Right Bundle Branch Block

rausda27

Well-Known Member
#1
I wanted to share my recent experience with a Right Bundle Branch Block that was discovered during a routine FAA 1st class EKG. A little background. I am healthy, I have a low BMI, eat low carb, no sugar diet, and exercise regularly. I do have hereditary hypertension thats well controlled with a low dose of a calcium blocker and am on a lipid management drug to control cholesterol and triglycerides. (another gift from my parents). All in all I feel healthy and have never had an issues from a cardiac standpoint.

So in early May, I went to my AME for my first class medical. All went well, last item was the EKG. Always been normal so no big deal. The AME runs the strip and starts saying something about checking my previous tracings. Goes and gets it and compares. He states theres a change. He believes its the leads. So he removes them all and double checks the correct placement. Runs it again and its abnormal. Cant explain it. Tells me cannot issue my medical. I was in shock. I literally saw my career coming to an unexpected end. As I am leaving, he gives me some advise. Go see a cardiologist. ASAP and have them verify the EKG abnormality.

My wife a RN, pulled some strings and was able to get me in to see a cardiologist the 2 days later. I can't stress this enough. Call as many offices as you can to get an appointment. In my area, they were booking weeks away for non life threatening conditions (or potential life altering in my case). The following day, I logged in the Airman Certification section of the FAA website and was able to see that under my medical section it stated "No medical information available". I was officially deferred to OKC. I looked up their contact information with the intent of making a call to see what steps I had to take. Normally, once the AME defers it can take a week or two for the deferral letter and required testing protocols to arrive via snail mail. I called the Aeromedical Branch in OKC )see contact info below) Selected option 2 for EKG. I spoke to a very nice woman and explained my situation. Professional pilot who had his medical deferred the day before. She understood. She appreciated my calm demeanor and polite approach. She then was able to get in touch with the physical assigned to my deferral while I was on hold. Great news, they agreed to process my letter immediacy and email the protocols to me. This saved me potentially weeks of the same document to arrive in the mail. I thanked her profusely and checked my email. Low and behold there is was a few hours later. This was key, because I was able to take this letter to the Cardiologist the next day so they could see what testing the FAA would require. I also was able to speak to a few other AME's for guidance (shout to to DR. Ross from Home for providing me with some guidance on this type of deferral)

The letter from the FAA with my testing protocol mentioned a letter from a cardiologist requiring the following:
1530198757677.png


I also gave the Cardiologist the following information for a Cardiovascular Evaluation as it mentioned some blood tests not included in the deferral letter:

Guide for Aviation Medical Examiners

My cardiologist was very understanding with the situation. My deferral letter also required a Nuclear stress test.

1530198960861.png


The FAA is very specific on what they require. I was lucky that my Cardiologist approved a Nuclear stress test. Normally they would just order a regular Bruce Protocol test without the radionuclide imaging. A few difference noted by the FAA requirements and the test how the cardiologist normal administers:
1-FAA wants Standing and Supine EKG tracings before the test
2-FAA wants 9 minutes minimum and 100% exertion. (to calculate 220-age=target) For younger guys this is a hard target to reach. Took me almost 15 minutes to stage 5.
3-FAA wants the rhythm strips as well as EKG tracings. They normally dont even print those.
4-FAA wants EKG for each stage and at end of each stage. At peak and a tracing for every minute during recovery for at least 5 minutes.

I made a checklist for the Nuclear tech and Doctor to help them keep track of all these requirements as I didn't want to miss anything.

FAA wanted originals, but the doctors office wasnt willing to give them away so they made high quality reproductions. I called the FAA to confirm as the letter stated no fax or xerox copies, but they said as long as there are legible then thats fine. They did give me the original rhythm strips and EKGs for pre test and my initial diagnostic EKG as well as photo printouts of my nuclear scans. If your Dr. puts the images on a disk, make sure they are just image files and dont require any included software to open the images. The government PCs at the FAA wont load the viewing software, so they need to be image files only, jpeg, img, etc.

I made copies of everything for my self and then bought some folders and labeled everything in sequence for the FAA. REVIEW EVERYTHING. The FAA wants it all in one mailing if possible. I triple checked it all. Made sure everything that was in the CVE protocol and the FAA Protocol was included. I also spent some time with the Cardiologist drafting the letter. It needs to be typed and specific. They basically want to see that the testing is normal, the diagnosis isn't sue to any coronary heart disease and you are fit for flight. If anyone is going through this I have a copy of the one my Dr submitted and will send by email if you PM me.

A word on outside medical deferral S/I companies. I called two. LeftSeat and Aviation Meadical Advisory Service. AMAS was $1800 I believe and LeftSeat was $2000, $1500 if you don't use the follow up stage. Based on advise gathered from AOPA and a few AME's I consulted with I went ahead with AOPA assistance and did the rest myself. I can't comment on the marketing information provided by either advisory/assistance companies other than they told me it would be months to get my medical back alone. That wasn't the case at all. I followed the FAA letter exactly as they outlined. I made sure all my documentation was complete and in order. I mailed it in one packet as requested. Then I waited one week. After I confirmed they received my overnight package, I called once or twice a week. Called OKC, option 1 and politely gave them my case # and simply asked for any status updates. Each time I did this, a note was sent to the reviewer indicating I was inquiring. I wasn't trying to pressure, just calm stated that I was a full time professional pilot and was trying to get an idea of timing. Apparently 1st class medicals get some priority and the representatives at the FAA said it doesn't hurt to do followups. They completely understand your situation and the anxiety involved. I got the same representative several times and he recognized me after a few calls. He mentioned that all types call, dont be one of those guys that freak out or scream at them. They know you're stressed and honestly I was amazed at the calm demeanor and professionalism with every contact I had at the FAA. They were all very understanding and helpful.

