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Can I fly if I have Ventricular Ectopics?

Q: I will be 30 years old in another month. I am working as an attack helicopter pilot. I have been flying for the air force since 9 years and currently I dispense my duties as a helicopter instructor. During the recent air crew medical it was detected that I have Ventricular Ectopics and referred for opinions to some cardiologists. One doctor decided that I need to go through radiotherapy in India, since a pilot cannot afford to have this and recommended me not to fly until the therapy is done which costs approximately a Lakh. I went to another doctor in Apollo hospital, which confirmed that the therapy was not necessary after pursuing my stress ECG and the 24 hour ECG but he informed me that the authorities will not allow me to fly back, which didn't happen. They cleared me for flying and I have started my flying again. What is the reason for the sudden detection of VE? Please advise the dangers of flying with this problem and what are the remedial actions I can take for this? My blood cholesterol has always been high during the last three years varying from 270 to 346.

A:From your note I understand that you get ventricular Ectopics and are asymptomatic otherwise, but your cholesterol levels are quite high. Ventricular ectopics, or extra systoles, are seen often in healthy people. They can be totally free of symptoms or can be associated with feeling of a missed beat because of a pause after the premature beat. These are also sometimes associated with a feeling of sinking sensation. Ventricular ectopics when present in absence of any structural heart disease i.e., in presence of a normal echocardiogram and a normal stress test are innocuous. This is especially true if these beats do not come in rows or more than 3 to 4 beats in continuation (Ventricular tachycardia). No drug treatment to make these beats disappear is required. In fact potent drugs to suppress these beats can be harmful (Pro-arrhythmia). Factors like smoking and excessive use of stimulants (like coffee) if there a cause and effect relationship should be avoided as far as possible. The situation is different if these beats are associated with a poor heart function like after a major heart attack, etc. In such a situation these beats can be an independent factor to increase serious complications and need medical attention by an expert. In high risk individuals like airline pilots, train and bus drivers, etc individuals with ectopics need an evaluation to rule out underlying heart disease and possibility of these beats degenerating into a ventricular tachycardia. I presume all this has been done in your case and you are fit to fly. Your high cholesterol levels however certainly need attention. Get a complete lipid profile done and if LDL cholesterol is high, it needs to be lowered, may be with statin group of drugs under supervision.

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