Air Surgeon's Medical Bulletin, which comes out four times a year to update and educate the AMEs. Here are two articles that I wrote when I was at the FAA on interpreting electrocardiograms: “Electrocardiogram Problems” and “ECG Guidance.”
When you have an EKG performed in your AME's office or bring one in from your own treating physician, it is critical to ask the AME how it looks. If he/she says that it is not normal, then you need to press him or her about obtaining more testing to demonstrate to the FAA that you are OK. Do not leave the office until you both agree on a next step to establish you are OK. Otherwise, if the doctor does not review the ECG and just lets you leave and the graph is not “negative,” some months later you may receive one of those letters that say that your electrocardiogram shows a “variance” and you need to provide the FAA with testing. If that happens, then I strongly suggest that you find yourself another AME!
I had written an earlier article on the circumstances where an electrocardiogram (EKG) might be requested for your FAA medical examination. In this current piece I am going to give you some ammunition to use on your aviation medical examiner (AME) in case the doctor doesn’t do his or her job properly.