Aeromedical Cardiology Flashcards
What is an estimate of a pt’s CV risk?
Decade
Name 4 CV physiologic effects of Gz- and at what G-level they occur.
Note incapcitation, not loss of consciousness.
Name 4 CV physiologic effects of Gz+ and the G-level at which they occur.
What activity if Gz- similar too?
Hanging upside down
What is the role of the baroreceptor reflex in Gz+ response?
- Is not strong enough to counter high Gz+ environment
- Increases G tolerance by ~1G if Gz is applied slowly
- However, it takes approx 10-15 sec for the response to develop
- Brain’s oxygen reserve is depleted after 5 sec
CO = SV x HR
How is this equation affected by Gz+?
- HR increases with decreased BP (baroreceptor reflex)
- SV decreased secondary to decreased venous return
- Therefore CO decreased
What is thought of dysrthythmias that occur with increased G-stress?
Normal physiologic response
What is the presenting symptom in 50% of people with heart disease?
Sudden cardiac death
Who gets echocardiograms?
Directed by H&P
Which test is the best test to screen for CAD in aviators?
Coronary artery calcium detection
What method is best for evaluating coronary artery calcium results?
Aggregate
What coronary artery calcium score is considered normal and what level ust be sent for waiver?
- Normal 0-9
- Waiver req’d for 10 or more
What 2 cardiac tests are required starting at age 35?
- Lipids
- EKG
How frequently is a flyer with CAD followed at ACS?
Define severity of CAD per USAF policy and what testing/waiver is required.
- MinCAD => aggregate <50% FC IIA waiver, annual noninvasive evaluation, cath only for sxs, worsened tests or unsuccessful risk factor modification
- ModCAD => aggregate >50 but <120%, FC IIC, limited to only one 50%-70% lesion and, for lesion 50%-70% normal perfusion distal to lesion annual evaluation, serial cath q 5 yr (NEW).
- SCAD => aggregate >120% or any single lesion >70% or Left main >50% = DQ w/o waiver
- Luminal irregularities =>needs waiver at 1 yr, then 4 yr, then annually
What are the roles of PCI and CABG in CAD? Thus, what can be said about risk factors?
- Palliative not curative
- Thus risk factors MUST be controlled, oherwise the disease process is still occuring
Differentiate WPW pattern from WPW syndrome.
- Pattern– no sx, just seen on EKG
- Syndrome– symptomatic (i.e. palpitations) –> ablate
- If the pattern is ablated, the risk of complication from the procedure is greater than risk of suuden cardiac death
- P-R nl on treadmill
- No risk of retrograde electrical flow
- Does not conduct quickly
What is the stroke risk of pt with lone a-fib, no CAD or HTN, age < 60?
Stroke rik is < 1% per year
What is VTach a marker for?
CAD or underlying myocardial scar?
When must a Holter be obtained when PVCs are seen on EKG?
- age < 35 –> 2 or more PVCs
- age > 35 –> 1 or more PVCs
What type of valvular regurg is abnormal? What is the prognosis? What can be said of the remaining types of valvular regurgitation?
- Mild mitral, pulmonic and tricuspid valve regurgitation rarely progress and may be a normal Variant.
- Mild Aortic valve regurgitation is not a normal variant and is more likely to progress.
- Trace regurgitation is ok. (published literature)
- Mild mitral, tricuspid and pulmonic valve regurgitation is ok Mild rarely progresses to moderate in otherwise normal valves (aortic valve is the exception)
- Moderate more commonly progresses to severe
- Severe is bad
- So moderate needs to monitored closely
What type of aortic valve replacement is waiverable?
What are aeromedical considerations for valvular regurgitation and stenosis?
-
Regurgitation OK usually until severe or symptomatic.
- Trace and mild is likely physiologic or normal variant respectively.
- Waiver only if moderate or greater regurgitation
- Exception is Aortic valve insufficiency
- Stenosis is usually NOT OK; limits preload, afterload, and ability to augment cardiac output
What is the aeromedical disposition of valvular regurgitation?
- Trace and mild Mitral, Tricuspid, and Pulmonic regurgitation needs no waiver or follow-up.
- Mild Aortic Valve regurgitation needs 3 year waiver.
- Moderate regurgitation needs every 3 years follow-up for all aviators.
- Exception: Moderate Aortic Valve regurgitation; needs annual follow-up and no untrained aviators.
What is the aeromedical disposition of BAV and MVP?
- BAV and MVP commonly progress
- All BAV and MVP need waiver and follow up based on degree of regurgitation/stenosis, every 3 years if none
What is the appropriate treatment for AVNRT?
Ablation
What is the management of lone a-fib? What is the success rate?
60-80% success with ablation. Should only be done if symptomatic, not because they want to fly
How may beats of VTach can be normal in a very active person in which the bad etiologies have been ruled out?
11
What is the aeromedical work-up for LBBB?
Angio vs CTA
What is the aeromedical work-up for RBBB?
TTE, no waiver needed if TTE normal
