MED.B.010 Cardiovascular System

Regulation (EU) 2019/27

(a)     Examination

(1)     A standard 12-lead resting electrocardiogram (ECG) and report shall be completed when clinically indicated and at the following moments:

(i)      for a class 1 medical certificate, at the initial examination, then every 5 years until age 30, every 2 years until age 40, annually until age 50, and at all revalidation or renewal examinations thereafter;

(ii)     for a class 2 medical certificate, at the initial examination, at the first examination after age 40 and then at the first examination after age 50, and every 2 years thereafter.

(2)     An extended cardiovascular assessment shall be required when clinically indicated.

(3)     For a class 1 medical certificate, an extended cardiovascular assessment shall be completed at the first revalidation or renewal examination after age 65 and every 4 years thereafter.

(4)     For a class 1 medical certificate, estimation of serum lipids, including cholesterol, shall be required at the initial examination, and at the first examination after having reached the age of 40.

(b)     Cardiovascular System – General

(1)     Applicants for a class 1 medical certificate with any of the following medical conditions shall be assessed as unfit:

(i)      aneurysm of the thoracic or supra-renal abdominal aorta, before surgery;

(ii)     significant functional or symptomatic abnormality of any of the heart valves;

(iii)     heart or heart/lung transplantation.;

(iv)     symptomatic hypertrophic cardiomyopathy.

(2)     Before further consideration is given to their application, applicants for a class 1 medical certificate with a documented medical history or diagnosis of any of the following medical conditions shall be referred to the medical assessor of the licensing authority:

(i)      peripheral arterial disease before or after surgery;

(ii)     aneurysm of the thoracic or supra-renal abdominal aorta after surgery;

(iii)     aneurysm of the infra-renal abdominal aorta before or after surgery;

(iv)     functionally insignificant cardiac valvular abnormalities;

(v)      after cardiac valve surgery;

(vi)     abnormality of the pericardium, myocardium or endocardium;

(vii)    congenital abnormality of the heart, before or after corrective surgery;

(viii)   vasovagal syncope of uncertain cause;

(ix)     arterial or venous thrombosis;

(x)      pulmonary embolism;

(xi)     cardiovascular condition requiring systemic anticoagulant therapy.

(3)              Applicants for a class 2 medical certificate with an established diagnosis of one of the conditions specified in points (1) and (2) shall be evaluated by a cardiologist before they may be assessed as fit, in consultation with the medical assessor of the licensing authority.

(4)              Applicants with cardiac disorders other than those specified in points (1) and (2) may be assessed as fit subject to satisfactory cardiological evaluation.

(c)      Blood Pressure

(1)     Applicants’ blood pressure shall be recorded at each examination.

(2)     Applicants whose’s blood pressure is not within normal limits shall be further assessed with regard to their cardiovascular condition and medication with a view to determining whether they are to be assessed as unfit in accordance with points (3) and (4).

(3)     Applicants for a class 1 medical certificate with any of the following medical conditions shall be assessed as unfit:

(i)      symptomatic hypotension;

(ii)     blood pressure at examination consistently exceeding 160 mmHg systolic or 95 mmHg diastolic, with or without treatment.

(4)     Applicants who have commenced the use of medication for the control of blood pressure shall be assessed as unfit until the absence of significant side effects has been established.

(d)     Coronary Artery Disease

(1)     Before further consideration is given to their application, applicants for a class 1 medical certificate with any of the following medical conditions shall be referred to the medical assessor of the licensing authority and undergo cardiological evaluation to exclude myocardial ischaemia:

(i)      suspected myocardial ischaemia;

(ii)     asymptomatic minor coronary artery disease requiring no anti-anginal treatment.

(2)     Before further consideration is given to their application, applicants for a class 2 medical certificate with any of the medical conditions set out in point (1) shall undergo satisfactory cardiological evaluation.

(3)     Applicants with any of the following medical conditions shall be assessed as unfit:

(i)      myocardial ischaemia;

(ii)     symptomatic coronary artery disease;

(iii)     symptoms of coronary artery disease controlled by medication.

(4)     Applicants for the initial issue of a class 1 medical certificate with a medical history or diagnosis of any of the following medical conditions shall be assessed as unfit:

(i)      myocardial ischaemia;

(ii)     myocardial infarction;

(iii)     revascularisation or stenting for coronary artery disease.

(5)     Before further consideration is given to their application, applicants for a class 2 medical certificate who are asymptomatic following myocardial infarction or surgery for coronary artery disease shall undergo satisfactory cardiological evaluation, in consultation with the medical assessor of the licensing authority. Such applicants for the revalidation of a class 1 medical certificate shall be referred to the medical assessor of the licensing authority.

(e)     Rhythm/Conduction Disturbances

(1)     Applicants with any of the following medical conditions shall be assessed as unfit:

(i)      symptomatic sinoatrial disease;

(ii)     complete atrioventricular block;

(iii)     symptomatic QT prolongation;

(iv)     an automatic implantable defibrillating system;

(v)      a ventricular anti-tachycardia pacemaker.

(2)     Before further consideration is given to their application, applicants for a class 1 medical certificate havingany significant disturbance of cardiac conduction or rhythm, including any of the following, shall be referred to the medical assessor of the licensing authority:

(i)      disturbance of supraventricular rhythm, including intermittent or established sinoatrial dysfunction, atrial fibrillation and/or flutter and asymptomatic sinus pauses;

(ii)     complete left bundle branch block;

(iii)     Mobitz type 2 atrioventricular block;

(iv)     broad and/or narrow complex tachycardia;

(v)      ventricular pre-excitation;

(vi)     asymptomatic QT prolongation;

(vii)    Brugada pattern on electrocardiography.

(3)     Before further consideration is given to their application, applicants for a class 2 medical certificate with any of the medical conditions specified in point (2) shall undergo satisfactory cardiological evaluation, in consultation with the medical assessor of the licensing authority.

(4)     Applicants with any of the following medical conditions may be assessed as fit subject to satisfactory cardiological evaluation and in the absence of any other abnormality:

(i)      incomplete bundle branch block;

(ii)     complete right bundle branch block;

(iii)     stable left axis deviation;

(iv)     asymptomatic sinus bradycardia;

(v)      asymptomatic sinus tachycardia;

(vi)     asymptomatic isolated uniform supra-ventricular or ventricular ectopic complexes;

(vii)    first degree atrioventricular block;

(viii)   Mobitz type 1 atrioventricular block.

(5)     Applicants with a medical history of any of the following medical conditions shall undergo satisfactory cardiovascular evaluation before they may be assessed as fit:

(i)      ablation therapy;

(ii)     pacemaker implantation.

Such applicants for a class 1 medical certificate shall be referred to the medical assessor of the licensing authority. Such applicants for a class 2 medical certificate shall be assessed in consultation with the medical assessor of the licensing authority.