February 2007 - American Bonanza Society

a tone of excited anticipation like we were going there to get abirthday surpri se.A heart murmur is an unusual sound coming from theheart heard through the stethoscope. Instead of lub-dub onemay hear an extra sound such as lub-swoosh-dub,lub-swoosh-dub. The swoosh may be blood forcing its waythrough a val ve that is too tight or it may indicate a backflowthrough the val ve.Some murmurs are called innocent or functional murmurs.They are not indicative of a pathological process in the heart.Small children often have a murmur caused by the forcefulmovement of blood through the small heart valve. These murmursare usually outgrown. Some murmurs can be indicative ofdecision made by the AMCD. A consultation with the AMEbefore the initial exam may help in gathering the propertests/information for the AMCD decision-making process.The AMCD will review the information provided to besure there is no serious functional impairment caused by theabnormal val ve structure. Often the airman is issued a medicalcertificate but is asked to provide a report and ultrasound examyearly. The periodic ultrasound exams measure the dimensionsof the valve openings and the amount of blood ejected throughthe valve with each contraction. The AMCD has certain limitsto how much these values can be compromised.If the stenosis or regurgitation causes functional impairment(the heart is not pumping out the blood in a normal quanseriousabnormalities in the architectureof the heart or the heart valve.The advent of modem technologyhas enabled medical practitioners tovisualize the dimensions and functionHeart valves are one-way devicesinside the heart that direct the flowof blood from one chamber toanother or out of the heart to theof the heart valves through ultrasonic lungs or the bodyimages. These images show the size and shape of the heartvalves and can estimate how much blood is moving throughthe valve, or if it is backilowing through the valve.Heart murmurs noted by the AME generally need to beevaluated. Sometimes the pilot may already know about themurmur and may have had it evaluated by a cardiologist. Thepilot should note this info in the history part of Fonn 8500, andbring all the information he can gather from his personalphysicians that reference previous evaluation of the murmur.The AME Guide directs the medical exantiner: "If a murmuris discovered during the course of conducting a routineFAA examination, report its character, loudness, timing, transntissionand change with respiration. It should be notedwhether it is functional or organic and if a special exantinationis needed. If the latter is indicated, the Examiner should deferissuance of the medical certificate and transmit the completedFAA Form 8500-8 to the FAA for further consideration."If an AME discovers a new murmur (or any time a newmurmur is discovered) he will usually order a cardiac ultrasoundexantination and/or refer to a cardiologist. Many timesthis can be done on short notice and the results noted. If theheart is normal in function and anatomy and the airman is otherwisequalified, the AME can probably consult AMCD or theRegional Right Surgeon to obtain a verbal authori zation tocertify the airman. If it shows some new heart valve conditionor other pathology, the AME will have to defer the issuance,the airman will need to get a more thorough evaluation, andthe certification decision is made by the AMCD.Pilots with valves that are too narrow (stenosis) or allowbackilow (regurgitation) must have their initial certificationtity or force), the affected individual,whether pilot or not, may be faced withthe deci sion of a surgical correction ofthe problem. Valves can be treated withsurgery or even replaced with amechanical valve or an animal valve.Individuals with mechanical valves will usually be treatedwith an anticoagulant like warfarin after their new valve isimplanted. This is done to reduce the risk of blood clots form ­ing around the valve. Pilots with mechanical valves and oncoumadin may stili be able to exercise their privileges under aspecial issuance.SummaryHeart valves are one-way devices inside the heart thatdirect the flow of blood from one chamber to another or out ofthe heart to the lungs or the body. There are four valves in thehuman heart. They can become diseased or have abnormal formationfrom birth.In many cases these abnormal valves will be detected bya sound heard through the stethoscope called a murmur. Valvescan be more accurately evaluated by ultrasonic imaging. Pilotswith murmurs or known heart valve problems usually requirefurther evaluation and a special issuance medical certificateissued by the AMCD.In many cases after the initial certification by the AMCD,the pilot may be allowed to recertify by AASI (AME AssistedSpecial Issuance) . In thi s process, the AME reviewstests/reports required by the AMCD on a periodic basis andmay, if the tests/reports are within defined parameters, reissuethe next medical certificate.Charles S. Davidson, M.o .. holds board certification in family medicineand emergency medicine. He has been an aviation medicalexaminer since 1978 and serves as a senior AME. He holds aprivate pilot license with muttiengine and instrument rating. He isan active pilot using general aviation for business and pleasurefor 23 years and is also an ABS board member. He flies on A36.