ITEM 36. Heart

CHECK EACH ITEM IN APPROPRIATE COLUMN Normal Abnormal

I. Code of Federal Regulations:

First-Class: 14 CFR 67.111(a)(b)(c)

Cardiovascular standards for first-class airman medical certificate are:

Second- and Third-Class: 14 CFR 67.211(a)(b)(c)(d)(e)(f) and 67.311(a)(b)(c)(d)(e)(f)

Cardiovascular standards for a second- and third-class airman medical certificate are no established medical history or clinical diagnosis of any of the following:

• II. Examination Techniques
• A. General Physical Examination. (Updated 06/24/2026)

ii. A cardiac evaluation may be needed to determine the applicant's qualifications. Temporary stresses or fever may, at times, result in abnormal results from these tests. If the AME believes this to be the case, the applicant should be given a few days to recover and then be retested. If this is not possible, the AME should defer issuance, pending further evaluation.

It is recommended that the AME conduct the auscultation of the heart with the applicant both in a sitting and in a recumbent position.

Aside from murmur, irregular rhythm, and enlargement, the AME should be careful to observe for specific signs that are pathognomonic for specific disease entities or for serious generalized heart disease. Examples of such evidence are: (1) the opening snap at the apex or fourth left intercostal space signifying mitral stenosis;

B. When General Examinations Reveal Heart Problems.

These specifications have been developed by the FAA to determine an applicant’s eligibility for airman medical certification. Standardization of examination methods and reporting is essential to provide sufficient basis for making determinations and the prompt processing of applications.

Smoking, drinking, and recreational habits of the applicant are pertinent as well as whether a program of physical fitness is being maintained. Comments on the level of physical activities, functional limitations, occupational, and avocational pursuits are essential.

A history of coronary artery bypass surgery is disqualifying for certification. Such surgery does not negate a past history of coronary heart disease. The presence of permanent cardiac pacemakers and artificial heart valves is also disqualifying for certification.

The FAA will consider an Authorization for a Special Issuance of a Medical Certificate (Authorization) for most cardiac conditions. Applicants seeking further FAA consideration should be prepared to submit all past records and a report of a complete current cardiovascular evaluation (CVE) in accordance with FAA specifications.

C. Medication

III. Aerospace Medical Disposition

The following is a table that lists the most common conditions of aeromedical significance, and course of action that should be taken by the AME as defined by the protocol and disposition in the table. Medical certificates must not be issued to an applicant with medical conditions that require deferral, or for any condition not listed in the table that may result in sudden or subtle incapacitation without consulting the AMCD or the RFS. Medical documentation must be submitted for any condition in order to support an issuance of an airman medical certificate.

• ARRHYTHMIAS
• All Classes
• (Updated 04/27/2022)

• PREMATURE ATRIAL CONTRACTION (PAC)
• All Classes
• (Updated 04/27/2022)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Asymptomatic,not requiring treatmentCurrent or history of PACs	If the AME can determine the pilot has no symptoms, required no treatment, and does not require medication:This includes PACs found incidentally on ECG.Asymptomatic PACs are considered a Normal Variant. No evaluation is required unless symptomatic or AME has concerns.	ISSUE Summarize this history in Block 60
B. SymptomaticORRequiring treatment	The pilot should submit the following for FAA review:☐ A current, detailed Clinical Progress Note generated from a clinic visit with your treating physician or cardiologist no more than 90 days before your AME exam. It should include a detailed summary of the history of the condition or diagnosis; treatments and outcomes; current medications, dosages, and side effects (if any); physical exam findings; applicable test results; assessment; plan (prognosis); and follow-up. ☐ ECG performed within the past 90 days or most recent (already performed). ☐ 24-hour cardiac ambulatory monitor (CAM) such as holter. ☐ Echocardiogram (echo). ☐ Any other testing deemed necessary by the treating physician.	DEFER Submit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings such as test abnormalities or symptoms) in Block 60.

ARRHYTHMIAS

All Classes (Continued) (Updated 10/26/2022)

• ATRIAL FIBRILLATION (AFIB)/A-FLUTTER
• All Classes
• (Updated 03/25/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Previously reported to FAA and the airman has a letter from the FAA that monitoring is not required.	The airman should bring his/her letter(s) from the FAA (for this condition) for the AME to review.If the AME’s history and exam do not reveal any evidence or concern of recurrence:	ISSUE Summarize this history in Block 60.
B. Previously warned; Now with New event or Findings:	Submit the following to the FAA for review: ☐ Non-Valvular Atrial Fibrillation (AFib)/A-Flutter Status Summary AND ☐ Detailed clinical progress notes from the treating physician(s) describing the new event or finding. PLUS: ☐ Current ≥ 24-hour cardiac monitor.	DEFERSubmit the information to the FAA for a possible Special Issuance.Follow-up Special Issuance – Will be per the Airman’s authorization letter
C. Non-Valvular AFib/A-FlutterHistory of at any time OR current:Single or multiple episodes Paroxysmal Persistent Permanent/chronic Untreated or treatedAFib treated with ablation (3-month recovery period) or cardioversion (1-month recovery period)Use this row for Atypical, symptomatic, or untreated atrial flutter	Submit the following to the FAA for review: ☐ Non-Valvular Atrial Fibrillation (AFib)/A-Flutter Status Summary AND ☐ Detailed clinical progress notes from any provider seen for this condition (PCP, cardiology, urgent care) which identify symptoms, testing performed, diagnosis and treatment. ☐ Hospital records (if applicable), including: o Admission (H&P) o Discharge summary ☐ Current ≥ 24-hour cardiac monitor ☐ Initial etiology work-up as follows: o TSH; o Sleep Study that meets current AASM or CMS Guidelines for a Type I or Type II sleep study	DEFERSubmit the information to the FAA for a possible Special Issuance.Follow-up Special Issuance – Will be per the Airman’s authorization letterSee Non-Valvular Atrial Fibrillation (AFib)/A-Flutter Status Summary
	(Type III or Type IV NOT allowed); o Cardiac echocardiogram; and o Exercise stress test ☐ If taking warfarin, submit info listed on Pharmaceutical Anticoagulants – Emboli Mitigation.
D. Treated with left atrial appendage (LAA) closure deviceex: Watchman	After a 3-month recovery period, submit the following to the FAA for review:☐ Cardiologist evaluation that describes why the procedure/device was indicated, treatment regimen throughout the process, any procedure complications, whether device is working properly, and the current status of AFib; ☐ Current CHA2DS2-VASc score; ☐ Current ≥ 24-hour cardiac monitor ☐ Initial AFib etiology work up (TSH, sleep study that meets current AASM or CMS Guidelines for a Type I or Type II sleep study [Type III or Type IV not allowed], cardiac echocardiogram, exercise stress test), if not previously submitted; ☐ Procedure report; ☐ TEE report from time of implantation, if performed (images not required in most cases); and ☐ TEE report from ≥ 45 days post procedure to evaluate for peridevice leaks (Recommended images at 0, 45, 90, and 135 degrees with 2-4 heartbeats to show appendage and occlusion device or in accordance with industry standards).	DEFERSubmit the information to the FAA for a possible Special Issuance.Follow-up Special Issuance – Will be per the Airman’s authorization letter