So my medical was deferred 3rd week of May. I received a call from the regional flight surgeon yesterday asking for my email to send my temporary certificate.

All in all the FAA had my file for 16 business days. Not months that the advisory service stated. Im not discounting the service they provide, but in my case, by the time they sent me the quote for services, I had already had my consult and follow up testing complete. My labs drawn and results in hand and had everything in order to submit to the FAA. I think my situation although potentially career ending, was more of a cut and dry type case, not one that has to go through the special issuance process. Perhaps I was lucky and got some great guidance from AOPA and some AME's that resulted in a quick turnaround. Plus the Right Bundle Branch Block was determined to not have any clinical impact on my cardiac health which obviously made it easier for the FAA to approve. All tests came back perfectly normal.

Contact info for OKC Aeromedical:

Medical Certification(405) 954-4821
option 2 for EKG-talk to them first
option 1 for follow up

Surprisingly the mailing address for submission of your packet wasnt in the deferral letter, so here it is. Use FedEx or UPS.

Federal Aviation Administration
Aerospace Medical Certification Division, AAM-300
CAMI Building, Building 13
6500 S. MacArthur Blvd
Oklahoma City, Oklahoma 73169

Neither FedEx or UPS could fit all the characters in so it printed on the label as:
Federal Aviation Admin.
Med Cert Division, AAM-300
CAMI BLDG, BLDG 13
6500 S. MacArthur Blvd
Oklahoma City, Oklahoma 73169

So I know this is a long post with a lot of information but I felt it was good to share. This condition came out of nowhere and according to the Cardiologist can happen for no apparent reason with no symptoms like in my case. I as all doom and gloom, but as it turns out, the FAA asked for information, I provided it as requested, followed up with them frequently and also treated them with respect, which they in turn reciprocated. It helped to have the support of my company and owner, and I am thankful to have my wings back. If anyone has any questions feel free to PM me or respond. Big shout out to my friends on here who lent me their ear during this process, thank you!
 

///AMG

Well-Known Member
#3
Great info, and I'm glad I saw this. Got identified as having RBBB during my initial military flight physical prior to entering active duty, and they did the whole stress test/work up back then. I'm wondering if they are going to want another one to be done when I apply for FAA class 1 later this year (since that was 13 years ago now). I don't know if the original testing was the nuclear type, or the other one you mentioned. I know they also had me sleep with a heart monitor for a couple days, not sure if that was part of your test as well. As for the doom and gloom, I remember when I first found out I was pretty sure that not only was I never going to fly again, but that I would also be dying in short order.
 

rausda27

Well-Known Member
#4
That was another discrepancy. I did the telephone consult with an AMAS physician the day I was deferred. He told me for a RBBB the FAA would require a 24 hour Holter Monitor and an electrocardiogram in addition to the nuclear perfusion stress test. In actuality all the FAA required was the nuclear stress. So I spent a couple days stressing about how to get the additional tests done when they weren’t even required.

As far as your baseline RBBB is concerned, I’d consult with one of the senior AME’s. Perhaps Dr. Ross can assist. I know once the FAA sees the RBBB documented it doesn’t need to be reported ever again. Funnily enough if your under 30 it’s not a deferral item apparently.
 

A80TRACON

I do the best imitation of myself
#6
As I've always said, treat your medical like gold. Pilot or ATC, you never know when you'll lose it.

It's very easy to lose and amazingly difficult to require.
 

pilot4500

IT Manager/ Former Cirrus Charter Pilot
#7
As I've always said, treat your medical like gold. Pilot or ATC, you never know when you'll lose it.

It's very easy to lose and amazingly difficult to require.
I wish that I could like this post 1,000 times. This is so true! I know this from personal experience.
 

higney85

Property of Scheduling
#8
Personal experience, also have a RBBB... get an EKG as part of a normal physical (non-ame) before age 35. I did my first at 22 after my first year at a regional. I knew it ran in the family, so wanted to clear hurdles while I still had time to make a career change OR just keep myself alive if a problem was real and not just a genetic thing. Showed the abnormal EKG, even after changing leads and a different machine. Full cardio workup with a cardiologist (echo, stress test, holter, nuclear test, blood panel, EKG...the whole 9 yards, ending with all test results and a letter from the cardiologist of “all good”) and brought it all to my AME at my next yearly interval. It was my normal and not a problem. Medical issued without problems and logged away as my norm. Fast forward about 7 years and had actual health issues, which is a whole different discussion, and the FAA had a baseline to see my EKG hadn’t changed and wasn’t a factor with my cancer diagnosis and treatment. I now have a yearly holter monitor/EKG and cardio visit but it’s all part of a SI due to cancer and not just for the RBBB. Had it not been for the major health issue there would be no monitoring from anyone for another couple years when the first age 35 EKG is required. Without the major health issue, the age 35 EKG would be the same and not require additional paperwork or tests. Food for thought when looking at a full career. Also, covered by insurance outside of copays, and remained working throughout the RBBB situation. Health is your biggest asset, so stay ahead if possible.
 
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