Heart murmur
What the FAA's documents say about heart murmur, in plain words, with the FAA's own words one press away.
Covers: All classes
Short version
The disposition table has two rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row ASystolic 1/6 or 2/6, or flow, functional, innocent, physiological | Examiner issues | Examiner can issue |
| Row BSystolic grade 3 or higher, any diastolic murmur, or symptomatic | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Heart murmur
- Row A · Examiner can issue
A systolic murmur of grade 1/6 or 2/6, or a flow, functional, innocent, or physiological murmur. If the examiner can determine the murmur is not pathologic and the individual has no symptoms that would interfere with flight duties, the table says ISSUE, and the examiner summarizes this history in Block 60.
A. Systolic Grade 1/6 or 2/6 OR flow, 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: ISSUE Summarize this history in Block 60.
- Row B · Special Issuance
A systolic murmur of grade 3 or higher, or any diastolic murmur, or a symptomatic murmur (chest pain, shortness of breath, etc.). The table lists what to submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
B. Systolic grade 3 or higher OR any diastolic murmur OR symptomatic (chest pain, shortness of breath, etc.) Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance.
The FAA pathways for heart murmur
Which exam
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: What the table says the examiner looks at
For Row A, what the examiner determines at the exam.For Row A, your AME determines whether the murmur is not pathologic and you have no symptoms that would interfere with flight duties.
At the exam
- The murmur is not pathologic
- No symptoms that would interfere with flight duties
- Your AME summarizes this history in Block 60
Show the FAA's words: What the table says the examiner looks at
If the AME can determine the murmur is not pathologic and the individual has no symptoms that would interfere with flight duties: ISSUE
FAA source: Heart Murmur Disposition Table. FAA date 24 June 2026; checked by Crosscheck 14 October 2026.
ISSUE Summarize this history in Block 60.
FAA source: Heart Murmur Disposition Table. FAA date 24 June 2026; checked by Crosscheck 14 October 2026.
Step 2: See your AME
If the examiner can determine the murmur is not pathologic and the individual has no symptoms that would interfere with flight duties, the table says ISSUE, and the examiner summarizes this history in Block 60.Exam day- If the examiner can determine the murmur is not pathologic and the individual has no symptoms that would interfere with flight duties, the table says ISSUE, and the examiner summarizes this history in Block 60.
Show the FAA's words: See your AME
A. Systolic Grade 1/6 or 2/6 OR flow, 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: ISSUE Summarize this history in Block 60.
FAA source: Heart Murmur Disposition Table. FAA date 24 June 2026; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
If the examiner can determine the murmur is not pathologic and the individual has no symptoms that would interfere with flight duties, the table says ISSUE, and the examiner summarizes this history in Block 60.
Row BDefers to the FAASpecial Issuance
The table lists what to submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
A systolic murmur of grade 1/6 or 2/6, or a flow, functional, innocent, or physiological murmur. If the examiner can determine the murmur is not pathologic and the individual has no symptoms that would interfere with flight duties, the table says ISSUE, and the examiner summarizes this history in Block 60.
A. Systolic Grade 1/6 or 2/6 OR flow, 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: ISSUE Summarize this history in Block 60.
- Row B · Special Issuance
A systolic murmur of grade 3 or higher, or any diastolic murmur, or a symptomatic murmur (chest pain, shortness of breath, etc.). The table lists what to submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
B. Systolic grade 3 or higher OR any diastolic murmur OR symptomatic (chest pain, shortness of breath, etc.) Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance.
If the examiner defersSpecial Issuance
The table marks Row B, systolic grade 3 or higher, any diastolic murmur, or symptomatic, DEFER.
What the FAA lists to send
- Item 1. A current, detailed clinical progress note from a clinic visit with the treating cardiologist no more than 90 days before the exam.
- Item 2. An item the physician specifically addresses: clinical correlation with echocardiogram findings. The FAA's progress-note sheet says that when a letter uses the words "it must specifically include", they highlight specific items (that may or may not be part of a standard current, detailed Clinical Progress Note) for the physician to address.
- Item 3. An echocardiogram report from a 2-D and Doppler flow study performed no more than 90 days prior to the exam.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table marks Row B, systolic grade 3 or higher, any diastolic murmur, or symptomatic, DEFER.
B. Systolic grade 3 or higher OR any diastolic murmur OR symptomatic (chest pain, shortness of breath, etc.) … DEFER Submit the information to the FAA for a possible Special Issuance.
What the FAA lists to send
- Item 1
A current, detailed clinical progress note from a clinic visit with the treating cardiologist no more than 90 days before the exam.
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.
- Item 2
An item the physician specifically addresses: clinical correlation with echocardiogram findings. The FAA's progress-note sheet says that when a letter uses the words "it must specifically include", they highlight specific items (that may or may not be part of a standard current, detailed Clinical Progress Note) for the physician to address.
2. It must specifically include clinical correlation with echocardiogram findings.
“IT MUST SPECIFICALLY INCLUDE” If this language is in your letter, it is to highlight SPECIFIC items (that may or may not be part of a standard current, detailed Clinical Progress Note). Make sure your physician addresses these specific items important for medical certification or clearance.
- Item 3
An echocardiogram report from a 2-D and Doppler flow study performed no more than 90 days prior to the exam.
3. Echocardiogram (Echo): Report from a 2-D and Doppler flow study performed no more than 90 days prior to the AME exam.
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later examsSpecial Issuance
The disposition table is headed All Classes.
Show the FAA's words: how often the FAA asks again
HEART MURMUR All Classes
Under an FAA Authorization, the table says follow-up issuance will be per the pilot's own authorization letter.
Show the FAA's words: at later exams
Follow up Issuance Will be per the airman’s authorization letter.
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workFollow-up issuance per the authorization letter
For Row B the table says follow-up issuance will be per the airman's authorization letter.
Show the FAA's words: Follow-up issuance per the authorization letter
Follow up Issuance Will be per the airman’s authorization letter.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
Any diastolic murmur is Row B
Row B is a systolic murmur of grade 3 or higher, or any diastolic murmur, or a symptomatic murmur, and it is marked DEFER.
Show the FAA's words: good to know, 2
B. Systolic grade 3 or higher OR any diastolic murmur OR symptomatic (chest pain, shortness of breath, etc.) … DEFER Submit the information to the FAA for a possible Special Issuance.
Clinical correlation with the echocardiogram
For Row B the table's second item says it must specifically include clinical correlation with echocardiogram findings, and the echocardiogram report is from a 2-D and Doppler flow study performed no more than 90 days prior to the exam. The FAA's progress-note sheet says that when a letter uses the words "it must specifically include", they highlight specific items (that may or may not be part of a standard current, detailed Clinical Progress Note) for the physician to address.
Show the FAA's words: good to know, 3
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.
“IT MUST SPECIFICALLY INCLUDE” If this language is in your letter, it is to highlight SPECIFIC items (that may or may not be part of a standard current, detailed Clinical Progress Note). Make sure your physician addresses these specific items important for medical certification or clearance.
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.