Specification for CARDIOLOGY REPORTS

The European Regulations and UK CAA’s Guidance Material for fitness decision, acceptable treatments and required investigations (if specified) can be found in the medical section of the CAA website (www.caa.co.uk). For many conditions, there are also flow charts available for guidance on the assessment process.

The following subheadings are for guidance purposes only and should not be taken as an exhaustive list.

1. Diagnoses

2. History

Presenting symptoms Nature of condition, circumstances surrounding onset, precipitating factors Other relevant medical history

3. Examination and Investigation Findings

Clinical Examination Blood Pressure within acceptable parameters (Hypertension flow chart) Blood tests (U&E, Renal and Liver Profile, Lipid Profile, Glucose) Confirmation no end organ damage

Cardiovascular Risk Assessment Family history, smoking, alcohol intake, weight (BMI), and lifestyle interventions Resting ECG Exercise Tolerance Test Report where indicated

1. Protocol used (e.g. CAA protocol - Symptom limited Bruce Protocol off cardioactive medication as directed by the investigating cardiologist)

2. Walking time 3. Symptoms experienced 4. ECG changes 5. Summary and conclusions

Echocardiogram where indicated 1. Valve structure and function 2. Standard chamber dimensions 3. Ejection Fraction (indicate measurement technique) 4. Summary and conclusions

24-hour ECG where indicated 1. Beats scanned 2. Number/frequency of ectopics/aberrants 3. Runs of abnormal rhythm (extracts) 4. Summary and conclusion

Angiogram where indicated 1. Full report 2. Measurement of degree of stenosis in each affected artery (annotated diagram of

coronary tree acceptable) Cardiac MRI, MPS, Stress Echocardiogram (dobutamine or exercise), CT as indicated

*Where investigations are abnormal or borderline the hard copy traces/images are likely to be required for review*

4. Treatment

Current and recent past medication (dose, frequency, start date) Confirmation no side effects from medication

5. Follow up and further investigations/referrals planned or recommended

Plan of management and anticipated follow up

6. Clinical Implications

Any concerns regarding disease progression, treatment compliance or risk of sudden incapacity

UK CAA Guidance - Reports Cardiology 1 of 1 January 2013 v1.1

Investigations required for abnormal ECG observations

1=Cardiologist review, 2=Exercise ECG 3=24hr Holter ECG, 4=Echocardiogram

* where there is guidance material and/or certificatory flow charts and assessment is straightforward, AMEs should make the fitness decision. For complex and/or borderline cases the AME should discuss the case with the Medical Assessment Team (MAT). Review of reports/investigations coordinated by the AME may be required for MAT review.

Diagnosis

Class 1 Flow Charts and guidance

available (Class 1/2)

Class 2

Fitness assessment

minimum Investigations;

others if clinically indicated

Fitness assessment*

minimum Investigations

others if clinically indicated

Rhythm

Incomplete RBBB AME Investigate if other abnormalities present

No

AME

Investigate if other abnormalities present

Atrial Fibrillation Atrial Flutter

AMS

1,2,3,4

Yes

1,2,3,4

Sinoatrial dysfunction or Sinus Pauses

No

Mobitz type 2 AV block

Complete RBBB Yes

Complete LBBB (Or RBBB+Left Axis deviation)

yes

Broad/narrow complex tachycardia no

Pacemakers yes

Mobitz type 1 AV block 1,3 No

1,3 SVEs/VEs Simple 1,3 Then possibly 2,4 Yes

SVEs/VEs Complex

1,2,3,4 1,2,3,4

WPW yes

Other inc AVNRT etc yes

Asymptomatic QT prolongation No

Brugada Pattern Yes

Post ablation yes

Coronary disease

Pathological Q waves T inversion

Q waves Poor R wave progression

AMS 1,2,3,4 yes AME 1,2,3,4

Cardiomyopathy

LVH, atrial enlargement, Flat or inverted T waves,

AMS 1,2,3,4 No AME 1,2,3,4,

Miscellaneous – new finding of...

Non-specific T wave changes

AMS

1,2

No AME

1,2

New or progressive Left axis deviation

ST segment sag

ST segment depression

First degree AV block (>240ms) 1,3

1,3

Bradycardia (rate < 40 bpm)

Tachycardia (rate > 100 bpm)

Asymptomatic Long QT 1,2,3 Yes 1,2

Investigation of ECG Abnormalities Table 03/2013 v1.0

1 of 1 Issued By: UK Civil Aviation Authority, Medical Department