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AVMO > Cardiology > Flashcards

Cardiology Flashcards

1
Q

That factors in the aviation environment may effect cardiovascular disorders

A 
Hypoxia - all types
Sustained G
G countermeasures
Stress
Physical activity/workload
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2
Q

Effects of CVS disorders on aviation operations

A 
Distracting symptoms: pain, palpitations
Suddenly incapacitation, Haemodynamic compromise
- Hypotension
- syncope
- silent disease
- sudden death
- thromboembolism

Medication side effects

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3
Q

Aortic stenosis, fit to fly?

A

No
Can’t increase CO in response to stresses
G strain eg would reduced CO
Possible exertional syncope

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4
Q

Relevant clinical information needed to access fit for fly

A

Aim to. Establish the Dx, ID aviation-relevant factors, determine risk of incapacitation, quantify risk of progression or recurrence, determine impact of tx on aviation safety.

Role, aircraft, type, crew configuration
Hx of symptoms
- symptoms awareness
- episodes of incapacitation
- relation to exertion
Cardiovascular RF
Lifestyle factors
Family history
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5
Q

What to ask a cardiologist on a referral

A 
Confirm diagnosis
Management recommendation
Prognosis
Risk of incapacitification
Follow up 
Or very specific Q

Never ask if pt fit to fly

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6
Q

Benefit and limitation of resting ECG

A

Cheap and easy, non invasive
Works better in serial
Useful for detection of rhythm and conduction disturbances

Very poor sensitive for underlying IHD in young asymptomatic individual

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7
Q

Benefit and limitation of exercise stress ECG

A

Easy, non-invasive, first line test for CAD

Bruce protocol required

  • 100% predicted HR
  • At least 9 mins

Monitor for 5 mins into recovery phase
No b blockers 48 hours

Contraindicated in unstable angina

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8
Q

Indication for holter monitor

A 
Non-invasive test for 24 hours
IX for 
- rhythms and conduction disturbances
- syncope and pre-syncope
- post ablation success
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9
Q

Use of MPS

A

Useful for detecting arterial spasm that doesn’t show up in coronary angiogram

The prognostic value related to ability of MPS to identify the presence and extent of jeopardised viable myocardium

Post MI - angiographic variables were not significant predictors of jeopardised viable myocardium regardless of underling coronary anatomy

Great negative predictive value

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10
Q

When to order a ECHO

A 
IX murmurs
Suspicion of structure all heart disease
Pressure gradient/velocities
Pericardial conditions
Cardiomyopathy
Ejection fraction estimation
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11
Q

Benefit of stress ECHO

A

Better sensitivity than exercise stress ECG
Assess functional ischaemia
Useful if ECG uniinterpretable
Negative results is very reassuring

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12
Q

Indications for coronary angiogram

A

Gold standard test for IHD
Clearly denies luminal coronary anatomy

Assesses left ventricular function
Clinical vs occupational indications
- pilot will need angiogram very 3-5 year after intervention

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13
Q

Indications for ambulatory BP monitoring

A

Diagnostic confirmation or investigate syncope

Eg rule out white coat hypertension

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14
Q

Calcium score benefit

A

Calcium score is an independent risk factor
Expensive
Stress echo is a better predictor
CAC means that atherosclerosis is present

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15
Q

Treatment considerations when assessing aircrew

A

Is the clinical conditions itself disqualifying
Is there definitive tx
What are the aviation relevant side effects
Is a ground trail required
Is tx providing effective control
Does control need to be monitored
Are there logistical treatment issues that interfere with aviation or deployment.

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16
Q

Consideration when starting antihypertensive therapy

A

Trial conservative therapy first
- no TMUFF in this time as long as <160/100mmHg and CVD risk score is acceptable and <6months

After trial then consider medication
- TMUFF 14 days initial and 7 day after a change
- UMECR required
Types
- ACEI/ARB first line agents
- Thiazides diuretics
- Ca Channel and B blocker - unfit for high-performance flying
- Alpha blockers not permitted for flying duties

17
Q

Consideration for lipid lowering agents

A

Conservative therapy +fish oil
- no TMUFF and MECR if CVD score ok

Statins first line

  • TMUFF 7 days initially and 7 days subsequent changes
  • UMECR required
  • Can add ezetimibe, bile acid sequestration, fibrates
  • Nicotinic acid not permitted for flying duties
18
Q

Considerations for anti arrhythmic

A

Underlying condition is likely disqualifying

In civilian aviation case by case assessment

  • AF increasingly common
  • rate control vs prophylaxis of AF
  • Sotalol and other B - Blockers
19
Q

Considerations for anti coagulation

A

Military aviation

  • aspirin acceptable
  • clopidogrel disqualifying
  • Factor Xa inhibitors - NOACs

Civilian aviation

  • warfarin requires evidence of stable dINR control
  • Class 1 multi crew only
20
Q

When to start anticoagulation

A

CHA2DS VASc
>/=2 high risk - oral anticoagulant maintain INR 2-3
1. Moderate risk - aspirin or oral anticoagulant INR 2-3
0 Low risk - no antithrombotic therapy or aspirin up to 325mg

21
Q

Consideration if pt requires CABG

A 
At least 6-12 months recovery
Waiver consideration
- cardiology review annually
- EF >50%
- Myocardial perfusion scan
- demonstrates RF control
22
Q

Consideration for pt after angioplasty. +/stenting

A 
There is a risk of early re-stenosis which eases over time
6-12 months recovery
Waiver considerations
- cardiology review annually
- normal ejection fraction
- Myocardial perfusion scan normal
- demonstrates risk factor control 
- no combination anti-platelet therapy
23
Q

What factors define MI as significant disease

A

Any LM lesion or >30% stenosis LAD
>50% luminal obstruction in any major vessel
>1 lesion of 30% stenosis in major vessels
Extensive disease with maximal lesion not exceeding 30-50% occlusion also requires consideration

24
Q

Considerations for pacing

A

Pacemaker use disqualifying for military flying due to potential for EMR interaction with device

CASA

  • restricted verification
  • Dual chambered, bipolar leads, annual check
25
Q

Considerations for radio- frequency and cryo ablation for AF

A

Pulmonary vein isolation procedure
Relatively high recurrence rate out to 12 months post procedure
Long-term risk pulmonary vein stenosis

26
Q

Prognostic considerations to ask cardiologist to advise

A 
Risk of subtle incapacitation
Risk of acute incapacitation
Risk of progression
Risk of recurrence
Likely future treatments
27
Q

CASA Standards for Heart function

A

Adequate left ventricular function >50%
Absence of jeopardised myocardium
- no reversible ischaemia
Acceptable incapacitation risk

28
Q

What risk calculator to us to determine screening for IHD in Pilots

A

Coronary heart disease risk factors prediction chart

29
Q 
Select all the results you need to see before considering a return to flight following coronary artery angioplasty and stenting
A. Cardiologist review
B. EF > 50%
C. Stress echo or MPS
D. Bloods lipids and glucose
A

All of the above

AVMO (49 decks)

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