Hypertrophic cardiomyopathy (HCM)
What the FAA's documents say about hypertrophic cardiomyopathy (HCM), in plain words, with the FAA's own words one press away.
FAA term: Hypertrophic Cardiomyopathy (HCM), Hypertrophic Obstructive Cardiomyopathy (HOCM), or Idiopathic Hypertrophic Subaortic Stenosis (IHSS)Covers: All classes
Show the FAA's words: which classes the FAA's table covers
Stenosis (IHSS) All Classes … A. Any history or suspected history (all classes)
Short version
The disposition table has one row, any history or suspected history, for all classes.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AAny history or suspected history | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Hypertrophic cardiomyopathy (HCM)
- Row A · Special Issuance
Any history or suspected history, for all classes. The table lists what to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and summarizes the findings in Item 60.
A. Any history or suspected history (all classes) Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance. Summarize findings in Item 60.
The FAA pathways for hypertrophic cardiomyopathy (HCM)
Your step-by-step plan
Step 1: The progress note and the risk score
From your treating cardiologist, with the 5-year risk score.Progress note
Within 90 days before the examA current, detailed progress note from a clinic visit with your treating cardiologist, no more than 90 days before the 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)
- Follow-up
It MUST include
- A complete history detailing any family history of unexplained sudden cardiac death
- Any personal history of non-sustained ventricular tachycardia, or unexplained syncope
5-year sudden cardiac death risk 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.
Show the FAA's words: The progress note and the risk score
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.
FAA source: Hypertrophic Cardiomyopathy (HCM). FAA date 29 July 2026; checked by Crosscheck 14 October 2026.
2. 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).
FAA source: Hypertrophic Cardiomyopathy (HCM). FAA date 29 July 2026; checked by Crosscheck 14 October 2026.
Step 2: Heart tests
The echo, the cardiac monitor, the stress test, the resting EKG and the cardiac MRI.Echocardiogram with Valsalva
Within 90 days before the examThe report and digital images from a 2-D and Doppler flow study performed with Valsalva maneuver, no more than 90 days before the exam.
It must include
- Complete measurements
- Specific attention to maximal LV wall thickness, left atrial size, and maximal LV outflow tract gradient (rest vs. Valsalva)
Also submitted
- The video from this study, on CD-ROM in DICOM compatible format
Cardiac monitor, 72 hours minimum
Within 90 days before the examA cardiac monitor of 72 hours minimum, no more than 90 days before the exam.
The report must include
- The data summary
- Representative EKG tracings
Maximal exercise stress test (EST)
Within 90 days before the examA maximal exercise stress test (EST), no more than 90 days before the exam: the report with the worksheet and representative EKG tracings (to exclude CAD).
Stress test requirements
- Protocol
- A 3-minute Bruce treadmill test: complete Stage 3 (>= 9 minutes) and reach 100% predicted maximal heart rate, unless medically contraindicated or prevented by symptoms or medication
- Medication
- Beta-blockers, calcium blockers (Diltiazem/Verapamil) and digoxin stopped for 48 hours before the test; if it is unsafe to stop, a doctor's note describing the contraindication is attached
- Treadmill not possible
- A doctor's note explaining why, and either bicycle ergometry (100% max heart rate and "greater than METS", as printed) or a nuclear stress test
- ECG printouts
- A full 12-lead at rest (supine and standing); 12 lead tracings and rhythm strips during and 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
- Sent as
- Original printouts only, by mail or electronic upload
Computer generated, sample-cycle ECG tracings or summary sheets are not acceptable, and faxes or photocopies are not accepted.
Resting EKG
Within 90 days before the examAn EKG (resting), no more than 90 days before the exam.
Cardiac MRI
A cardiac MRI, no more than 12 months before the exam, with the report and actual digital images.
Show the FAA's words: Heart tests
3. 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.
FAA source: Hypertrophic Cardiomyopathy (HCM). FAA date 29 July 2026; checked by Crosscheck 14 October 2026.
4. 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. The report must include the data summary and representative EKG tracings.
FAA source: Hypertrophic Cardiomyopathy (HCM). FAA date 29 July 2026; checked by Crosscheck 14 October 2026.
5. 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).
FAA source: Hypertrophic Cardiomyopathy (HCM). FAA date 29 July 2026; checked by Crosscheck 14 October 2026.
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.
FAA source: Hypertrophic Cardiomyopathy (HCM). FAA date 29 July 2026; checked by Crosscheck 14 October 2026.
6. EKG (resting) performed no more than 90 days prior to the AME exam.
FAA source: Hypertrophic Cardiomyopathy (HCM). FAA date 29 July 2026; checked by Crosscheck 14 October 2026.
7. Cardiac MRI performed no more than 12 months prior to the AME exam. Include report and actual digital images.
FAA source: Hypertrophic Cardiomyopathy (HCM). FAA date 29 July 2026; checked by Crosscheck 14 October 2026.
Step 3: Historical medical records
Past heart care, operative reports and earlier imaging.The historical medical records the table lists.
Past cardiac care
- All prior heart evaluation and treatment records
- Records for any procedures, for example myomectomy, alcohol ablation, chordal realignment
Operative reports
- Official operative reports for all past heart surgeries (if applicable)
Advanced imaging and tests
- All prior test results and advanced imaging, for example chest CT, MRI
- Both the written reports and the actual image files
Show the FAA's words: Historical medical records
8. 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.
FAA source: Hypertrophic Cardiomyopathy (HCM). FAA date 29 July 2026; checked by Crosscheck 14 October 2026.
