Coronary heart disease

Your step-by-step plan

1. 1

   Step 1: The recovery period

   The time after the event before the post-event tests.

   After the required recovery period, the items are obtained and submitted to the FAA.

   Recovery period for pilots

   • 6 monthsAfter a bypass (CABG)
   • 3 monthsAfter a heart attack (MI)
   • 3 monthsAfter a stent in any coronary artery, including the left main

   Post-event testing should not be done until after the recovery period.

   Show the FAA's words: The recovery period

   Recovery period: Condition Pilots (1 st or 2 nd class) ATCS (contract and employee) Coronary Artery Bypass Graft (CABG) 6 months 3 months Myocardial infarction (MI)/Heart attack 3 months 3 months Stent placed in any coronary artery including LEFT MAIN 3 months 3 months

   After the required recovery period, obtain the following and submit to the FAA. Post-event testing should NOT be obtained until AFTER the recovery period. The AME is required to DEFER.

   FAA source: Coronary Heart Disease Protocol – 1st and 2nd Class. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.

2. 2

   Step 2: Hospital records

   Copies of the records of the hospital stay or procedure.

   Copies of your hospital records.

   Including

   • Admission history and physical (H&P)
   • Operative report, if a procedure was performed (CABG, stent or other)
   • Discharge summary from the physician, not the discharge papers given to you
   • Heart cath or ischemia work-up, if performed: the images on CD and the printed report

   Show the FAA's words: Hospital records

   Hospital records. Submit copies of: • Admission history & physical (H&P); • Operative report, if applicable (CABG, stent, or other procedure performed); • Discharge summary from the physician (NOT the discharge instructions/paperwork given to the patient when leaving the hospital); and • Coronary catheterization (heart cath) or ischemia work up (if performed). Submit both the images on CD AND the printed report.

   FAA source: Coronary Heart Disease Protocol – 1st and 2nd Class. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.

   Cath/angiogram reports (Do not submit images on CD unless requested.)

   …Note: Post-Event Cath is NOT required for routine Limited 2 nd class. Do not submit unless requested.

   FAA source: Coronary Heart Disease Disposition Table. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.

   Hospital records. Submit copies of: • Admission history & physical (H&P); • Operative report, if applicable (CABG, stent, or other procedure performed); • Discharge summary from the physician (NOT the discharge instructions/paperwork given to the patient when leaving the hospital). Typically, the patient portal notes or after visit summary (AVS) that can be printed from the electronic medical record are NOT sufficient for pilot medical certification purposes.); and • Coronary catheterization (heart cath) or ischemia work up (if performed), submit both the images on CD AND the printed report.

   …Note: Do not submit imaging on CD unless requested by the FAA.

   FAA source: Coronary Heart Disease Protocol – 3rd Class. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.

   Cath/angiogram reports (do not submit images on CD unless requested)

   FAA source: Coronary Heart Disease Disposition Table. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.

3. 3

   Step 3: The cardiology narrative

   A current evaluation by your cardiologist, as a detailed progress note.

   A current evaluation by your cardiologist, in the form of a detailed progress note.

   It includes

   • History of any cardiac or co-morbid conditions
   • Personal and family history, including premature heart disease
   • Current medications, dosage and any side effects
   • Cardiac and general physical exam findings
   • Results of any testing
   • Diagnosis
   • Assessment and plan
   • Prognosis and follow-up

   And specifically

   • The events that led to any hospital stay, procedure or treatment
   • Your functional capacity, and whether you have returned to your regular activity
   • Attempts to meet the guidelines for modifiable risk factors, such as lipid levels, aspirin, beta-blockers and stopping smoking
   • The prognosis for incapacitation

   Show the FAA's words: The cardiology narrative

   Cardiology narrative. A current evaluation by the cardiologist in the form of a detailed Clinical Progress Note which must include: • A detailed summary of the history of any cardiac or co-morbid condition(s); • Personal and family medical history including premature heart disease; • Current medications, dosage, and side effects (if any); • Clinical cardiac and general physical exam findings; • Results of any testing performed; • Diagnosis; • Assessment and plan; • Prognosis and Follow-up. It must specifically include: • If hospitalization or procedure, include a summary of events that led to the cardiac intervention(s) or treatment; • A statement regarding the individual’s functional capacity and if they have been returned to their regular activity; • Attempts to meet the guidelines for modifiable risk factors (such as lipid levels, aspirin use, beta-blocker use, and smoking cessation per the American College of Cardiology and American Heart Association); and • Prognosis for incapacitation.

