Coronary artery disease (CAD) occurs when there is a slow build-up of fatty deposits on the inner wall of blood vessels supplying the heart with blood (the coronary arteries).
These fatty deposits gradually clog the arteries and reduce the flow of blood to the heart. This process, called atherosclerosis, begins when people are young, and can advanced well into middle age. CAD can lead directly to coronary heart disease if left untreated.
There is no single cause for coronary artery disease, but there are risk factors that increase your chance of developing it, including:
- smoking and exposure to second hand smoke
- high blood cholesterol
- high blood pressure
- diabetes
- physical inactivity
- being overweight
- depression, social isolation and a lack of social support
- being male
- advancing age
- having a family history of coronary heart disease.
While you can't change risk factors such as age and gender, there are steps that you can take to reduce your risk of developing CAD.
Effects of flying on CAD
Stressful phases of flight can force the cardiac system to work harder. The sedentary nature of aviation can also be detrimental to this condition.
Effects of CAD on operators
Coronary artery disease is associated with:
- distracting pain
- acute shortness of breath
- arrhythmia
- sudden death.
Effects of CAD treatment on aviation
Some drug therapies for CAD can limit your G-tolerance. Antiplatelets (medicines that stop blood cells from clotting) can cause bleeding in the brain.
Implications for pilots and controllers
Pilots and controllers who have been diagnosed with CAD must ground themselves and notify their Designated Aviation Medical Examiner (DAME) and us of this condition. Other requirements include:
- a minimum of six months grounding following a heart attack or coronary artery intervention. There is an exception in some cases of stent implant or coronary by-pass surgery
- annual review (this is a minimum requirement)
- Pilots may require multi-crew restriction.
Even after receiving successful treatment, there is still an increased risk of another event during this time. changing your lifestyle habits and using preventative medicines can reduce the risk of future events.
Approach to medical certification
You will face at least a 6 month grounding after experiencing:
- myocardial infarction (a heart attack)
- most coronary artery procedures (stents, balloon angioplasty, coronary artery bypass etc.).
This will occur before we can conduct a risk assessment.
If you have a stent, we may be able to consider re-certification any time after 6 weeks following the procedure. This depends on your cardiologist's reports and DAME evaluation.
You will need to see a cardiologist before seeking certification or re-certification.
Please see our Clinical Practice Guidelines for more information.
More likely to gain certification
You are more likely to gain certification if you have:
- there is an absence of significant symptoms during the grounding period
- your doctor reports you are effectively managing risk factors such as smoking, lipids, glucose, appropriate medication
- ongoing anticoagulation or antiplatelet therapy as advised by specialist
- successful surgical management for example, percutaneous angioplasty and stent or coronary artery bypass grafting.
Less likely to gain certification
You are less likely to gain certification if you have:
- angina persists or you require ongoing medication for angina
- you experience exertional dyspnoea
- there is evidence of reversible ischaemia (note: findings on coronary angiogram do not negate the prognostic significance of reversible ischaemia)
- there is evidence of rhythm disturbance
- detection of the LV ejection fraction less than 50% or significant abnormality of wall motion on echocardiogram.
You are unique
Every patient is different. Each person affected by coronary artery disease will face unique problems and have different needs.
You should seek medical advice about this condition.
Further information
For further information see the Australian Heart Foundation.