Atrial fibrillation case-based scenario

Grahame is a successful businessman in his 60s. Over the years, he has owned various aircraft for both recreational and business activities.

For 30 years, Grahame has held a Private Pilot's Licence with a Class 2 medical certificate. Grahame visits his Designated Aviation Medical Examiner (DAME) to renew his medical certificate every 2 years.

Grahame was playing a game of tennis with some friends when he began to feel very unwell and took a turn for the worse. Grahame started to fear his flying days were over.

Calling the ambulance

Until his 60s, Grahame had enjoyed good health. His GP started him on medication for high blood pressure when he was 63, after weight loss and dietary changes failed.

Grahame’s GP told him to cut back on his alcohol, as he still drank a little more than the National Health and Medical Research Council guidelines recommend.

Grahame continued to exercise, and he enjoyed his weekly tennis game.

When Grahame first started to feel unwell during his weekly match, he wasn't too fazed. He had been to a work function the night before and felt a little hungover and dehydrated.

'At first I thought I was paying the price for a boozy night out,' he says. 'Then, 10 minutes into the match I started to feel so dizzy that I thought I was going to faint. I lay down for a bit but my heart kept pounding.’

‘My friends called an ambulance. The ambos helped me onto the stretcher and carried me into the ambulance. I was utterly helpless.'

Receiving a diagnosis

The ambulance officers examined Grahame and connected him to a heart trace machine (ECG). It showed that Grahame's heart was beating abnormally, up to 160 beats per minute.

The emergency department doctors contacted the duty cardiologist to discuss Grahame's presentation. They decided to try an injection into his blood stream to get his heart to return to normal.

‘They brought my heart rate back to normal by attaching electrodes to my chest and giving me an electric current,’ he said. ‘My heart returned to normal and they admitted me to hospital overnight.'

After his discharge from hospital, Grahame had:

  • an ultrasound of the heart (echocardiogram)
  • an exercise stress test
  • some further blood tests.

Grahame met with the cardiologist to discuss the test results. The cardiologist determined that Grahame had suffered an episode of fast atrial fibrillation. The test results were mostly normal, although there was some enlargement of the chambers at the top of Grahame's heart.

Cleared for flying

Grahame contacted his DAME and told him of this new diagnosis. The DAME notified Aviation Medicine (AvMed) of a change in Grahame’s medical condition in accordance with the Civil Aviation Safety Regulations.

Concerned with the Grahame’s symptoms during his episode, AvMed asked for a follow up report from the cardiologist. AvMed also asked for the cardiologist's opinion of Grahame’s risk of another episode or a stroke in the next 12 months.

The cardiologist determined Grahame’s risk was low. The cardiologist also confirmed the results of a repeat ECG were normal and that Grahame required no blood thinning drugs.

As a result, AvMed cleared Grahame to fly with a requirement on his medical certificate that he must undergo annual review with the specialist, including a resting ECG and echocardiogram.

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