AMC2 MED.C.025 Content of aero-medical assessments

ED Decision 2019/002/R

CARDIOVASCULAR SYSTEM

(a) Examination

(1) A standard 12-lead resting electrocardiogram (ECG) and report should be completed on clinical indication, at the first examination after the age of 40 and then at least every five years after the age of 50. If cardiovascular risk factors such as smoking, abnormal cholesterol levels or obesity are present, the intervals of resting ECGs should be reduced to two years.

(2) Extended cardiovascular assessment should be required when clinically indicated.

(b) Cardiovascular system - general

(1) Cabin crew members with any of the following conditions:

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

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

(iii) heart or heart/lung transplantation

should be assessed as unfit.

(2) Cabin crew members with an established diagnosis of one of the following conditions:

(i) peripheral arterial disease before or after surgery;

(ii) aneurysm of the abdominal aorta, before or after surgery;

(iii) minor cardiac valvular abnormalities;

(iv) after cardiac valve surgery;

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

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

(vii) a cardiovascular condition requiring systemic anticoagulation;

(viii) vasovagal syncope of uncertain cause;

(ix) arterial or venous thrombosis; or

(x) pulmonary embolism

should be evaluated by a cardiologist before a fit assessment may be considered.

(c) Thromboembolic disorders

Whilst anticoagulation therapy is initiated, cabin crew members should be assessed as unfit. After a period of stable anticoagulation, a fit assessment may be considered with limitation(s), as appropriate. Anticoagulation should be considered stable if, within the last 6 months, at least 5 INR values are documented, of which at least 4 are within the INR target range and the haemorrhagic risk is acceptable. In cases of anticoagulation medication not requiring INR monitoring, a fit assessment may be considered after a stabilisation period of 3 months. Cabin crew members with pulmonary embolism should also be evaluated by a cardiologist. Following cessation of anticoagulant therapy, for any indication, cabin crew members should undergo a re-assessment.

(d) Syncope

(1) In the case of a single episode of vasovagal syncope which can be satisfactorily explained, a fit assessment may be considered.

(2) Cabin crew members with a history of recurrent vasovagal syncope should be assessed as unfit. A fit assessment may be considered after a 6-month period without recurrence, provided cardiological evaluation is satisfactory. Neurological review may be indicated.

(e) Blood pressure

Blood pressure should be recorded at each examination.

(1) The blood pressure should be within normal limits and should not consistently exceed 160 mmHg systolic and/or 95 mmHg diastolic, with or without treatment, taking into account other risk factors.

(2) Cabin crew members initiating medication for the control of blood pressure should be assessed as unfit until the absence of any significant side effects has been established and verification that the treatment is compatible with the safe exercise of cabin crew duties has been achieved.

(f) Coronary artery disease

(1) Cabin crew members with:

(i) cardiac ischaemia;

(ii) symptomatic coronary artery disease; or

(iii) symptoms of coronary artery disease controlled by medication

should be assessed as unfit.

(2) Cabin crew members who are asymptomatic after myocardial infarction or surgery for coronary artery disease should have fully recovered before a fit assessment may be considered. The affected cabin crew members should be on appropriate secondary prevention treatment.

(g) Rhythm/conduction disturbances

(1) Cabin crew members with any significant disturbance of cardiac conduction or rhythm should undergo cardiological evaluation before a fit assessment may be considered.

(2) Cabin crew members with a history of:

(i) ablation therapy; or

(ii) pacemaker implantation

should undergo satisfactory cardiovascular evaluation before a fit assessment may be made.

(3) Cabin crew members with:

(i) symptomatic sinoatrial disease;

(ii) symptomatic hypertrophic cardiomyopathy

(iii) complete atrioventricular block;

(iv) symptomatic QT prolongation;

(v) an automatic implantable defibrillating system; or

(vi) a ventricular anti-tachycardia pacemaker

should be assessed as unfit.