• NON-VALVULAR ATRIAL FIBRILLATION (AFIB)/A-FLUTTER
• STATUS SUMMARY
• (Updated 03/27/2024)

Name ______________________________ Birthdate _______________________________

Applicant ID# ___________________________ PI# ____________________________________

Instructions:

medical attention, or other concerns.)..........................................................................................

Treatment _______________________________________________________________

If other emboli mitigation strategy utilized, describe: ________________________________

medication? (Also check YES* if significant side effects.) ........................................

__________________________________________________________________________ ___________________________________________________________________________________________________________________________

Cardiologist Signature Date of evaluation

AME instructions:

INITIAL A-Fib consideration. AME must defer.

Recertification. If the pilot has a valid AASI for Atrial Fibrillation and each item on the AFib/A-Flutter Status Summary is in the left-hand column (NO “yes” answers) follow AASI instructions.

IF ANY ANSWER FALLS IN YES* COLUMN ABOVE, THE AME MUST DEFER.

• NO YES*
• NO YES*
• NOT indicated
• OR
• NO problems
• With treatment
• YES*
• Indicated but NOT being treated*
• CHA2DS2- VASc score
• Treatment
• NOT indicated
• OR treatment goals met *Indicated but NOT treated
• OR goals
• NOT met
• NO YES*
• NO YES*

• ATRIAL FLUTTER / TYPICAL ATRIAL FLUTTER
• All Classes
• (Updated 04/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.• Typical Atrial Flutter successfully treated with ablation 2 or more years ago• Asymptomatic• No Anti-arrythmia medications required or recommended	The AME should review a completed and signed Typical Atrial Flutter Treated with Ablation Status Summary from the CARDIOLOGIST.If all items fall into the “YES” column, and the AME has no concerns:	ISSUEAnnotate Block 60 and submit the evaluation to the FAA for retention in the file.
B.TYPICAL Atrial Flutter successfully treated with ablation within the previous 2 yearsORTreated with Anti-arrythmia medications	After a 90-day recovery period, Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating physician or cardiologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must include if they have been, or are currently symptomatic and the clinical interpretation of any studies performed (echo, ECG, stress test, etc.)3. Echocardiogram (Echo). Copies of a 2-D and Doppler flow study report performed no more than 90 days prior to the AME exam.4. 24-hour cardiac monitor performed at least 90 days after the procedure.≥ 24-hour cardiac monitor (such as a Holter, Zio Patch, etc.) It should have	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.
	atrial and ventricular ectopic counts; hourly tabular data to include the longest pause duration and counts of all pauses > 2.0 or 2.5 seconds; heart rate (max, min, and average); other histograms and frequency graphs; and percentage of atrial fibrillation/flutter.
C.History of:• Atypical Atrial Flutter• Any other type of flutter• Atrial Fibrillation• Symptomatic	See the Atrial Fibrillation, Row C.	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

Typical Atrial Flutter Treated with Ablation Status Summary

(Updated 01/28/2026) Name: _______________________________ Birthdate: ______________________ Applicant ID: __________________________ PI#: ___________________________

Please have your Cardiologist provide the requested information in the space provided. Submit this summary or a detailed Clinical Progress Note describing all of the information below to your AME for upload into your FAA file:

Date of Ablation ____________________

________________________________________________ __________________ Treating Cardiologist Signature Date of Evaluation

Name or Office Stamp Phone Number

AME: If ALL items fall into the clear “YES” column, the AME may issue.

If Any Single Item falls into the shaded “NO” column, the AME MUST DEFER. The AME should note what aspect caused the deferral and explain any “NO” answers. Attach the most recent detailed Clinical Progress Note(s) which addresses these items.

NOTE: This Status Summary is NOT required (clinical records may be submitted); however, it will help to streamline and significantly DECREASE FAA review time.

