For atrial fibrillation, the concerns are that the patient's hemodynamic status is not compromised and that risk of stroke is minimal. It is reassuring that his echocardiogram reveals no anatomical heart abnormalities or thrombus formation. However, his record lacks a current Holter monitor and stress testing to rule out life-threatening arrhythmias or myocardial ischemia. Chronic atrial fibrillation is acceptable if shown to be stable, if the heart has good ventricular function, and if no other serious cardiovascular abnormalities are present. Airmen taking anticoagulants are required to submit INR reports on a scheduled basis.
Substance abuse is a serious matter because abusers are unpredictable.
Our applicant was last documented to have abused drugs in 1995. Since that time, there is no documentation of continued abstinence. Outcome Certification was denied for this airman. He may seek certification once the appropriate documentation is in place. He needs a current report from a cardiologist that should include a current Holter monitoring and stress testing.