Step 4: At the exam
What the examiner does with the information.Your AME defers, submits the information to the FAA for a possible Special Issuance, and summarizes the findings in Item 60.
Show the FAA's words: At the exam
DEFER Submit the information to the FAA for a possible Special Issuance. Summarize findings in Item 60.
FAA source: Hypertrophic Cardiomyopathy (HCM). FAA date 29 July 2026; checked by Crosscheck 14 October 2026.
8. Historical Medical Records
Provide both the written reports AND the actual image files. Note: once these records are reviewed, additional testing or information may be required.
FAA source: Hypertrophic Cardiomyopathy (HCM). FAA date 29 July 2026; checked by Crosscheck 14 October 2026.
What the examiner checks
Row ADefers to the FAASpecial Issuance
The table lists what to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and summarizes the findings in Item 60.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Special Issuance
Any history or suspected history, for all classes. The table lists what to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and summarizes the findings in Item 60.
A. Any history or suspected history (all classes) Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance. Summarize findings in Item 60.
If the examiner defersSpecial Issuance
The table marks its one row, any history or suspected history, 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, including what the table lists.
- Item 2. Documentation of a 5-year sudden cardiac death risk score, compiled using the most recent version of the American Heart Association (AHA) risk calculator.
- Item 3. An echocardiogram performed with Valsalva maneuver, the report and digital images from a 2-D and Doppler flow study no more than 90 days prior to the exam, with the video on CD-ROM in DICOM compatible format.
- Item 4. A cardiac monitor, 72 hours minimum, performed no more than 90 days prior to the exam, whose report includes the data summary and representative EKG tracings.
- Item 5. A maximal exercise stress test (EST) performed no more than 90 days prior to the exam, the report with the worksheet and representative EKG tracings, to the table's stress test requirements.
- Item 6. An EKG (resting) performed no more than 90 days prior to the exam.
- Item 7. A cardiac MRI performed no more than 12 months prior to the exam, with the report and actual digital images.
- Item 8. Historical medical records -- past cardiac care, operative reports (if applicable), and advanced imaging and tests.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table marks its one row, any history or suspected history, DEFER.
A. Any history or suspected history (all classes) … 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, including what the table lists.
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
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. 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).
- Item 3
An echocardiogram performed with Valsalva maneuver, the report and digital images from a 2-D and Doppler flow study no more than 90 days prior to the exam, with the video on CD-ROM in DICOM compatible format.
3. 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. … Submit the video resulting from this study on CD-ROM in DICOM compatible format.
- Item 4
A cardiac monitor, 72 hours minimum, performed no more than 90 days prior to the exam, whose report includes the data summary and representative EKG tracings.
4. Cardiac monitor. 72 hours minimum performed no more than 90 days prior to the AME exam. … The report must include the data summary and representative EKG tracings.
- Item 5
A maximal exercise stress test (EST) performed no more than 90 days prior to the exam, the report with the worksheet and representative EKG tracings, to the table's stress test requirements.
5. 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
- Item 6
An EKG (resting) performed no more than 90 days prior to the exam.
6. EKG (resting) performed no more than 90 days prior to the AME exam.
- Item 7
A cardiac MRI performed no more than 12 months prior to the exam, with the report and actual digital images.
7. Cardiac MRI performed no more than 12 months prior to the AME exam. Include report and actual digital images.
- Item 8
Historical medical records -- past cardiac care, operative reports (if applicable), and advanced imaging and tests.
8. Historical Medical Records • Past Cardiac Care: … • Operative Reports: Submit official operative reports for all past heart surgeries. (If applicable) • Advanced Imaging & Tests:
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 workGood 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.
Two histories the progress note MUST include
The table says the progress note MUST include a complete history detailing any family history of unexplained sudden cardiac death, and any personal history of non-sustained ventricular tachycardia, or unexplained syncope.
Show the FAA's words: good to know, 2
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.
The echo is performed with Valsalva
The table's echo is performed with Valsalva maneuver, with specific attention to the maximal LV outflow tract gradient (rest vs. Valsalva), and the video from the study goes on CD-ROM in DICOM compatible format.
Show the FAA's words: good to know, 3
3. Echocardiogram (Echo) performed WITH Valsalva maneuver. … maximal LV outflow tract gradient (rest vs. Valsalva). Submit the video resulting from this study on CD-ROM in DICOM compatible format.
The bicycle line prints no METS figure
Where a treadmill is not possible, the stress test requirements say bicycle ergometry "Must reach 100% max Heart Rate and greater than METS". No figure for METS is printed, and this page does not supply one.
Show the FAA's words: good to know, 4
• 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).
Original printouts, not faxes or photocopies
The stress test requirements say computer generated, sample-cycle ECG tracings or summary sheets are not acceptable, and to submit original printouts only (by mail or electronic upload); faxes or photocopies are not accepted.
Show the FAA's words: good to know, 5
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.
The cardiac MRI's window is 12 months
The cardiac MRI is from no more than 12 months prior to the exam, where the echo, the cardiac monitor, the stress test and the resting EKG are from no more than 90 days prior.
Show the FAA's words: good to know, 6
7. Cardiac MRI performed no more than 12 months prior to the AME exam. … 3. 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. … 4. Cardiac monitor. 72 hours minimum performed no more than 90 days prior to the AME exam. … 5. Maximal Exercise stress test (EST) performed no more than 90 days prior to the AME exam. … 6. EKG (resting) performed no more than 90 days prior to the AME exam.
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.