Coronary Heart Disease (CHD)

Guide for Aviation Medical Examiners – Version 03/27/2024

CORONARY HEART DISEASE (CHD)

50% stenosis or higher; intervention (Stent, PTCA, CABG);

Myocardial Infarction (MI)/Heart Attack; Acute Coronary Syndrome;

or Coronary Artery Disease (CAD)

All Classes

(Updated 05/29/2024)

DISEASE/CONDITION

EVALUATION DATA

DISPOSITION

A. CHD in any single

coronary artery vessel

with 50% stenosis or greater

Cardiac Event

• Myocardial Infarction

(MI)/ heart attack

Either ST Elevation MI

(STEMI) or Non-ST

Elevation MI (NSTEMI)

Required treatment such as:

• Coronary Artery

Bypass Graft (CABG)

• Stent (Heart

stent/coronary

stent/PTCA, Drug

Eluting Stent [DES])

This is a Specifically Disqualifying

condition.

After the required recovery period:

6 months for:

Coronary Artery Bypass Graft (CABG) or

Stent placed in LEFT MAIN coronary artery.

3 months for:

Stent (PTCA) placed in any other coronary

artery or

MI/Heart attack or NSTEMI

Obtain the following evaluation(s) and

submit to the FAA for review:

All items on the Protocol for Coronary

Heart Disease 1

or 2

Class (See protocol

for specific details.)

1. A current, detailed cardiology evaluation

including functional status and attempts to

meet modifiable risk factors and risk.

2. Lab - Lipid panel + A1c. Include INRs if

using warfarin (Jantoven).

3. Post-Event Radionuclide stress

test (Stress RS) with SPLASH imaging on

CD in DICOM format.

Note: Stress ECHO or routine Exercise

Stress Test (Bruce) are NOT Acceptable.

4. Hospital records, including:

• Discharge summary

• Operative/procedure report

DEFER

Submit the

information to the

FAA for a possible

Special Issuance.

Once all information

is received, the

Federal Air

Surgeon's

Cardiology

Consultant(s) review

these cases.

Guide for Aviation Medical Examiners – Version 03/27/2024

DISEASE/CONDITION

EVALUATION DATA

DISPOSITION

• Cath/angiogram reports with full

motion images

• Admission (H&P)

5. Civil Aerospace Medical Institute (CAMI)

Limited Certificate Petition

6. Post-Event Cath with full motion

images on CD in DICOM format

Note: For antithrombotic therapy after

stenting, the applicant should be following

the current ACC/AHA guidelines for dual

antiplatelet therapy:

• Drug-eluting stents: One (1) year

• Bare metal stents: At least 30 days,

preferably for one year.

B. Limited* 2

class

Limited second-class

medical certificate refers to a

second-class certificate with

a functional limitation such as

“Not Valid for Carrying

Passengers for

Compensation or Hire” or

"Not Valid for Pilot in

Command, Valid Only

When Serving as a Pilot

Member of a Fully Qualified

Two-Pilot Crew."

After the required recovery period,

6 months for:

Coronary Artery Bypass Graft (CABG) or

Stent placed in LEFT MAIN coronary

artery.

3 months for:

Stent (PTCA) placed in any other coronary

artery or

MI/Heart attack or NSTEMI

Obtain the following items from the

Protocol for Coronary Heart Disease 1

Class (See protocol for specific details.)

1. A current, detailed cardiology evaluation

including functional status and attempts to

meet modifiable risk factors and risk.

2. Lab - Lipid panel + A1c. Include INRs

if using warfarin (Jantoven).

3. Post-Event Radionuclide stress test

Note: Stress ECHO or routine Exercise

Stress Test (Bruce) are NOT Acceptable.

4. Hospital records including:

• Discharge summary

DEFER

Submit the

information to the

FAA for a possible

Special Issuance.

Once all information

is received, the

Federal Air

Surgeon's

Cardiology

Consultant(s) review

these cases.

Guide for Aviation Medical Examiners – Version 03/27/2024

DISEASE/CONDITION

EVALUATION DATA

DISPOSITION

• Operative/procedure report

• Cath/angiogram reports (Do not

submit images on CD unless

requested.)

• Admission (H&P)

5. Civil Aerospace Medical Institute (CAMI)

Limited Certificate Petition

Note: Post-Event Cath is NOT required for

routine Limited 2

class. Do not submit

unless requested.

For antithrombotic therapy after stenting,

the applicant should be following the

current ACC/AHA guidelines for dual

antiplatelet therapy:

• Drug-eluting stents: One (1) year

• Bare metal stents: At least 30 days,

preferably for one year

C. 3rd class

There is NO mandatory recovery period per

Public Law 114-190 5/2017 but individual

should be released by the treating

physician.

Once released by the treating physician,

obtain the following evaluation(s) and

submit to the FAA for review:

All items on the Protocol for Coronary

Heart Disease - 3rd Class (See protocol for

specific details)

1. A current, detailed Cardiology evaluation

including functional status and attempts to

meet modifiable risk factors and risk)

2. Lab - Lipid panel + A1c. Include INRs if

using warfarin (Jantoven).

3. Post-Event Exercise Stress Test (with

electrical tracings) in accordance with the

Exercise Stress Test (EST) Protocol

requirements

4. Hospital records including:

• Discharge summary

• Operative/procedure report

DEFER

Submit the

information to the

FAA for a possible

Special Issuance

Once all information

is received, the AAM

physicians with

expertise in

aerospace

cardiology review

these cases. Some

may require

additional review

from FAS

Cardiology

Consultant.

Guide for Aviation Medical Examiners – Version 03/27/2024

DISEASE/CONDITION

EVALUATION DATA

DISPOSITION

• Cath/angiogram reports (do not

submit images on CD unless

requested)

• Admission (H&P)

Note: For antithrombotic therapy after

stenting, the applicant should be following

the current ACC/AHA guidelines for dual

antiplatelet therapy:

• Drug-eluting stents: One (1) year

• Bare metal stents: At least 30 days,

preferably for one year