3rd Class SI post Heart Attack

[kayakmike]

Read through some past posts and got some great info here. Didn't want to hijack one of the other threads so starting a new one.

Had a heart attack Sept 9. 100% occluded LAD & stent placed. Discharge ECG showed EF 55-60% and "completely normal global and regional left ventricular systolic function with no evidence of wall motion abnormalities."

I've been planning to get a new 3rd Class SI. I've been gathering required documents per 5/29/24 "Protocol for Coronary Heart Disease (CHD) 3rd Class". Just waiting on stress test next week (at METS 14/Bruce protocol stage 5 in cardiac rehab with no issues). Working with AOPA PPS to review documents prior to meeting with an AME. Pretty much returned to normal exercise activities ~2 weeks post discharge (including 2-3 hour long aggressive bike rides).

I saw references, particularly from Dr. Chien, on some posts about having no part of the heart behind a 70% lesion. Cath report makes reference to 2 smaller vessels with 80% stenosis (but too small to treat).

Is that 70% documented somewhere (couldn't find reference to that other than posts on this site)? It looks like CAD rules were tweaked 5/29/24 (i.e. no wait time post MI for 3rd class, etc.) and not sure if that 70% still applies or where it is documented.

Am I just spinning my wheels if all vessels need to be <70%, but there are 2 that cannot be treated that sit at 80%? Seems like this may be a no-win situation if a cardiologist says it's medically untreatable and unnecessary but FAA has other requirements?

 

[Jon Wilder]

I'm sure @bbchien will chime in soon, but I believe you're in for at least a 2 year journey before you'll see a medical certificate again. The important thing is to get with your AME ASAP. Get every bit of documentation you can and bring it to him. Have him evaluate and advise a plan to follow going forward before applying for a medical certificate. May be even easier if you can get your AME and your cardiologist talking and working together on this. The sooner you get this ball rolling the better.

 

[regularguy]

I am in a somewhat similar situation (MI last spring, also 100% LAD, stent). I was operating under basicmed at the time, which of course now requires the one time SI.

My understanding from the last time I looked was that a 6 month wait is required before reapplying if you have a private (longer for commercial/ATP). I thought about it and decided going through the SI process wasn't worth the cost and, more importantly, the risk of not being able to fly a light-sport if the SI is denied. For the kind of flying I do and the kind of planes I like to fly, SP/LSA is all I need. I only got my last medical, with subsequent basicmed, because the plane I was flying was slightly too heavy for LSA. Besides, I expect the pool of aircraft available to a sport pilot will dramatically increase next year assuming MOSAIC passes. Most likely it will be announced this summer at Oshkosh. Unless you fly IFR or need a 4 seater you might want to wait.

 

[bbchien]

It's not written. It falls into "operational policy". But is is fact. The no part left behind a 70% or greater std has been in place since 1997.

The way around this is the "after 3 month" (yes that is still a thing and has NOT been changed) stress needs be supramaximal and got well into stage 4 (12 minutes, 12 METS) if you can and it has to be a negative stress treadmilll NUCLEAR at the end of the run.

You also need all 30 duplicate originals of the stress treadmill tracings. B/W reporductions rarely make it through the FAA's imaging system, intelligibly. And your risk factor control has to be PERFECT. WORK ON IT, and do not submit a MedX until you have these in hand. So no "shaving of the corners" here.

Get your LDL-c under control, your HBA1c needs to be in range, and shed the pounds if you can. This is a hey no kiddin wake up, and you were one lucky guy. (Plays Rocky" music in the background).

 

[Charlie Golf]

All I want to say is that I'm glad you're well. 100% occluded LAD is scary stuff (widowmaker!)

Take care!

 

[kayakmike]

I am in a somewhat similar situation (MI last spring, also 100% LAD, stent). I was operating under basicmed at the time, which of course now requires the one time SI.

My understanding from the last time I looked was that a 6 month wait is required before reapplying if you have a private (longer for commercial/ATP). I thought about it and decided going through the SI process wasn't worth the cost and, more importantly, the risk of not being able to fly a light-sport if the SI is denied. For the kind of flying I do and the kind of planes I like to fly, SP/LSA is all I need. I only got my last medical, with subsequent basicmed, because the plane I was flying was slightly too heavy for LSA. Besides, I expect the pool of aircraft available to a sport pilot will dramatically increase next year assuming MOSAIC passes. Most likely it will be announced this summer at Oshkosh. Unless you fly IFR or need a 4 seater you might want to wait.

Congrats on surviving that too!

That's my mindset too. If 70% is a hard & fast rule, there really is no point in going down the SI route if it closes the window for SP/LSA forever. I'm on the OR coast, so we do get marine layer that we need to get through frequently so being able to fly IFR in a pinch is nice. Also, my Piper Archer wouldn't make the cut based on the last revision of MOSAIC (but maybe if they bump up the clean stall speed a bit on the final version it will).

