Coronary artery disease (CAD) and aviation safety fact sheet

In coronary artery disease (CAD) there is a slow build-up of fatty deposits on the inner wall of the blood vessels that supply the heart muscle 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 be well advanced by middle age. If left untreated, CAD can lead directly to coronary heart disease.

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 some of these risk factors (such as age and gender) can't be changed, the good news is that there are many steps that you can take to reduce your risk of developing coronary artery disease.

The effect of aviation on the condition

  • Stressful phases of flight can force the cardiac system to work harder.
  • The sedentary nature of aviation can be detrimental to this condition.

The effect of the condition on aviation

Coronary artery disease is associated with:

  • distracting pain
  • acute shortness of breath
  • arrhythmia
  • sudden death.

The effect of treatment on aviation

  • Some drug therapies 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 are required to ground themselves and notify their Designated Aviation Medical Examiner (DAME) and CASA Aviation Medicine (AvMed) of this condition.
  • A minimum of six months grounding is required following a heart attack or coronary artery intervention except in some cases of stent implant or coronary by-pass surgery.
  • There is an increased risk of another event during this time, even in those cases that have been successfully treated.
  • Annual review will be required as a minimum.
  • Multi-crew restriction may be required for pilots.
  • The risk of future events is greatly reduced by lifestyle modification and the use of preventative medications.

Approach to medical certification

You will need to be grounded for at least six months after experiencing either myocardial infarction (a heart attack) or after most coronary artery procedures (stents, balloon angioplasty, coronary artery bypass etc.) before CASA can conduct a risk assessment.

If you have been given a stent, CASA may be able to consider re-certification any time after six weeks following the procedure, depending on your cardiologist’s reports and DAME evaluation.

You will need to see a cardiologist before seeking certification or re-certification. Please see the CASA Clinical Practice Guidelines for more information.

More likely to be certified

You are more likely to be certified or re-certified if:

  • 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 be certified

You are less likely to be certified or re-certified if:

  • 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
  • the LV ejection fraction <50% or significant abnormality of wall motion is detected 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:

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