Coronary Artery Disease Screening

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This guidance applies to pilots undergoing coronary artery disease screening as required in the Special Reports and Tests schedule found in chapter 4.4 Special Reports and Tests Required for Medical Certification of the DAME Handbook.

Multifactorial risk assessment to stratify risk (Framingham) using the Coronary Heart Disease Risk Factor Prediction Chart (CRI) found in chapter 4.4 Special Reports and Tests Required for Medical Certification of the DAME Handbook.

Certification of applicants with elevated risk (CRI >14) will depend upon satisfactory functional testing
Referral for Exercise ECG
If exercise ECG suggestive of reversible myocardial ischaemia:
- Ground applicant
- Exercise echocardiogram OR
- Myocardial perfusion scan
Functional testing acceptance criteria:
- no reversible myocardial ischaemia
- ejection fraction (LVEF) of 50% or more
- absence of significant arrhythmias
Cardiological interventions as clinically indicated and report on risk factor management

An assessment a Cardiologist with respect to:

confirmed diagnosis
clinical status including any symptoms
investigations conducted including the results of a recent stress test (echo or myocardial perfusion scan)
angiogram reports if applicable
management:
- control of risk factors
- treatment and any side-effects
- risk of any acutely disabling cardiovascular event
- planned monitoring

If intervention is required see the information below.

Initial notification to CASA and grounding required on positive (or equivocal) stress test. Clearance by CASA required before exercising privileges

No reversible myocardial ischaemia
Ejection fraction (LVEF) of 50% or more
Absence of significant arrhythmias
Management of risk factors for coronary artery disease (e.g. smoking, lipids, glucose)
Acceptable risk of future cardiovascular event

Symptoms of chest pain (angina) or inappropriate shortness of breath with stress test
Stress ECG changes consistent with ischaemia
Stress ECG changes consistent with stress induced arrhythmia
Evidence of reversible ischaemia on stress echocardiogram (note: findings on coronary angiogram do not negate the prognostic significance of reversible ischaemia)
Evidence of reversible ischaemia on stress myocardial perfusion scanning (note: findings on coronary angiogram do not negate the prognostic significance of reversible ischaemia)
LV ejection fraction less than 50%

Cardiovascular risk management reduces the risk of sudden incapacitation from heart attack and stroke
Early detection of coronary artery disease improves health outcomes
Coronary artery disease risk is not static and increases steadily with age. Variable risk factors include age, smoking, diabetes, high blood pressure and high cholesterol. Fixed risk factors include male gender, ethnicity and family history
Pilots and controllers who have a positive (or equivocal) stress test are required to ground themselves and notify this result to their DAME and CASA AVMED
Processing of the application is halted pending the outcome of further investigations

The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer