Aeromedical Cardiology

Question 1

What is an estimate of a pt’s CV risk?

Answer 1

Decade

Question 2

Name 4 CV physiologic effects of Gz- and at what G-level they occur.

Answer 2

Note incapcitation, not loss of consciousness.

Question 3

Name 4 CV physiologic effects of Gz+ and the G-level at which they occur.

Answer 3

Question 4

What activity if Gz- similar too?

Answer 4

Hanging upside down

Question 5

What is the role of the baroreceptor reflex in Gz+ response?

Answer 5

• 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

Question 6

CO = SV x HR

How is this equation affected by Gz+?

Answer 6

• HR increases with decreased BP (baroreceptor reflex)
• SV decreased secondary to decreased venous return
• Therefore CO decreased

Question 7

What is thought of dysrthythmias that occur with increased G-stress?

Answer 7

Normal physiologic response

Question 8

What is the presenting symptom in 50% of people with heart disease?

Answer 8

Sudden cardiac death

Question 9

Who gets echocardiograms?

Answer 9

Directed by H&P

Question 10

Which test is the best test to screen for CAD in aviators?

Answer 10

Coronary artery calcium detection

Question 11

What method is best for evaluating coronary artery calcium results?

Answer 11

Aggregate

Question 12

What coronary artery calcium score is considered normal and what level ust be sent for waiver?

Answer 12

• Normal 0-9
• Waiver req’d for 10 or more

Question 13

What 2 cardiac tests are required starting at age 35?

Answer 13

• Lipids
• EKG

Question 14

How frequently is a flyer with CAD followed at ACS?

Question 15

Define severity of CAD per USAF policy and what testing/waiver is required.

Answer 15

• 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

Question 16

What are the roles of PCI and CABG in CAD? Thus, what can be said about risk factors?

Answer 16

• Palliative not curative
• Thus risk factors MUST be controlled, oherwise the disease process is still occuring

Question 17

Differentiate WPW pattern from WPW syndrome.

Answer 17

• 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

Question 18

What is the stroke risk of pt with lone a-fib, no CAD or HTN, age < 60?

Answer 18

Stroke rik is < 1% per year

Question 19

What is VTach a marker for?

Answer 19

CAD or underlying myocardial scar?

Question 20

When must a Holter be obtained when PVCs are seen on EKG?

Answer 20

• age < 35 –> 2 or more PVCs
• age > 35 –> 1 or more PVCs

Question 21

What type of valvular regurg is abnormal? What is the prognosis? What can be said of the remaining types of valvular regurgitation?

Answer 21

• 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

Question 22

What type of aortic valve replacement is waiverable?

Question 23

What are aeromedical considerations for valvular regurgitation and stenosis?

Answer 23

• 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

Question 24

What is the aeromedical disposition of valvular regurgitation?

Answer 24

• 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.

Question 25

What is the aeromedical disposition of BAV and MVP?

Answer 25

• 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

Question 26

What is the appropriate treatment for AVNRT?

Answer 26

Ablation

Question 27

What is the management of lone a-fib? What is the success rate?

Answer 27

60-80% success with ablation. Should only be done if symptomatic, not because they want to fly

Question 28

How may beats of VTach can be normal in a very active person in which the bad etiologies have been ruled out?

Answer 28

11

Question 29

What is the aeromedical work-up for LBBB?

Answer 29

Angio vs CTA

Question 30

What is the aeromedical work-up for RBBB?

Answer 30

TTE, no waiver needed if TTE normal