YES NO*

• PACEMAKER
• All Classes
• (Updated 05/29/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Pacemaker Only*Initial FAA review	After a 2-month recovery period,Submit the following to the FAA for review.☐ Items on Pacemaker Protocol ☐ Pacemaker Status SummaryNOTE: All testing must be performed AFTER the 2-month recovery period.	DEFER Submit the information to the FAA for a possible Special Issuance.1st and 2nd class airmen are reviewed by the FAS Cardiology Panel or ConsultantFollow up Issuance Will be per the airman’s authorization letter.
B. Pacemaker with Implantable Cardiac Defibrillator (ICD)*An active ICD is disqualifying for all classes. Pacemaker with ICD will be considered only with documentation from the treating cardiologist that the ICD circuit has been turned OFF (i.e., deactivated).	☐ Cardiac narrative, (current within the past 90 days) from the treating physician which describes the reason the pacemaker and ICD were implanted, a statement if the ICD is needed or not, an assessment regarding the general physical and cardiac examination to include symptoms or treatment referable to the cardiovascular system; interim and current cardiac condition; functional capacity; and medical history; ☐ Medication list ☐ Hospital records to include o Admission (history & physical), o Coronary catheterization/angiography report (if performed), o Operative report that includes the make of the generator and leads, model and serial number, o All ECG tracings, and	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the airman’s authorization letter
	o Discharge summary; ☐ A report of hemoglobin A1c and current blood lipid profile to include cholesterol, HDL, LDL, and triglycerides. Interrogation report from the ICD for the past 60 days.
C. Pacemaker Lead replacement	After a 2-month recovery period (to ensure lead stability), submit the following to the FAA for review:1. Procedure note detailing the replacement 2. Pacemaker Status Summary 3. Status report from the surgeon indicating the procedure was successful; device is functioning properly with no residual complications.Note: In accordance with CFR61.53, airmen who currently hold a medical certificate and have a lead replaced should NOT fly. Once the above information is submitted and if the FAA authorizes the Special Issuance, the airman may resume flight duties.	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the airman’s authorization letter.
D. Pacemaker Battery/Generator Replacement	After a 14-day recovery period, if the cardiologist OR AME verifies:• The pocket is healing well;• Off pain medications; and• No complications: Submit the following to the FAA for retention in the file: 1. Procedure note detailing the replacement 2. Pacemaker Status SummaryNote: In accordance with CFR61.53, pilots who currently hold a medical certificate and have not yet met the above criteria, should NOT fly.	ISSUE Annotate Block 60Submit the information to the FAA for retention in your file.

Notes:

Estimated battery longevity is required for recertification and we cannot issue without this specific piece of information. Please note that battery voltage and/or RRT, ERI, or EOL flags are not acceptable substitutes. With the Medtronic REVO pacemaker, the pacer clinic will need to call Medtronic at 1-800-505-4636 with a current scan in order to determine battery longevity. *Permanent cardiac pacemaker implantation is a specifically disqualifying condition per Code of Federal Regulations 14 CFR 67.111(a) (5), 67.211(e), and 67.311(e).

WOLFF PARKINSON WHITE (WPW) and other pre-excitation conditions

All Classes

(Updated 06/24/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. WPW PATTERN on EKG/ECG• Incidental finding on EKG/ECG• NO symptoms• Never required treatment	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating electrophysiologist or cardiologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must specifically include if the diagnosis is WPW pattern, WPW syndrome, or other.3. Echocardiogram (Echo). Report from a 2-D and Doppler flow study performed no more than 90 days prior to the AME exam.4. 24-hour cardiac monitor performed no more than 90 days prior to the AME exam.≥ 24-hour cardiac monitor (such as a Holter, Zio Patch, etc.). It should have atrial and ventricular ectopic counts; hourly tabular data to include the longest pause duration and counts of all pauses > 2.0 or 2.5 seconds; heart rate (max, min, and average); other histograms and frequency graphs; and percentage of atrial fibrillation/flutter.5. Exercise stress test (EST) performed no more than 90 days prior to the AME exam.6. Other testing. Copies of any testing deemed clinically necessary by the treating physician.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60.
B. WPW SYNDROME TREATED with radiofrequency ablation• ANY time in the pastAND• Does not need antiarrhythmic medication to sustainNote: Do NOT use the typical atrial flutter page.	After a 3-month recovery, obtain the following and submit for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating electrophysiologist or cardiologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must specifically include:• Date(s) of ablation procedure(s);• if anti-arrhythmia medications are needed; and• any continued symptoms.3. Echocardiogram (Echo). Report from a 2-D and Doppler flow study performed no more than 90 days prior to the AME exam.4. 24-hour cardiac monitor performed at least 90 days AFTER THE ABLATION and no more than 90 days prior to the AME exam.≥ 24-hour cardiac monitor (such as a Holter, Zio Patch, etc.). It should have atrial and ventricular ectopic counts; hourly tabular data to include the longest pause duration and counts of all pauses > 2.0 or 2.5 seconds; heart rate (max, min, and average); other histograms and frequency graphs; and percentage of atrial fibrillation/flutter.5. Exercise stress test (EST) performed no more than 90 days prior to the AME exam.6. Other testing. Copies of any testing deemed clinically necessary by the treating physician.7. Copies of all ablation procedure reports.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60.
C. WPW SYNDROME (had symptoms at any time)NOT ablatedORPrevious ablation but requires medication to control rate or symptoms.	Submit the following for FAA review:All information in row BThe cardiology progress note must specifically include:• date(s) of all ablation procedure(s);• are anti-arrhythmia medications needed;• any symptoms; and• cause of recurrence/failure.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60.

