Abstract
Clinically significant coronary artery disease (CAD) in military and civilian pilots may result in disasterous consequences. Pilots with undiagnosed CAD occasionally suffer acute coronary syndrome (ACS) inflight. In single-pilot operations, ACS often ends in crew and passenger fatality. Current standards for assessing the presence of CAD are inadequate. In other nations, additional modalities are used to assess pilots for CAD. A 38-year-old F-16 pilot with no cardiac risk factors presents with chest pain following an 8-hour flight. Angiogram reveals significant single lesion stenosis. The pilot undergoes coronary artery bypass graft. Significant CAD is present in a very small minority of young pilots and more so in older pilots and those with cardiac risk factors. Exercise treadmill test (ETT) followed by multislice computed tomography (MSCT), in lieu of coronary angiography, is highly sensitive and specific in the diagnosis of CAD. MSCT has been implemented by the German Air Force with good results.
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