Aeromedical Forum: October 2014

Most airmen can get through their flying careers without ever getting hooked up to one of those funny machines that spew out lots of wiggly lines. Those of us in the medicinal trade call it an electrocardiogram or EKG or ECG.

Why the “K” instead of a “C”? The first practical electrocardiogram was introduced by a Dutch gentleman named Dr. Einthoven who spelled it with a C. However his bratwurst ingesting brethren in Germany popularized the procedure and called it an elektrokardiogramm. So to honor the Teutonic origins of the contraption, the German spelling has traditionally been retained in the abbreviation.

Younger and more Anglophilic heads abbreviate it ECG. But I digress. EKGs are required for First Class Medical Certificates. You are required to get your first EKG when you turn 35. At age 40 a yearly tracing is required. Folks who are going for a Third Class or Second Class might also have to submit an EKG if they have bad high blood pressure among other things.

The FAA has loosened up a lot over the past year in what requires their review for a “Special Issuance.” If your blood pressure is not badly elevated (at or below 155/95) and stable, you have no symptoms and you are not taking a medication that can screw you up with side effects, your AME can issue your ticket on the spot. If any of these criteria are not met, then they’ll have to defer to the FAA and you’ll need an EKG among other tests. Likewise if your AME takes your pulse and finds it doing the Macarena, they’ll probably want an EKG to decide if they can or cannot issue. Long story short, EKGs are not only for First Class certification.

A question that sometimes comes up is whether or not to get an EKG on an airman applying for an initial First Class who is under age 35 and having no problems, since it’s not required. The applicant usually is a young guy or gal starting flight training with the idea of working for the airlines. His CFI advises him to go for a First Class just to make sure he qualifies for Part 121 left or right seat, even though he only needs a Third Class for his training. This is reasonable advice. You’d hate to sink several thousand dollars into training to later find out that some health problem will prohibit you from flying for the regionals and living in the Motel 8 in Cincinnati.

We do a pretty good number of such exams. Most folks are just as healthy as they thought they were. Every now and then, however we do turn up something that would be an obstacle to a successful commercial flying career. So should you ask for an EKG in addition to the normal lab work done for a First Class under age 35? I think it depends on several things. First of all, what’s the cost? That can vary widely. On line sources state the cost nationally ranges from about $470 to $2,850 with the average at $1,500. Presumably that includes the cost of a sub-specialty trained cardiologist looking at the thing and providing an interpretation. Your friendly AME can probably do it for a good deal less, especially if she/he has her own EKG machine and isn’t working for a big health care system.

Also, most modern electrocardiographs have built in software that does a pretty good job of interpreting the tracings — cardiologist in a box! Nonetheless, make sure you ask what the tariff is. Second, do you really need an EKG? The vast majority of healthy folks in their 20s or early 30s who feel fine will have a perfectly normal EKG. Congenital heart problems that can lead to sudden death in a young person are rare. Yet, since these problems are rare and often lead to death during exercise, they are widely reported when they do occur.

There are a number of different things that can go wrong with heart structure or function that can cause these tragedies. Many of them can be detected by EKG. So how do you decide if you have anything to worry about? Sudden and unexplained fainting that occurs during exercise could be a sign that you have a heart problem. The other major warning sign is a family history of unexplained deaths before age of 50. Either of these things should at the least provoke a talk with your family doc. If you don’t have either of these problems and feel fine, you probably will be OK if you don’t pony up the extra bucks for an EKG. You can save your quarters for the pop machine in the Motel 8!

Fly wisely. See you next month!

As always, comments, questions and suggestions are welcome: jdlakin@mnallergyclinic.com.