CORONARY HEART DISEASE

50% stenosis or higher; intervention (Stent, PTCA, CABG); Myocardial Infarction (MI)/Heart Attack; Acute Coronary Syndrome; or Coronary Artery Disease (CAD)

All Classes

(Updated 03/25/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.1st class, 2nd class, ATCS^withCHD in any single coronary artery vessel with 50% stenosis or greaterORCardiac Event• Myocardial Infarction (MI)/ heart attackEither ST Elevation MI (STEMI) or Non-ST Elevation MI (NSTEMI)ORRequired treatment such as:• Coronary Artery Bypass Graft (CABG)• Stent (Heart stent/coronary stent/PTCA, Drug Eluting Stent [DES])^ATCS see Protocol for Coronary Heart Disease	This is a Specifically Disqualifying condition.After the required recovery period:6 months for:Coronary Artery Bypass Graft (CABG)3 months for:Stent (PTCA) placed in any other coronary artery (including Left main) orMI/Heart attack or NSTEMIObtain the following evaluation(s) and submit to the FAA for review:All items on the Protocol for Coronary Heart Disease 1st or 2nd Class (See protocol for specific details.)1. A current, detailed cardiology evaluation including functional status and attempts to meet modifiable risk factors and risk.2. Lab - Lipid panel + A1c. Include INRs if using warfarin (Jantoven).3. Post-Event Radionuclide stress test (Stress RS) with SPLASH imaging on CD in DICOM format.Note: Stress ECHO or routine Exercise Stress Test (Bruce) are NOT Acceptable.4. Hospital records, including:• Discharge summary• Operative/procedure report• Cath/angiogram reports with full motion images• Admission (H&P)	DEFERSubmit the information to the FAA for a possible Special Issuance.Once all information is received, the Federal Air Surgeon's Cardiology Consultant(s) review these cases.
	5. Civil Aerospace Medical Institute (CAMI) Limited Certificate Petition6. Post-Event Cath with full motion images on CD in DICOM formatNote: For antithrombotic therapy after stenting, the applicant should be following the current ACC/AHA guidelines for dual antiplatelet therapy:• Drug-eluting stents: One (1) year• Bare metal stents: At least 30 days, preferably for one year.
B. Limited* 2nd class* Limited second-class medical certificate refers to a second-class certificate with a functional limitation such as “Not Valid for Carrying Passengers for Compensation or Hire” or "Not Valid for Pilot in Command, Valid Only When Serving as a Pilot Member of a Fully Qualified Two-Pilot Crew."	After the required recovery period,6 months for:Coronary Artery Bypass Graft (CABG) or3 months for:Stent (PTCA) placed in any other coronary artery (including Left Main) orMI/Heart attack or NSTEMIObtain the following items from the Protocol for Coronary Heart Disease 1st or 2nd Class (See protocol for specific details.)1. A current, detailed cardiology evaluation including functional status and attempts to meet modifiable risk factors and risk.2. Lab - Lipid panel + A1c. Include INRs if using warfarin (Jantoven).3. Post-Event Radionuclide stress testNote: Stress ECHO or routine Exercise Stress Test (Bruce) are NOT Acceptable.4. Hospital records including:• Discharge summary• Operative/procedure report• Cath/angiogram reports (Do not submit images on CD unless requested.)• Admission (H&P)	DEFERSubmit the information to the FAA for a possible Special Issuance.Once all information is received, the Federal Air Surgeon's Cardiology Consultant(s) review these cases.
	5. Civil Aerospace Medical Institute (CAMI) Limited Certificate PetitionNote: Post-Event Cath is NOT required for routine Limited 2nd class. Do not submit unless requested.For antithrombotic therapy after stenting, the applicant should be following the current ACC/AHA guidelines for dual antiplatelet therapy:• Drug-eluting stents: One (1) year• Bare metal stents: At least 30 days, preferably for one year
C. 3rd class	There is NO mandatory recovery period per Public Law 114-190 5/2017 but individual should be released by the treating physician.Once released by the treating physician, obtain the following evaluation(s) and submit to the FAA for review:All items on the Protocol for Coronary Heart Disease - 3rd Class (See protocol for specific details)1. A current, detailed Cardiology evaluation including functional status and attempts to meet modifiable risk factors and risk)2. Lab - Lipid panel + A1c. Include INRs if using warfarin (Jantoven).3. Post-Event Exercise Stress Test (with electrical tracings) in accordance with the Exercise Stress Test (EST) Protocol requirements4. Hospital records including:• Discharge summary• Operative/procedure report• Cath/angiogram reports (do not submit images on CD unless requested)• Admission (H&P)	DEFERSubmit the information to the FAA for a possible Special IssuanceOnce all information is received, the AAM physicians with expertise in aerospace cardiology review these cases. Some may require additional review from FAS Cardiology Consultant.
	Note: For antithrombotic therapy after stenting, the applicant should be following the current ACC/AHA guidelines for dual antiplatelet therapy:• Drug-eluting stents: One (1) year• Bare metal stents: At least 30 days, preferably for one year

CHEST PAIN

Angina; Angina Pectoris; Unstable Angina;

