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Aeromedical Forum

Coronary Artery Calcium Score: What's it add up to?

This spring I received a note from an airman wondering about his odds of getting off a Special Issuance. Five years previously he had a heart artery calcium scan which showed heavy calcification in one of his coronaries-arteries that supply the heart muscle with blood. He reported this to the FAA. They promptly requested additional studies including a stress test and imaging studies. These looked OK, according to the airman. However, they placed him on a Special Issuance requiring these tests to be repeated every year to maintain his medical certificate. He had had no symptoms of chest pain, shortness of breath or anything else that would raise concern about the heart prior to the coronary artery calcium scan. He's had no symptoms since. So why was the FAA gong bananas about a high coronary artery calcium score?

To answer that question let's look at this heart scan also known as a coronary artery calcium scan (CACS) and what it measures. The CACS is a specialized X-ray examination that looks at the amount of calcium in your coronary arteries. Coronary arteries carry blood to the muscle of your heart, providing the essential oxygen needed to keep your ticker ticking. Any time your heart muscle is not getting enough blood and the oxygen it carries, its viability is threatened. You begin to experience chest pain, often traveling into your neck or down your left arm. You might break out into a sweat or become short of breath. Often, if you rest, these symptoms go away. If, however the coronary artery is really blocked, even rest doesn't do it and the pain continues until some of your heart muscle is killed off. You've had a heart attack! Or myocardial infarction as we say in the trade. Obviously, this kind of thing is darn serious and can even be life threatening. That's just what you need when you're trying to shoot the ILS in the clag.

OK, so heart attacks in the cockpit are bad. How does a CACS figure in? As we said, the CACS measures the amount of calcium in those coronary arteries that need to pump blood to your heart muscle.

Calcium along with fats and cholesterol comprise plaque, a fancy word for crud that accumulates on the lining of your coronaries. With time almost everyone will accumulate a bit of plaque in the coronaries. Some people however are predisposed to form more. The risk factors for excessive plaque formation are pretty well known: genetic predisposition-heart disease running in families, overweight, diabetes, cigarette smoking, lack of exercise. If its already known that you have heart disease a CACS is not necessary. However, if you have some risk factors or are just not sure, your doctor may order a scan. If it does indicate you are at an increased risk of getting a heart attack there probably are things you can do to lessen that chance: Stop smoking. Loose weight. Get more exercise. Get the diabetes under better control.

So, what about our airman on the SI? Unfortunately, a high calcium score (greater than 1,500) is a pretty strong indicator of a high risk of heart attack or heart related death. As we said, our particular pilot has been followed closely over five years by his cardiologist and never had any symptoms nor any detectable progression of his coronary artery calcification. What's his risk going forward? Sad to say, the data is sparse. We'll have to wait and see what the FAA decides.

Fly wisely. See you next month.

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