Coronary Artery Disease case-based scenario

It was a shock to Anthony, a 64-year-old airline captain, when a routine exercise test showed he was at risk of a heart attack.

For his entire adult life, Anthony has been subject to regular medical assessments for his aviation licence. He had very few medical issues beside slowly increasing weight, blood pressure and cholesterol.

'I know the toll being a long-haul pilot can take on your health,’ Anthony said. ‘I try to exercise and eat well when I'm away from home. Finding I was at risk of coronary heart disease was a real worry.'

Visiting the DAME

Anthony met with his Designated Aviation Medical Examiner (DAME) where results of Anthony’s medical renewal were put into CASA’s risk calculator. He also ordered an exercise stress test.

Anthony's indications were not positive.

You can estimate a person's risk of a heart attack or stroke in the next 5 years based on their:

  • glucose level or history of diabetes
  • cholesterol levels
  • blood pressure
  • age
  • gender
  • smoking history.

‘The exercise stress test was uncomfortable,’ Anthony said. ‘I did okay when the treadmill was flat but, I really struggled when the treadmill got steeper. In the end, I was short of breath and my chest felt so heavy that the technician had to stop the test.'

A cardiologist advised Anthony that the test suggested the blood vessels supplying his heart were narrowing. This was consistent with a diagnosis of angina. The cardiologist made recommendations for investigation and treatment.

The DAME contacted Aviation Medicine (AvMed) to notify a change in Anthony's medical condition in accordance with the Civil Aviation Safety Regulations.

With a diagnosis of angina, Anthony must not fly until he receives clearance from CASA or his DAME.

Receiving a diagnosis

Anthony underwent an angiogram, a procedure which x-rays the blood vessels around the heart. It showed narrowing of 2 of Anthony's blood vessels.

During the procedure, the cardiologist placed metal sleeves (stents) into the arteries to hold them open.

Upon his review with the cardiologist, Anthony learnt the stents were working well. The underlying problem causing the narrowing was atherosclerosis. It’s managed with special medications and permanent changes to lifestyle and diet.

Anthony’s condition would need reviewing every year including the effects of the new medications on his blood pressure and cholesterol.

Cleared for flying

Anthony booked an appointment with his DAME to review the cardiologist's reports. The DAME notified AvMed of the change in Anthony's medical condition.

AvMed required Anthony to take another exercise stress test before they could clear him to fly again. This time, the result was completely normal and AvMed issued a clearance.

Anthony’s narrowed arteries had been successfully treated but the disease that caused the narrowing was still in his arteries. Anthony’s risk factors must be closely monitored to help slow or halt the progression of the disease.

AvMed assessed the risk of Anthony having a cardiac event in the next 12 months as acceptably low.

After his mandatory grounding, a minor surgical procedure and new medication, Anthony resumed flying once again.

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