It's not written. It falls into "operational policy". But is is fact. The no part left behind a 70% or greater std has been in place since 1997.

The way around this is the "after 3 month" (yes that is still a thing and has NOT been changed) stress needs be supramaximal and got well into stage 4 (12 minutes, 12 METS) if you can and it has to be a negative stress treadmilll NUCLEAR at the end of the run.

You also need all 30 duplicate originals of the stress treadmill tracings. B/W reporductions rarely make it through the FAA's imaging system, intelligibly. And your risk factor control has to be PERFECT. WORK ON IT, and do not submit a MedX until you have these in hand. So no "shaving of the corners" here.

Get your LDL-c under control, your HBA1c needs to be in range, and shed the pounds if you can. This is a hey no kiddin wake up, and you were one lucky guy. (Plays Rocky" music in the background).

Thanks, that's kind of the info I'm looking for.

I can't post a link here since I'm a newbie, but googling "Protocol for Coronary Heart Disease (CHD) 3rd Class" shows the 5/29/24 rules (which it states it applies to STEMI & stent) that state for 3rd class there is no longer a 90 day waiting period, just have to be discharged from treating physician. I could possibly see a waiting period in the "Coronary Heart Disease Disposition Table" since #A & #C sort of contradict each other. But if 70% comes into play it doesn't really matter if it's 90 minutes, 90 days or 90 years. ;(

3rd class rules don't show a need for nuclear stress test, but understand they can come back later and ask for whatever they want. I did do "stage 6" yesterday in rehab (their treadmill maxes out at 15% grade, so ~15 METS). Have had heart rate into the 170s in rehab or bike rides after (PMHR = 164). Labs have always been in range. I'm 5'8/160 and have always been very physically active. Last checkup before MI doc had me at a low cardiac risk. But low is not none, and I think all the docs said I'm not their typical patient. Only risk factor I have changed is a bit better diet.

This is a hey no kiddin wake up, and you were one lucky guy. (Plays Rocky" music in the background).

All I want to say is that I'm glad you're well. 100% occluded LAD is scary stuff (widowmaker!)

Take care!

Yeah, knowing what I know now post widowmaker, the odds are very low that I should even be here. I was on a bikepacking trip on a remote island when it happened, and had to be LifeFlighted out, which makes the fact I survived even more amazing.

In the big picture, if I'm stuck SP/LSA vs. being underground, I'll take the former!

 

[bbchien]

Congrats on surviving that too!

That's my mindset too. If 70% is a hard & fast rule, there really is no point in going down the SI route if it closes the window for SP/LSA forever. I'm on the OR coast, so we do get marine layer that we need to get through frequently so being able to fly IFR in a pinch is nice. Also, my Piper Archer wouldn't make the cut based on the last revision of MOSAIC (but maybe if they bump up the clean stall speed a bit on the final version it will).


Thanks, that's kind of the info I'm looking for.

I can't post a link here since I'm a newbie, but googling "Protocol for Coronary Heart Disease (CHD) 3rd Class" shows the 5/29/24 rules (which it states it applies to STEMI & stent) that state for 3rd class there is no longer a 90 day waiting period, just have to be discharged from treating physician. I could possibly see a waiting period in the "Coronary Heart Disease Disposition Table" since #A & #C sort of contradict each other. But if 70% comes into play it doesn't really matter if it's 90 minutes, 90 days or 90 years. ;(

3rd class rules don't show a need for nuclear stress test, but understand they can come back later and ask for whatever they want. I did do "stage 6" yesterday in rehab (their treadmill maxes out at 15% grade, so ~15 METS). Have had heart rate into the 170s in rehab or bike rides after (PMHR = 164). Labs have always been in range. I'm 5'8/160 and have always been very physically active. Last checkup before MI doc had me at a low cardiac risk. But low is not none, and I think all the docs said I'm not their typical patient. Only risk factor I have changed is a bit better diet.




Yeah, knowing what I know now post widowmaker, the odds are very low that I should even be here. I was on a bikepacking trip on a remote island when it happened, and had to be LifeFlighted out, which makes the fact I survived even more amazing.

In the big picture, if I'm stuck SP/LSA vs. being underground, I'll take the former!

Kayak Mike, they don't publish everything, of course.
The former mandatory 90 day wait is now a medical 90 day wait (you just don't speak bureaucratese!). That's because 90% of the closures of a stent, occur in the first 90 days after the stent.

I do have six pilots, who got through the way I outlined. One was the founder of the Stearman organization. The key is the agency reviewer seeing the supramaximal negative nuke and going "that can't possibly be 80% given the nuclear result".

My take: find a knowledgealbe AME who is willing to set all this up but isn't obligated to send in a thing. And only then apply if you have IT ALL.

THEN, you can go to Basic.

B

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