• Chest Discomfort (non-specific term); Palpitations
• All Classes
• (Updated 03/27/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. If the term angina orchest pain is used on reportsORThe individual lists angina or chest pain in history	Chest pain can be nonspecific and described with multiple terms.The AME should review the hospital/clinic reports to identify the CAUSE of the angina or chest pain.If cause identified, see that page (e.g., musculoskeletal pain, GERD, CAD, MI, etc.).If no cause identified, go to Row B.	See corresponding condition page
B. Cause of angina or chest pain NOT Identified or uncertain in medical records.	Submit the following for FAA review:1. Hospital records to include:• Admission history & physical (H&P)• Discharge summary from the physician (NOT the discharge instructions/paperwork given to the patient when leaving the hospital).2. Coronary catheterization/ angiography report (if performed).3. Current, detailed Clinical Progress Note(s) from any follow-up visits. It must specifically include the diagnosis and whether it was cardiac in nature or other. If cardiac, additional evaluation may be required.4. Any other testing already performed for this condition.If no cause is identified, additional information may be required.	DEFERSubmit the information to the FAA for a possible Special Issuance.Annotate (elements or findings) in Block 60.
C. Angina confirmed to be of cardiac origin (based on document review).	See page for:Coronary Heart Disease (CHD) - 50% stenosis or higher; Intervention (Stent, PTCA, CABG); Myocardial Infarction/Heart Attack; Acute Coronary Syndrome; or Coronary Artery Disease	DEFER Submit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

• HYPERTENSION (HTN)
• All Classes
• Updated 10/28/2015

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. No medication(If treating physician discontinued medications 30 days ago or longer.)	If airman meets standards:	ISSUE Summarize this history in Block 60.
B. Treated with 3 or fewer* acceptable medications.	See CACI – Hypertension WorksheetFor additional information, see Hypertension FAQs	Follow the CACI – Hypertension Worksheet. Annotate Block 60.
C. Any of the following:• Treated with 4 or more* acceptable medications;• HTN is clinically uncontrolled;• Unacceptable medications are used;• Side effects are present;• Medical status of the airman is unclear; orCertification has been specifically reserved to the FAA	Submit the following to the FAA for review: ☐ Current status report from treating physician with treatment plan, prognosis and how long the condition has been stable; ☐ Specific mention if there is a secondary cause for HTN or any evidence of a co-morbid condition (ex. diabetes or OSA), or end organ damage (ex. renal insufficiency, kidney disease, eye disease, MI, CVA heart failure, etc.); and ☐ List of medications, dates started and stopped, and any side effects.	DEFERSubmit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the airman’s authorization letter

Notes: *Number of medications counts each component. (Example: lisinopril/HCTZ is 2 medications.)

If this airman is new to you or you are not certain of their HTN control, you may request a current status report from the treating physician for your review.

If the airman did not meet standards on exam, See Item 55. Blood Pressure.

CACI - Hypertension Worksheet

(Updated 04/13/2022) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. HOWEVER, the AME is not required to review a Clinical Progress Note from the treating physician IF the AME can otherwise determine that the applicant has had stable clinical blood pressure control on the current antihypertensive medication for at least 7 days, without symptoms from the hypertension or adverse medication side-effects, and no treatment changes are recommended. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified hypertension. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified hypertension.

[ ] NOT CACI qualified hypertension. I have deferred. (Submit supporting documents.)

HYPERTENSION (HTN) - FREQUENTLY ASKED QUESTIONS (FAQs)

(Updated: 10/28/2015) We continue to see deferrals when an airman has HTN and is on medications. Please review the following FAQs before making a determination.

GENERAL:

The maximum systolic during exam is 155mmHg and the maximum diastolic is 95mmHg during the exam. (See Item 55. Blood Pressure.)

Not necessarily. If the airman’s blood pressure is elevated in clinic, you have any the following options:

No.

MEDICATION(S):

Yes, the majority of common blood pressure medications can be approved for flight. If the airman’s blood pressure is controlled with 3 or fewer medications and there are no adverse medication side effects, the AME can often issue an unrestricted medical certificate (if otherwise qualified). See Hypertension Disposition Table.

See Pharmaceuticals – Antihypertensive.

The airman must provide the required information for each condition.

• SYNCOPE
• All Classes
• (Updated 05/29/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Simple, known cause* (e.g., blood draw)ANDCompletely resolved*May be single or multiple events from known cause.	The AME should gather information regarding the diagnosis, severity, treatment, symptoms, and address ALL of the questions on the Syncope Decision Tool for the AME.If an underlying cause if found, or if from head injury or associated with drugs or alcohol, see that section.	If ALL items on the Syncope Decision Tool are in the “NO”/clear column, the AME may:ISSUESummarize this history and annotate Block 60 with “Discussed the history of SYNCOPE, no positives to screening questions, and no concerns.”If any “YES” answers, any AME concerns, or unable to verify history - go to Row B.
B. Unknown or unexplained causeORMultiple unrelated syncopal eventsIf due to a cardiac cause such as myocardial infarction or ischemia, see that page	Submit the following for FAA review:Testing must be performed within the past 90 days to be considered current.• Cardiac Evaluation;• Echocardiogram (Echo);• Exercise Stress Test (EST);• 14-day Holter (event) monitor;• Lab: o Hemoglobin A1c o Lipid panel o Complete Blood Count• EMS/ambulance run sheet (if applicable);• Emergency Department records (if applicable); and• If age 40 or older at time of event, a carotid duplex ultrasound performed within the previous one (1) year.	DEFER Submit the information to the FAA for a possible Special Issuance.
C. Unexplained syncope AFTER a cardiac evaluation has been performed (and no cardiac cause found)	Submit the following for FAA review:• Items in Row B• A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.Note: If no definitive cause for syncope (e.g., unexplained loss of consciousness), a two (2) year recovery period is required.If head injury occurred, see that page.	DEFERSubmit the information to the FAA.

SYNCOPE DECISION TOOL FOR THE AME

(Updated 03/25/2026) The AME should elicit what likely caused the syncopal episode(s). If the individual has recently been exposed to these event(s) (e.g., blood draw, dehydration, etc.), do they continue to react? The AME should also take into consideration the likelihood of the likely cause being encountered when flying or in everyday life.

