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Head over heart

Heart disease and mental health

There has been a great deal of attention in the past couple of years to the growing epidemic of mental health issues that affect not just the pilot population but our entire population. 

Life often gets in the way of living, and in our pressure-cooker society, those life events that may begin as a minor annoyance can slowly and insidiously escalate into a bona fide medical crisis, leaving the patient despondent, fearful, and feeling lost without a rudder.

Aside from obvious mental health compromises that result from untreated or undertreated depression, anxiety, PTSD, and myriad other diagnoses that fall into the behavioral health category, mental instability can affect the function of other organ systems.

People with severe mental health diagnoses have an increased risk of developing heart disease. Symptoms of anxiety or anxiety disorders, along with experiences of persistent or intense or posttraumatic stress disorder, may, to a lesser degree, be independently associated with an increased risk of developing coronary heart disease (CHD). The FAA 2022 Aerospace Medical Certification Statistical Handbookcites more than 10,000 cardiac-related issuances, including myocardial infarction, coronary angioplasty with and without stent, coronary artery bypass surgery, pacemaker, and aortic and mitral valve pathologies.

The FAA requirements for a cardiac special issuancestart with a standard recipe of basic testing. For myocardial infarction, chest pain (angina pectoris), angioplasty with or without stent, or coronary artery bypass, the FAA will wantbasichospital records, including admission history and physical, preop cardiac cath, if performed, operative report, and discharge summary.

You will also need a current (within the preceding 90 days) cardiovascular evaluation including an exercise Bruce protocol stress test, lab report for cholesterol and triglycerides, and fasting blood sugar (because there is a correlation between diabetes and coronary heart disease). You will also need a current detailed narrative evaluationfrom your treating physician.

The last important point to keep in mind is the FAA is overwhelmed with medical applications, and the wait time for a special issuance isfour to seven monthsafter all required information is in its system.

Gary Crump is the director of medical certification for the AOPA Pilot Information Center.

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
Frederick, MD USA

Gary Crump

Gary is the Director of AOPA’s Pilot Information Center Medical Certification Section and has spent the last 32 years assisting AOPA members. He is also a former Operating Room Technician, Professional Firefighter/Emergency Medical Technician, and has been a pilot since 1973.

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