Cardiovascular System - Examination

Implementing Rules (IRs), Acceptable Means of Compliance (AMCs) and Guidance Material (GM) on examination of the cardiovascular system

The following are the requirements for the medical certification of aircrew, including guidance material issued by the UK CAA Medical Department in relation to the cardiovascular system.

Implementing Rules	Acceptable Means of Compliance	Guidance Material
MED.B.010 Cardiovascular System
(a) Examination (1) A standard 12-lead resting electrocardiogram (ECG) and report shall be completed on clinical indication, and: (i) for a class 1 medical certificate, at the examination for the first issue of a medical certificate, then every 5 years until age 30, every 2 years until age 40, annually until age 50, and at all revalidation or renewal examinations thereafter; (ii) for a class 2 medical certificate, at the first examination after age 40 and then every 2 years after age 50.		Investigation of ECG abnormalities table CAA ECG reporting system ECG Diagnostic Statements Advice on acceptable ECG diagnostic software and acceptable diagnostic statements Standard ECG Letters Are available in AME admin information. NOT YET AVAILABLE

(2) Extended cardiovascular assessment shall be required when clinically indicated.		Extended cardiovascular assessment An extended cardiovascular assessment should include a clinical report of an examination by an accredited physician/cardiologist, an exercise ECG and any other test that is clinically indicated.

Implementing Rules	Acceptable Means of Compliance	Guidance Material
	Class 1/2 (a) EXAMINATION Exercise electrocardiography An exercise ECG when required as part of a cardiovascular assessment should be symptom limited and completed to a minimum of Bruce Stage IV or equivalent.	Exercise electrocardiography (instructions for the Bruce protocol)
	Class 1 (1) Cardiovascular Risk Factor Assessment 1.1 Serum lipid estimation is case finding and significant abnormalities should require review, investigation and supervision by the AeMC or AME in conjunction with the licensing authority. 1.2 An accumulation of risk factors (smoking, family history, lipid abnormalities, hypertension, etc.) should require cardiovascular evaluation by the AeMC or AME in consultation with the licensing authority.	Cardiovascular risk assessment A cardiovascular risk assessment tool useful for AMEs.
	(2) Cardiovascular Assessment 2.1 Reporting of resting and exercise electrocardiograms should be by the AME or an accredited specialist.	Reporting of resting and exercise ECGs All ECGs should be reported by an accredited physician/cardiologist.

(3) For a class 1 medical certificate, an extended cardiovascular assessment shall be completed at the first revalidation or renewal examination after age 65 and every 4 years thereafter.	2.2 The extended cardiovascular assessment should be undertaken at an AeMC or may be delegated to a cardiologist.	Age 65 and over extended cardiovascular assessment. When a Class 1 Medical Certificate holder reaches the age of 65, they will be sent a standard letter from the UK CAA to advise them of the need for an extended cardiovascular assessment within the next six months. If the pilot has had an acceptable review and exercise test within the preceding two years, this will be deemed as acceptable to meet this requirement. They will require follow-up four years from the last test or sooner if clinically indicated.
	Class 2 (1) Cardiovascular Risk Factor Assessment An accumulation of risk factors (smoking, family history, lipid abnormalities, hypertension, etc.) requires cardiovascular evaluation.	Cardiovascular risk assessment A cardiovascular risk assessment tool useful for AMEs.
	(2) Cardiovascular Assessment Reporting of resting and exercise electrocardiograms should be by the AME or an accredited specialist.	Reporting of resting and exercise ECGs All ECGs should be reported by an accredited physician/cardiologist.

Implementing Rules	Acceptable Means of Compliance	Guidance Material
(4) For a class 1 medical certificate, estimation of serum lipids, including cholesterol, shall be required at the examination for the first issue of a medical certificate, and at the first examination after having reached the age of 40.