If the AME is unsure of any of the above criteria, the diagnosis, or severity - DEFER and describe in Item 60

AME Instructions: Address each the following items in your in-office exam and history review:

(Common causes of syncope include viral illness, GI, prolonged standing, dehydration, or blood draw.)

*If ALL items fall into the clear/NO column, the AME may issue with notes in Item 60 which show you discussed the history of syncope, found no positives to the screening questions, AND had no concerns.

If ANY SINGLE ITEM falls into the SHADED/YES COLUMN, the AME MUST DEFER. The AME report should note what aspect caused the deferral and explain any YES answers from the shaded column.

This decision tool is for AME use; it does not have to be submitted to the FAA.

HEART MURMUR

All Classes

(Updated 06/24/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Systolic Grade 1/6 or 2/6ORflow, functional, innocent, or physiological	If the AME can determine the murmur is not pathologic and the individual has no symptoms that would interfere with flight duties:	ISSUESummarize this history in Block 60.
B. Systolic grade 3 or higherORany diastolic murmurORsymptomatic (chest pain, shortness of breath, etc.)	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating cardiologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must specifically include clinical correlation with echocardiogram findings.3. Echocardiogram (Echo). Report from a 2-D and Doppler flow study performed no more than 90 days prior to the AME exam.	DEFERSubmit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the airman’s authorization letter

• VALVULAR DISEASE
• All Classes
• (Updated 01/28/2026)

*For Mitral Valve Disease [Mitral Regurgitation, Mitral Insufficiency, Mitral Valve Prolapse (MVP)] see following pages.

ENDOCARDITIS

All Classes

(Updated 06/24/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Current or historical diagnosisIf resulting in cardiac valve repair or valve replacement, see that page.	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with an infectious disease specialist or cardiologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. Echocardiogram (Echo). Copies of a 2-D and Doppler flow study report performed no more than 90 days prior to the AME exam.3. Other testing: Any deemed clinically necessary and already performed by the treating physician.4. Hospital records: History and Physical (H&P), operative notes, and discharge summary (if applicable).	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

MITRAL VALVE DISEASE

Mitral Regurgitation, Mitral Insufficiency, Mitral Valve Prolapse (MVP)

All Classes

(Updated 01/28/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.MILD or TRACE(based on ECHO results)• Mitral Valve regurgitation;or• Mitral Valve insufficiency;or• Mitral Valve Prolapse (MVP);ANDAsymptomatic	The AME should review:1. Echocardiogram (Echo). Copies of the most recent 2-D and Doppler flow study report.ORA clinical problem list or progress note which lists the echo findings as mild.If the AME can determine the condition is Asymptomatic and the valve disease is MILD:	ISSUEAnnotate this information in Block 60.
B. MODERATE(based on ECHO results)• Mitral Valve regurgitation;or• Mitral Valve insufficiency;or• Mitral Valve Prolapse (MVP);ANDAsymptomaticNote: For Asymptomatic individuals, if the ECHO report reads mild to moderate, use row B (Moderate). If it reads moderate to severe, use row C (Severe).	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating physician or cardiologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must include if they have been, or are currently symptomatic and the clinical interpretation of any studies performed (echo, ECG, stress test, etc.)3. Echocardiogram (Echo). Copies of a 2-D and Doppler flow study report performed no more than 90 days prior to the AME exam.	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.
	4. 24-hour cardiac monitor performed no more than 90 days prior to the AME exam.≥ 24-hour cardiac monitor (such as a Holter, Zio Patch, etc.). It should have atrial and ventricular ectopic counts; hourly tabular data to include the longest pause duration and counts of all pauses > 2.0 or 2.5 seconds; heart rate (max, min, and average); other histograms and frequency graphs; and percentage of atrial fibrillation/flutter.
C. SEVERE(based on ECHO results)• Mitral valve regurgitation;or• Mitral valve insufficiency;or• Mitral Valve Prolapse (MVP);ORSymptomatic(any severity) (e.g. Chest pain, palpitations, fatigue, shortness of breath, dizziness or pre-syncopal episodes)Note: For Asymptomatic individuals, if the ECHO report reads mild to moderate, use row B (Moderate). If it reads moderate to severe, use row C (Severe).	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating physician or cardiologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must include if they have been, or are currently symptomatic and the clinical interpretation of any studies performed (echo, ECG, stress test, etc.)3. Echocardiogram (Echo). Copies of a 2-D and Doppler flow study report performed no more than 12 months prior to the AME examIf valve surgery has been performed, see:• Mitral Valve Repair Disposition Table or• Protocol for Cardiac Valve Replacement	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

• MITRAL VALVE REPAIR
• All Classes
• Updated 05/29/2024

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. 5 or more years ago and no co-morbid conditions*	See CACI – Mitral Valve Repair Worksheet.Note to pilot: Take the CACI worksheet to your cardiologist so they can fully address the FAA requirements.	Follow the CACI – Mitral Valve Repair WorksheetAnnotate Block 60.
B. Less than 5 years agoORAny of the co-morbid conditions below*	After a 3 month recovery period submit the following to the FAA for review:☐ Hospital admission history and physical; ☐ Operative report/surgical report; ☐ Hospital discharge summary; ☐ Current status report from the treating cardiologist which should describe the type of repair, any complications, current treatment needed, and follow up plan; ☐ List of medications and side effects, if any; ☐ Cardiac testing performed AFTER the 3 month recovery period and within the last 90 days: o 24-hour Holter; o Electrocardiogram (ECG); o Echo; and☐ Other imaging reports (if any) for studies performed by the treating cardiologist (e.g., Cath, CTA, or MRA).	DEFER Submit the information to the FAA for reviewFollow up Issuance Will be per the airman’s authorization Letter

Notes:

*Co-morbid conditions for FAA purposes include:

CACI – Mitral Valve Repair Worksheet

(Updated 03/27/2024) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.

