Neurocardiogenic Syncope

[arwalke]

I've searched this forum and found some encouraging (and discouraging) posts about neurocardiogenic syncope.

I'm a college student with an expired 3rd class medical certificate (expired in January), and was planning to renew it this summer. I had an episode in one of my classes about 2 weeks ago where I passed out (no previous history of this or any other significant medical conditions). The school required me to go to the student health center where I was referred to a cardiologist in the area.

After an appointment with the cardiologist, I was ordered to take a tilt-table test, stress echo, and electrophysiology study. I had the tilt-table test today and failed about 15 minutes into the test (at 70% tilt). My BP went from about 120/80 to around 87/47 with my pulse dropping from about 60 to 21. I was immediately revived without medication (they put the table flat). My cardiologist was present before and after the test and said I had neurocardiogenic syncope and he gave me some pointers on how to handle it (maneuvers to restore blood flow). I had significant warning prior to my first episode in class and prior to failing the tilt table test. I am taking the stress echo and EP study next week.

My question is, do I have any hope of getting a fresh 3rd or higher class medical certificate? I haven't had any episodes since the one in class two weeks ago, and know what the warning signs are before I fully pass out. I'm unclear as to what constitutes a definite no-go with the FAA in this realm and plan to consult a local AME soon (preferably one the cardiologist knows).

Thanks!

 

[SFCC/UND]

I saw this on the ALPA website:

The FAA’s current policy is that an abnormal tilt-table test, done for any reason, will result in a minimum 4-year grounding. For that reason, the ALPA Aeromedical Office discourages pilots from undergoing tilt-table testing unless a definite clinical indication requires that test.

 

[My Flight Surgeon]

This type of syncope will be DQ. If the electrophysiologist finds something fixable (radioablation) then you will be able to get a Special Issuance after about 2 months. If they find nothing, I doubt they will grant you a medical.

 

[arwalke]

Thanks for the quick response. I did some searching of the FAA website and came across this edition of the Federal Air Surgeon's Medical Bulletin:

http://www.faa.gov/library/reports/medical/fasmb/media/200804_web.pdf

On pages 10-11, there's an article about a first-class pilot who had very similar symptoms to what I had and received a diagnoses of a form of neurocardiogenic syncope (without a tilt-table test). At the end of the article, it is mentioned that he was ultimately found medically eligible (presumably, because the loss of consciousness event was sufficiently explained).

If my cardiologist were to establish a diagnosis of neurocardiogenic syncope without a tilt-table test and document it thoroughly (with only one instance of it outside of a lab setting), would that be sufficient to try for a third class medical?

Going a step further, if it were sufficiently documented, would I be eligible for sport pilot medical (if I didn't go forward to an AME and try to get a new medical certificate and it presumably would be denied)? The rules seem vague on certifying yourself (essentially) for sport pilot medical.

Thanks!

 

[wheelsup]

A serious question - do you want to be operating an aircraft with the possibility of losing consciousness??? That seems scary to me.

 

[SteveC]

Thanks for the quick response. I did some searching of the FAA website and came across this edition of the Federal Air Surgeon's Medical Bulletin:

http://www.faa.gov/library/reports/medical/fasmb/media/200804_web.pdf

On pages 10-11, there's an article about a first-class pilot who had very similar symptoms to what I had and received a diagnoses of a form of neurocardiogenic syncope (without a tilt-table test). At the end of the article, it is mentioned that he was ultimately found medically eligible (presumably, because the loss of consciousness event was sufficiently explained).

If my cardiologist were to establish a diagnosis of neurocardiogenic syncope without a tilt-table test and document it thoroughly (with only one instance of it outside of a lab setting), would that be sufficient to try for a third class medical?

Going a step further, if it were sufficiently documented, would I be eligible for sport pilot medical (if I didn't go forward to an AME and try to get a new medical certificate and it presumably would be denied)? The rules seem vague on certifying yourself (essentially) for sport pilot medical.

Thanks!

As a disinterested outside observer, I wonder if it wouldn't be worth your time and money to make a trip to see Dr. Forred? It sounds to me like your case is a lot more involved than can be covered over an internet forum, and a few hundred dollars for airfare to see someone as well-versed in working with the FAA as Dr. Forred is might be a worthwhile investment.

Just a thought.

 

[arwalke]

A serious question - do you want to be operating an aircraft with the possibility of losing consciousness??? That seems scary to me.

After the tilt-table test yesterday, I definitely know what it feels like when this happens and feel I could definitely stop it in its tracks if it were to happen again (I've only had it happen once so far in an uncontrolled environment). There are two "maneuvers" to get blood flow to the brain (lying down - not possible in an airplane) or crossing the legs and tightening your chest (very possible in a small airplane or in a car). That's if an episode were to occur while flying...which I think is EXTREMELY unlikely simply due to what it looks like the triggers are in my case (sleep deprivation, high general stress level/anxiety (school), moving up and down a lot--sitting and standing up frequently, dehydrated). When it happened in class all of these known triggers for neurocardiogenic syncope were occurring (it was a lab where I was moving all around the room from computer to computer and different pieces of equipment and sitting on stools and standing). Sitting in an airplane seems to me to be one of the least likely places for this to happen (as long as I'm hydrated and not extremely tired...two things I should be anyways before getting behind the controls).

That said, I'd definitely "self-ground" myself for at least the next 6 months to a year to see if it happens again; I'm a full-time student about to finish my undergrad and getting ready to start law school so the funds for flying are low anyways and taking some more time off isn't a dealbreaker by any means...I just want to know if this will hold me back in the future and want to try to resolve this as best I can now so when I have time/money to fly again I can hopefully get a medical.

I'd definitely be open to flying/traveling to see a specialist to work this out, and I appreciate Dr. Forred's time on this forum.

 

[My Flight Surgeon]

Well in flying you will have these triggers (sleep deprivation, high general stress level/anxiety , dehydration). The problem is when you are on short final in solid IMC at the end of a long flight all of the above apply. Unless the electrophysiologist finds something fixable, I don't want to fly with you.

I would be glad to help you work on getting approval from the FAA.