Pilots, hypertrophic cardiomyopathy, and issues of aviation and public safety.

v u h viation safety is dependent in part on the cardiovascular health of pilots. Hypertrophic cardiomypathy (HC) is an often unpredictable, genetic cardiac isease associated with a risk for sudden cardiac death r periods of impaired consciousness. A recent preceent-setting decision of the National Transportation afety Board medically certified a commercial airline ilot with HC, despite the potential for sudden unexected incapacitation in the cockpit implicit for this isease and the possible risk to public safety. Because irline pilots have a unique occupation which assumes rofessional responsibility for large numbers of pasengers, this decision may be regarded as controverial. Hypertrophic cardiomyopathy (HC) is a relatively ommon genetic heart disease, and an important cause f impaired consciousness and disability at any ge.1–4 Sudden cardiovascular events in HC are nown to be associated with a high degree of unpreictability.5–11 HC is recognized as the single most ommon cause of sudden death in young trained athetes11 and the risks associated with such extreme ifestyles have stimulated expert consensus criteria for isqualification from competitive sports.12 The relation between underlying heart disease and nexpected sudden death and impaired consciousness as also been a concern for individuals with other nusual occupations or lifestyles such as commercial ilots.13,14 Commercial airline travel presents unique ircumstances in which hundreds of passengers are ependent on the general medical condition and cariovascular status of the pilot. Accordingly, the Fedral Aviation Administration (FAA) has established edical standards for pilot certification in an effort to nsure aviation safety.15 Although sudden pilot incaacitation due to cardiovascular disease appears to be relatively uncommon primary cause of air carrier ccidents,16–20 such incidents are known to occur21–23 nd public awareness has recently been heightened egarding the safety of air travel, including the medial histories of pilots. A recent judicial proceeding under the jurisdiction f the National Transportation Safety Board (NTSB)