Decision Considerations - Aerospace Medical Dispositions
Item 36. Heart - Other Cardiac Conditions

The following conditions must be deferred:

1. Hypertrophic Cardiomyopathy (HCM) [formerly called hypertrophic obstructive cardiomyopathy (HOCM); idiopathic hypertrophic sub-aortic stenosis (IHSS)]
2. Non-compaction cardiomyopathy
3. Cardiac Transplant - see Disease Protocols
4. Cardiac decompensation
5. Congenital heart disease
6. Hypertrophy or dilatation of the heart as evidenced by clinical examination and supported by diagnostic studies. (Concentric LVH with no dilatation can be issued by the AME if no symptoms.)
7. Pericarditis, endocarditis, or myocarditis
8. Cardiac enlargement or other evidence of cardiovascular abnormality, If the applicant wishes further consideration, a consultation is required, preferably from the applicant's treating physician. It must include a narrative report of evaluation and be accompanied by an ECG with report and appropriate laboratory test results which may include, as appropriate, 24-hour Holter monitoring, thyroid function studies, ECHO, and an assessment of coronary artery status.
9. Anti-tachycardia devices
10. Implantable defibrillators (ICDs)
11. Anticoagulants may be allowed, if the condition is allowed.
12. Cardioversion (electrical or pharmacologic), may be allowed. A current, complete cardiovascular evaluation (CVE) and follow up Holter monitoring test is required. A 1-month observation period must elapse after the procedure before consideration for certification.
13. Any other cardiac disorder not otherwise covered in this section.
14. Hypotension. A history of low blood pressure requires elaboration. If the Examiner is in doubt, it is usually better to defer issuance rather than to deny certification for such a history.

For all classes, certification decisions will be based on the applicant's medical history and current clinical findings. Evidence of extensive multi-vessel disease, impaired cardiac functioning, precarious coronary circulation, etc., will preclude certification. Before an applicant undergoes coronary angiography, it is recommended that all records and the report of a current cardiovascular evaluation (CVE), including a maximal electrocardiographic exercise stress test, be submitted to the FAA for preliminary review. Based upon this information, it may be possible to advise an applicant of the likelihood of favorable consideration.