Medical Renewal risks and Cardiovascular Health

Airborne_Again wrote:

My impression (correct me if I’m wrong, @MedEwok and @Tango) is that BP measurements are really for screening

I think so – it’s a test with a high negative predictive value (normal value strongly predicts normal condition) like any good screening tool, and with the puny tools we have that usually means the positive predictive value is not great (high value does not imply disease).

I think most MDs are well aware that hitting someone with a hammer on the thumb right before measuring BP might not be a great idea and there is certainly intraday variation. However a single high value can be clearly an issue (eg with simultaneous evidence of end organ damage in the retina which is why they shine in your eye with the blinding light :-) or evidence of renal failure which is one of the reasons a urine sample is tested) or it can be ambiguous and 24h measurement is helpful.

Peter wrote:

And testing the right hand produces about 3/3 less BP because it is further from the heart

That is not correct. BP on both arms should be identical give or take a few mmHg. If not there is strong suspicion of vascular disease in the central arteries. Regarding distance from the heart, pressure wave propagation in the human body is an incompletely understood topic that involves capacitance, elastic recoil, reflected waves and amplification and is a rabbit hole which I’m sure would be appealing to many to dive into. But if anything, BP increases (due to increasing wall stiffness) with distance from the heart.

If not there is strong suspicion of vascular disease in the central arteries

Interesting… but would you not say the vast majority of pilots (both GA and airline, but especially GA) have CHD to some degree, and carry on because a resting ECG finds nothing? Then one day something breaks, they get a stent (or worse), bang go your medical(s) and you are off into a world of hassle, money, and more money.

We did this in the health thread but basically GA pilots are largely in pretty bad CV health, eating the worst junk food at airports. The most popular is the “all day breakfast” and some pilots have stated they choose their destinations primarily for this. This is likely country-dependent (I don’t think the French eat much of that crap) but it is widespread. Take a look around your local GA watering hole

I don’t think the French eat much of that crap

The food at the airport cafe at Avignon is pretty good and definitely not of the “all day breakfast” variety!

Tango wrote:

is an incompletely understood topic that involves capacitance, elastic recoil, reflected waves and amplification

Sounds like you need the help of an RF engineer, not a doctor, for this stuff!

basically GA pilots are largely in pretty bad CV health, eating the worst junk food at airports

Yes, but considering the low average frequency, the impact should not even be measurable. It’s probably more the off airport fish & chips & beer that is the problem

Peter wrote:

Then one day something breaks

I read somewhere (maybe on this forum?) that aviation is a job where you are 1 medical away from unemployment and I get where that’s coming from. You may be right about GA pilots being more in danger of having CV disease than airline pilots – at least I don’t think I’ve ever seen a CAT pilot with a manifestly unhealthy appearance.

Yes; both private and CAT pilots are just 1 medical away from hobby termination or unemployment.

But as a cardiologist you will know that nearly everything in the heart can be fixed.

Which makes it all the more weird that of the many people I have known who gave up, a large % did so due to medical loss, and the majority of those due to cardiac causes. Then, inexplicably, instead of getting themselves fixed and enjoyed many more years of life, most of them drop flying and think that they will now be ok…

Honestly, if I had a cardiac condition that cost me my medical, I would get the medical issue cleared up, but unless it was something that was simple to get my medical back, I’d hang up my headsets. The ballache of the battery of (expensive) tests to get an FAA medical back are just too great to be worthwhile, when sailing scratches all the same itches as flying does, and motorcycling scratches the majority of those same itches – without all the downsides of GA (the reams of paperwork, and annoyances around airfields that seem intent at turning away good paying business).

I would regret the day I sold the Auster because it’s such a nice flying plane, but it’d be better to sell her to someone who can get on with flying, rather than sit in the hangar for 2 years while I go through test after test.

There is a lot of forum mythology around this, much of it wrong, and it depends on the detail, and FAA differs from UK/EASA.