Pilot Heart Health: Keeping You Safe in the Sky

Pilots must meet rigorous heart health standards
Pilot Heart Health

Just as a pilot’s plane needs maintenance for safety, the pilot himself needs regular checkups for his own health — especially when it comes to heart health.

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With the help of their cardiologists, many pilots can keep their hearts strong and continue to fly.

Checking pilots’ health

Federal Aviation Administration-authorized aviation medical examiners evaluate pilots and issue medical certificates for them. The FAA has strict rules about heart conditions and pilots.

For medical certification, the FAA sometimes requires a cardiovascular evaluation with a treadmill stress test, echocardiograms and 24-hour Holter monitoring.

Sometimes these FAA exams uncover heart conditions. In fact, cardiovascular problems are among the most common causes for delays in or denials of certification.

But  there are proven treatments for many of these conditions. After treatment, a pilot can often get or renew his or her pilot’s license.

Special concerns for pilots with heart conditions

Thomas Callahan, MD, Director of Inpatient Services in the Section of Pacing and Electrophysiology at Cleveland Clinic, says that heart conditions are of special concern to all pilots.

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“For a pilot, this can mean one of their greatest passions or perhaps even their livelihood is in jeopardy.  As a private pilot myself and growing up with my father, a professional pilot, I understand many of the concerns other pilots have when it comes to these medical issues,” he says.

As they would for any other patient, doctors work with pilots to diagnose their heart problems and find the best treatments for their specific situation.

Heart conditions ready for takeoff

Some heart conditions need no further tests. Others require treatment.

  • Heart rhythm disorders. The FAA issues certificates for several types of arrhythmias, such as atrial fibrillation, not associated with underlying ischemic heart disease, cardiomyopathy or significant valve defects.
  • The FAA evaluates heart murmurs on a scale of 1 to 6 depending on how audible the murmur is. Very low-grade murmurs might receive a medical pass, but moderate or higher-grade murmurs need to be investigated. After passing physical tests and a monitoring period, the FAA may issue certification to the pilot.
  • Atrial fibrillation. Before approval, pilots with chronic atrial fibrillation undergo further testing and treatment.
  • Pilots whose hypertension is controlled with diet and exercise usually receive a standard license.
  • Left bundle branch block is a heart signal abnormality and it has a strong connection to coronary artery disease. This problem requires additional and frequent evaluation.

Pilots with these conditions may receive a conditional license that will require more frequent testing and elaborate monitoring. But usually they are cleared for takeoff.

Cautions and no-fly conditions

There are some cardiovascular conditions that require additional testing and/or recovery time prior to receiving approval to fly:

  • Coronary heart disease, history of heart attack or coronary interventions.
  • Permanent pacemakers, mitral valve disease, other valve problems or have had valve surgery.
  • Many types of cardiomyopathy if not severe.

These pilots require specific testing to insure they have recovered fully and able to fly safely.  In some cases ongoing monitoring is required, but they do not necessarily prevent issuance of an Airman’s medical certificate

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Cardiovascular conditions that  lead to the denial of a health certificate and a pilot’s license  are considered too risky for medical certification and include:

  • Stroke with neurocognitive impairment.
  • Sudden cardiac arrest.
  • An implantable cardiac defibrillator.
  • Failure to meet the standards of required testing with one of the above conditions.

Keeping up with advances in treatment

Recent policy changes have eased the follow-up requirements for some conditions and reflect the most recent advances in cardiac care. Certification after diagnosis and treatment is based on submission of complete records and periodic cardiovascular re-evaluation.

“One of my favorite facets of my practice is treating pilots and, whenever I can, helping to keep them flying safely,” Dr. Callahan says.

Luckily for professional pilots, only a few cardiac conditions affecting a minority of pilots lead to permanent disqualification.

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