• AME MUST REVIEW ACCEPTABLE
• CERTIFICATION
• CRITERIA

The airman had Mitral Valve Repair surgery 5 or more years ago for primary mitral valve disease (not secondary MR or functional MR due to coronary heart disease, MI, ischemic disease, or cardiomyopathy).

[ ] Yes The treating cardiologist’s current, detailed Clinical Progress Note verifies:

[ ] Yes

The airman has NO history of:

HTN; or

The most recent echo was performed within the last 24 months shows:

o Dilated aorta greater than 4 cm;

o Hypertrophic cardiomyopathy or other cardiomyopathy;

o Left Atrial Enlargement;

o Aortic regurgitation/insufficiency (any severity);

o Regurgitation of any valve moderate or higher; or o Structural abnormalities (dilated ventricle, atria, etc.)

[ ] Yes

Notes:

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Mitral Valve Repair.

[ ] Has current OR previous SI/AASI but now CACI qualified Mitral Valve Repair.

[ ] NOT CACI qualified Mitral Valve Repair. I have deferred. (Submit supporting documents.)

CONGENITAL HEART CONDITIONS

Atrial Septal Defect (ASD); Coarctation of the Aorta; Patent Foramen Ovale (PFO); Pulmonary Atresia; Tetralogy of Fallot; Tricuspid Atresia; Ventricular Septal Defect (VSD), and others

All Classes

(Updated 06/24/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Patent Foramen Ovale (PFO) which is:• Not surgically corrected,• Uncomplicated,• Asymptomatic.This may be identified as a finding on an imaging study such as echo.	If the AME can determine the individual has no symptoms or current problems that would interfere with flight duties and no treatment is recommended:	ISSUEDiscuss the history and if any current symptoms in Item 60If any concerns, go to row B.
B. Atrial Septal Defect (ASD)--simple surgical closureORPatent Foramen Ovale (PFO) -- surgically closedAnd now Asymptomatic	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating cardiologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. Echocardiogram (Echo). Report from a 2-D and Doppler flow study performed no more than 90 days prior to the AME exam.3. 24-hour cardiac monitor performed no more than 90 days prior to the AME exam.≥ 24-hour cardiac monitor (such as a Holter, Zio Patch, etc.). It should have atrial and ventricular ectopic counts; hourly tabular data to include the longest pause duration and counts of all pauses > 2.0 or 2.5 seconds; heart rate (max, min, and average); other histograms and frequency graphs; and percentage of atrial fibrillation/flutter.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60.
	4. Operative report if surgery was performed in the previous 5 years.
C.• Atrioventricular Septal Defect (ASD)• Coarctation of the Aorta*• Double-outlet Right Ventricle• d-Transposition of the Great Arteries• Ebstein Anomaly• Hypoplastic Left Heart Syndrome• Interrupted Aortic Arch•Patent Ductus Arteriosus (PDA)• Pulmonary Atresia• Single Ventricle• Tetralogy of Fallot• Total Anomalous Pulmonary Venous Return• Tricuspid Atresia• Truncus Arteriosus• Ventricular Septal Defect (VSD)ORAny other congenital heart/cardiac condition	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating cardiologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.If surgery was remote, and they are no longer seeing their cardiologist, the progress note can be from a board-certified cardiologist.2. Echocardiogram (Echo). Report and images from a 2-D and Doppler flow study performed no more than 90 days prior to the AME exam.3. 24-hour cardiac monitor performed no more than 90 days prior to the AME exam.≥ 24-hour cardiac monitor (such as a Holter, Zio Patch, etc.). It should have atrial and ventricular ectopic counts; hourly tabular data to include the longest pause duration and counts of all pauses > 2.0 or 2.5 seconds; heart rate (max, min, and average); other histograms and frequency graphs; and percentage of atrial fibrillation/flutter.4. Exercise stress test (EST) performed no more than 90 days prior to the AME exam.5. Operative report(s) from all cardiac/heart surgery performed. (if applicable)6. Copies of any advanced imaging [e.g., Chest Computed Tomography (CT) or Magnetic Resonance Imaging (MRI)] already performed. Include both Report AND actual images.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60.
	7. * Coarctation of the Aorta, must also include a Brain MRA performed no more than 90 days prior to the AME exam.Note: Once these records are reviewed, additional testing or information may be required.

FIBROMUSCULAR DYSPLASIA

All Classes

(Updated 06/24/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Any history	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit from the physician (who made the diagnosis or follows clinically) no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. Imaging (MRA or CTA) of major vascular systems performed within the previous two (2) years. Submit reports for images of:• Brain;• Head and neck;• Coronary arteries (CTA); and• Abdomen and pelvis to include iliac arteries.3. Other testing: Copies of any other testing already performed by the treating physician.	DEFERSubmit the information to the FAA for a possible Special Issuance.Annotate (elements or findings) in Block 60.