   FAA source: Coronary Heart Disease Protocol – 1st and 2nd Class. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.

   Cardiology narrative. A current evaluation by your cardiologist in the form of a detailed Clinical Progress Note which must include:

   …It must specifically include: • If hospitalization or procedure, include a summary of events that lead to the cardiac intervention(s) or treatment; • A statement regarding the individual’s functional capacity and if they have been returned to their regular activity;

   …• Attempts to meet the guidelines for modifiable risk factors (such as lipid levels, aspirin use, beta-blocker use, and smoking cessation per the American College of Cardiology and American Heart Association); and • Prognosis for incapacitation.

   FAA source: Coronary Heart Disease Protocol – 3rd Class. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.

4. 4

   Step 4: Labs and heart tests

   Labs from the last 90 days, and the post-event tests for your class.Three things to bring

   • Labs

     Within 90 days before the exam

     Labs performed no more than 90 days before the exam.

     The labs

     • Hemoglobin A1c
     • Lipid profile: total cholesterol, HDL, LDL and triglycerides
     • Monthly INR readings, if you are on warfarin (Jantoven)

   • Radionuclide stress test

     A post-event radionuclide stress test (stress RS) with imaging, performed after the event.

     Submit

     • The report
     • The images on CD, in DICOM format
     • The electrical tracings

     Not accepted

     • Not: A stress echo or a routine exercise stress test (Bruce) in its place
     • Not: Xeroxed or faxed images

   • Post-event heart catheterization

     A post-event heart cath (cardiac angiography) with imaging: the report and the actual images on CD.

     For a new applicant, performed within the last five years.

   Show the FAA's words: Labs and heart tests

   Labs performed no more than 90 days before AME exam • Hemoglobin A1c; • Lipid profile to include total cholesterol, HDL, LDL, and triglycerides; and • INR monthly readings if on warfarin (Jantoven)

   FAA source: Coronary Heart Disease Protocol – 1st and 2nd Class. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.

   Labs performed no more than 90 days before AME exam • Hemoglobin A1c; • Lipid profile to include total cholesterol, HDL, LDL, and triglycerides; and • INR monthly readings if on warfarin (Jantoven)

   FAA source: Coronary Heart Disease Protocol – 3rd Class. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.

   Post-Event Radionuclide stress test (Stress RS) with imaging performed AFTER the event. Submit the report, images on CD in DICOM format (e.g., the “Rest/Stress multi-slice three-axis splash images”), and electrical tracings. Note: A Stress echo cannot take the place of the stress RS for 1st or 2 nd class (full or limited). Due to poor image quality, Xeroxed or faxed images will not be accepted.

   FAA source: Coronary Heart Disease Protocol – 1st and 2nd Class. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.

   Note: Stress ECHO or routine Exercise Stress Test (Bruce) are NOT Acceptable.

   FAA source: Coronary Heart Disease Disposition Table. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.

   Post-Event Heart Catheterization (Heart cath/cardiac angiography) with imaging. Submit both the report AND actual images on CD. • Required for 1st class and for full 2nd class • Not required for Limited Second Class or ATCS • For new applicants, the post-event cath must have been performed within the last five (5) years.

   FAA source: Coronary Heart Disease Protocol – 1st and 2nd Class. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.

   Exercise Stress Test (EST) with electrical tracings performed AFTER the event and within 90 days of the AME exam which meets the Exercise Stress Test (EST) Protocol Requirements. If a radionuclide stress (RS) or cardiac catheterization (cardiac angiogram) were performed, submit those reports.

