Guide for Aviation Medical Examiners
Special Issuances - AME Assisted - All Classes Coronary Heart Disease (CHD)
AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to reissue an airman medical certificate to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations, (14 CFR) part 67. This AASI is for an applicant with a history of Angina Pectoris; Atherectomy; Brachytherapy; Coronary Bypass Grafting; Myocardial Infarction; Percutaneous Transluminal Angioplasty (PTCA); Rotoblation; or Stent Insertion for any class.
The FAA physicians provide the initial certification decision and grant the Authorization for Special Issuance of a Medical Certificate (Authorization) in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the issuance determination. If this is first-time application for an AASI for the above disease/condition, and the airman has all the requisite medical information necessary for a determination, you must defer and submit all of the documentation to the AMCD or your RFS for the initial determination.
Examiners may re-issue an airman medical certificate if the applicant provides the following:
- Authorization granted by the FAA;
- Status report - Performed within the past 90 days in accordance with the CHD Protocol; and
- Current maximal stress test GXT - See GXT Protocol.
The AME must defer medical certification if the applicant has:
- Any other disqualifying medical conditions or therapy not previously reported;
- Any other reason for not renewing an AASI;
- Bleeding that required medical intervention or other;
- Chest pain - Complains of chest pain at any time (exclude chest pain with a firm diagnosis of non-cardiac causes of chest pain);
- New Event - Has another event, develops a new condition or identification of an additional cardiac condition not previously reported (such as myocardial infarction, or restenosis requiring CABG, atherectomy, brachytherapy, PTCA, stent or other procedure);
- Nitrate - Is placed on a long acting nitrate for any reason;
- Risk factors - Inadequately controlled; or
- Unacceptable exercise stress test (GXT) results include:
| TEST | IF ANY OF THE FOLLOWING ARE NOTED, THE AME MAY NOT ISSUE. | |
|---|---|---|
| All classes | Exercise stress test (EST) | PMHR (predicted maximal heart rate) less than 85%;
Time less than 9 minutes--under age 70; 1 mm ST depression or greater at any time during stress testing - UNLESS the applicant has additional medical evidence such as a nuclear imaging study or a stress echocardiogram showing the absence of reversible ischemia or wall motion abnormalities reviewed and reported by a qualified cardiologist. |
NOTE: If ANY of the items from the regular Bruce EST are not acceptable, the AME MUST DEFER. An AME is NOT authorized to recertify a CHD AASI for any class if a nuclear stress test or stress echo is required.