AOCOPM 2024 Midyear Educational Conference-346719

346719 - Article 7

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The document outlines guidelines for evaluating electrocardiograms (ECGs) in civil aviation medicine, specifically distinguishing between normal variants and abnormal findings that may require further evaluation. It specifies normal ECG variants which do not usually necessitate follow-up, such as sinus bradycardia with a heart rate greater than 44 beats per minute, sinus tachycardia with a heart rate less than 110 beats per minute, and the presence of low atrial rhythm, single premature ventricular contractions (PVCs), and premature atrial contractions (PACs) if asymptomatic, among others. Certain conditions, like an incomplete right bundle branch block (RTBBB) that progresses to a complete form, fall under normal variants but may still need observation.<br /><br />Moreover, the document provides parameters for normal and abnormal ECG intervals, such as a PR interval of less than 0.21 milliseconds and a QRS interval of less than 0.12 milliseconds, along with specific criteria for axis deviations.<br /><br />For abnormal findings, the document advises on various standard evaluations. For instance, prolonged PR intervals, advanced bradycardia, and tachycardia require cardiovascular evaluations, stress tests, and potentially long-term monitoring with devices like a Holter. New occurrences of complete right or left bundle branch blocks and atrial fibrillation/flutter demand comprehensive follow-up, including stress tests, echocardiograms, and other diagnostic procedures to assess the individual's cardiovascular health.<br /><br />The thoroughness ensures that conditions potentially affecting a pilot's health and by extension, flight safety, are adequately addressed following specific protocols, like the Maximal Bruce Protocol Nuclear stress test and continuous heart monitoring, ensuring pilots are fit to maintain operational responsibilities safely.

Keywords

ECG evaluation

civil aviation medicine

normal ECG variants

abnormal findings

sinus bradycardia

premature ventricular contractions

right bundle branch block

PR interval

cardiovascular evaluations

pilot health