HEART TRANSPLANT (cardiac transplant, heart replacement)

All Classes

(Updated 06/24/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. 1st or 2nd class and ATCS	Submit the following for FAA review:The most recent detailed Clinical Progress Note generated from a clinic visit with their cardiologist or cardiac surgeon which verifies the transplant has been performed.	DEFERSubmit the information to the FAA verifying the procedure and reason it was performed.
B. 3rd class only	There is NO mandatory recovery period per Public Law 114-190 May 2017, but should be released by the treating physician.After the treating cardiologist and/or transplant surgeon has determined that the condition is stable, obtain the following evaluation(s) and submit them to the FAA for review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating cardiologist or transplant surgeon no more than 90 days prior to the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must specifically include:• A statement regarding functional capacity, modifiable cardiovascular risk factors, and prognosis for incapacitation;• Any evidence of rejection and complete documentation of all rejection history, whether treated or not;• A complete history regarding any infectious process;• A complete history regarding any malignancy; and• Comment on the donor heart status, including any evidence of allograft vasculopathy or any disease state.	DEFERSubmit the information to the FAA for a possible Special Issuance.Once all information is received, these cases are reviewed by a FAS Cardiothoracic Surgery consultant.
	3. Labs performed no more than 90 days prior to the AME exam:• Hemoglobin A1C and• Lipid profile to include total cholesterol, HDL, LDL, and triglycerides.4. Hospital records to include:• Operative report;• Discharge summary from the physician (NOT the discharge instructions/paperwork given to the patient when leaving the hospital);• Admission (history & physical);• Pathology report (if performed); and• DO NOT submit miscellaneous hospital records such as flowsheets, nursing notes, physician orders, and medication administration records.5. Coronary Angiogram [cardiac cath] performed no more than 12 months before the AME exam:• Must submit both of the report(s); and• Actual imaging on CD in DICOM format.6. 24-hour cardiac monitor performed no more than 90 days prior to the AME exam:≥ 24-hour cardiac monitor (such as a Holter, Zio Patch, etc.). It should include atrial and ventricular ectopic counts; hourly tabular data to include the longest pause duration and counts of all pauses 2.5 seconds or greater; heart rate (max, min, and average); other histograms and frequency graphs; and the percentage of atrial fibrillation/flutter.7. Stress Echo. Graded Exercise Stress ECHO (with electrical tracings) no more than 90 days prior to the AME exam in accordance with the enclosed specification sheet.8. Any other testing already completed or deemed necessary by the treating physician (e.g., myocardial biopsy)

Hypertrophic Cardiomyopathy (HCM), Hypertrophic Obstructive Cardiomyopathy (HOCM), or Idiopathic Hypertrophic Subaortic Stenosis (IHSS)

All Classes

(Updated 07/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.Any history or suspected history(all classes)	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating cardiologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.It MUST include a. Complete history detailing any family history of unexplained sudden cardiac death, and b. Any personal history of non-sustained Ventricular Tachycardia, or unexplained syncope.Hypertrophic Cardiomyopathy 5-Year SCD Score: Documentation of a 5-year sudden cardiac death risk score (compiled using the most recent version of the American Heart Association (AHA) risk calculator).2. Echocardiogram (Echo) performed WITH Valsalva maneuver. Report and digital images from a 2-D and Doppler flow study performed no more than 90 days prior to the AME exam. Must include complete measurements and specific attention to maximal LV wall thickness, left atrial size, and maximal LV outflow tract gradient (rest vs. Valsalva).Submit the video resulting from this study on CD-ROM in DICOM compatible format.3. Cardiac monitor. 72 hours minimum performed no more than 90 days prior to the AME exam. Note: Some cases may require a 30-day monitor.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60.
	The report must include the data summary and representative EKG tracings.4. Maximal Exercise stress test (EST) performed no more than 90 days prior to the AME exam.Submit the report with worksheet and representative EKG tracings (to exclude CAD).STRESS TEST REQUIREMENTS• Protocol: 3-minute Bruce treadmill test. Must complete Stage 3 (>= 9 minutes) and reach 100% predicted maximal heart rate unless medically contraindicated or prevented by symptoms or medication.• Medication: Stop beta-blockers, calcium blockers (Diltiazem/Verapamil), and digoxin for 48 hours before the test. If it is unsafe to stop, attach a doctor's note describing the contraindication.• Treadmill Not Possible: Provide a doctor's note to explain why and perform either bicycle ergometry (Must reach 100% max Heart Rate and greater than METS) or a Nuclear Stress Test (pharmacological stress radionuclide myocardial perfusion scintigraphy).• ECG Printouts Required: Full 12-lead taken at rest (supine and standing). 12 lead tracings + rhythm strips during each stage, at the end of each stage, at peak, and every minute during recovery for at least 5-minutes or until the tracings return to baseline level. Computer generated, sample-cycle ECG tracings or summary sheets are not acceptable.• Submit original printouts only (by mail or electronic upload). Faxes or photocopies are not accepted.5. EKG (resting) performed no more than 90 days prior to the AME exam.6. Cardiac MRI performed no more than 12 months prior to the AME exam. Include report and actual digital images.7. Historical Medical Records
	• Past Cardiac Care: Submit all prior heart evaluation and treatment records. Include records for any procedures (e.g., myomectomy, alcohol ablation, chordal realignment).• Operative Reports: Submit official operative reports for all past heart surgeries. (If applicable)• Advanced Imaging & Tests: Submit all prior test results and advanced imaging (e.g., Chest CT, MRI). Provide both the written reports AND the actual image files.Note: once these records are reviewed, additional testing or information may be required.

Other Cardiac Conditions

(Updated 06/24/2026) Note: Some conditions previously on this list have been moved to a disposition table.

The following conditions must be deferred:

For all classes, certification decisions will be based on the applicant's medical history and current clinical findings. Evidence of extensive multi-vessel disease, impaired cardiac functioning, precarious coronary circulation, etc., will preclude certification. Before an applicant undergoes coronary angiography, it is recommended that all records and the report of a current cardiovascular evaluation (CVE), including a maximal electrocardiographic exercise stress test, be submitted to the FAA for preliminary review. Based upon this information, it may be possible to advise an applicant of the likelihood of favorable consideration.