Coronary Artery Disease and Your Medical Certification

 R   aymond Basri, MD, FACP     236 Crystal Run Rd, Ste. 2 Middletown, NY 10941 June 18, 2014   Coronary Artery Disease and Your Medical Certification Pilots can have coronary artery disease and not be retired on disability. Here is a case where the pilot regained his Class 1 Medical Certificate exactly 6 months after having a mycardial infarction and coronary artery stent. The FAA mandates a 6 month medical furlough after any cardiac incident or procedure including coronary artery bypass surgery (CABG). Although the 6 Months is a minimum, many airmen are never returned to duty sometimes becasue they did not seek out the proper medical advice. In order to return to full duty with the least time off, pilots should work with their Senior AME to plan the testing and reporting needed to satisfy the FAA. We are experienced with these issues and have successfully returned scores of airmen to work and recreational flying. Here is an example of how we approach the return to duty. Ray Basri, MD, FACP Senior Aviation Medical Examiner   Manager,  Aeromedical Certification Division PO Box 26080 Oklahoma City, OK 73126   Dear Dr. XXXX at FAA,   I performed the cardiovascular exam as per protocol for the first request for Authorization for Special Issuance of a First Class Medical Certificate. This airman has a history of MI in March 2013 followed by successful PTCA and stenting of the distal circumflex artery on March 28 using a Resolute drug eluting stent. He made an excellent recovery and underwent nuclear exercise stress testing on August 29 with normal exercise capacity (Bruce stage 4, 10 minutes) and normal scans. This airman also had transthoracic echocardiography done on the same date, which showed normal wall motion and LVEF. Furthermore, after these tests were done and reported as normal, this pilot underwent another cardiac catheterization which showed normal flow through the stent and excellent perfusion to all areas of the myocardium. I am pleased to report that his health continues to be good, free of cardiovascular symptoms of chest discomfort, shortness of breath, palpitations, dizziness, or side effects from his medications. He is currently taking Lisinopril 5 mg per day, Dexilant 60 mg per day, Crestor 10 mg per day, Plavix 75 mg per day and ASA 81 mg per day. His metoprolol was discontinued after the normal stress test and catherization. He has no side-effects from these medications. He does not use tobacco, family history is negative for CVD, and his weight has come down from 232 to 225 lbs. He runs a couple of miles daily. This airman has normal blood pressure 120/80 in each arm on 3 separate visits, and physical exam shows: HEENT- Anicteric, PERLA, EOMI, Fundi nl Neck- supple, JVD neg , no bruits Lungs- clear to A & P, well healed midline CABG scar COR- RSR no murmurs, gallops or rubs, PMI is not displaced Abd- soft, no organomegaly, no CVAT Ext- no clubbing cyanosis or edema Neuro- A & O X 3, Cr Nerves II-XII intact, Motor intact EKG- Normal Sinus at 65 per minute, normal axis and intervals, no acute ST-T wave changes, no change from recent EKGs Labs showing fasting glucose of 102, total cholesterol of 145, triglycerides of 76, and LDL of 86. I am enclosing a copy of all the pertinent medical records including the old and recent catherization reports, stress test, and blood work. He will be followed closely by me in the office every 90 days and report any symptoms immediately. I would like to emphasize my support for this pilot’s efforts and comfort with Special Issuance of a First Class Medical Certificate.   Sincerely, Raymond S. Basri, MD, FACP Senior Aviation Medical  Examiner