   Note: Do not submit imaging on CD unless requested by the FAA.

   FAA source: Coronary Heart Disease Protocol – 3rd Class. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.

5. 5

   Step 5: Sending it to the FAA

   The petition for first and second class, and how the package goes.

   The Civil Aerospace Medical Institute (CAMI) Limited Certificate Petition, which tells the FAA whether you will accept a lower-class certificate.

   It is submitted whatever your answer.

   Show the FAA's words: Sending it to the FAA

   Civil Aerospace Medical Institute (CAMI) Limited Certificate Petition. (Informs FAA if you will accept a lower-class medical certificate). It should be submitted regardless of the answer chosen.

   FAA source: Coronary Heart Disease Protocol – 1st and 2nd Class. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.

   It is the responsibility of each pilot/ATCS to provide the medical information required to determine his/her eligibility for airman medical certification.

   To aid in the review process, it is critical that the individual’s full name and date of birth appear on all correspondence and reports. The AME may upload the reports electronically; however, the CD containing images must be mailed.

   Alternatively, the AME may mail all items together in one package—do not send items in separate shipments.

   …NOTE: No consideration will be given for special issuance/special consideration until ALL the required data has been received.

   FAA source: Coronary Heart Disease Protocol – 1st and 2nd Class. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.

   It is the responsibility of each applicant to provide the medical information required to determine his/her eligibility for airman medical certification.

   To aid in the review process, it is critical that the applicant’s full name and date of birth appear all correspondence and reports. Bring all information to your AME to upload into your FAA record.

   Note: If Images (CDs) are required, all items should be mailed to one of the following:

   …No consideration will be given for special issuance until ALL the required data has been received.

   FAA source: Coronary Heart Disease Protocol – 3rd Class. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.

6. 6

   Step 6: See your AME

   The table calls it a specifically disqualifying condition. After the required recovery period, all the items on the first- and second-class protocol are obtained and submitted to the FAA for review. The examiner defers for a possible Special Issuance, and the Federal Air Surgeon's Cardiology Consultants review these cases once all the information is received.Exam day

   • The table calls it a specifically disqualifying condition. After the required recovery period, all the items on the first- and second-class protocol are obtained and submitted to the FAA for review. The examiner defers for a possible Special Issuance, and the Federal Air Surgeon's Cardiology Consultants review these cases once all the information is received.

   Show the FAA's words: See your AME

   1 st class, 2 nd class, ATCS^ with CHD in any single coronary artery vessel with 50% stenosis or greater OR Cardiac Event • Myocardial Infarction (MI)/ heart attack Either ST Elevation MI (STEMI) or Non-ST Elevation MI (NSTEMI) OR Required treatment such as: • Coronary Artery Bypass Graft (CABG) • Stent (Heart stent/coronary stent/PTCA, Drug Eluting Stent [DES])

   …This is a Specifically Disqualifying condition. After the required recovery period:

   …Obtain the following evaluation(s) and submit to the FAA for review: All items on the Protocol for Coronary Heart Disease 1 st or 2 nd Class (See protocol for specific details.)

   …DEFER Submit 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.

   FAA source: Coronary Heart Disease Disposition Table. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.

7. 7

   Step 7: After the FAA decides

   The AASI says FAA physicians provide the initial certification decision and grant the Authorization; after that, examiners may reissue when the applicant provides what the AASI lists.

   • The AASI says FAA physicians provide the initial certification decision and grant the Authorization; after that, examiners may reissue when the applicant provides what the AASI lists.

   Show the FAA's words: After the FAA decides

   The FAA physicians provide the initial certification decision and grant the Authorization for Special Issuance of a Medical Certificate (Authorization) in accordance with 14 CFR § 67.401.

   …AMEs may reissue an airman medical certificate if the applicant provides the following:

   FAA source: AASI – Coronary Heart Disease (CHD), third class. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.