Trace Tricuspid Insufficiency?

[Guest wojo]

I recently went on PDT with AFROTC and was disqualified for my Jet Orientation ride because of a "heart murmur" that was heard by the flight doc using a stethoscope. I had never heard anything from any of my other doctors about it both before and after his finding and the ones after looked very hard to find it. They heard nothing, but to be sure they sent to me get an echocardiogram done. I had already taken 2 electrocardiograms too be sure nothing was wrong and they both came back normal, even though they do not diagnos heart murmurs. The echocardiogram results were just given to me and it said the following:

Description Of Procedure: Technical quality of study is good.

1) The left ventricle appears normal in size without hypertrophy and with overall normal systolic function. Estimated ejection fraction is approximately 60%. Segmental wall motion analysis reveals no abnormality.

2) There is no significant pericardial effusion.

3) The left atrium, right heart chambers and aortic root appear normal in size.

4) The valves appear structurally normal.

5) There is trace tricuspid insufficiency.

6) Doppler interrogation of the mitral inflow pattern reveals no abnormality.

Conclusion:

1) Normal left ventricular size and function.

2) Trace tricuspid insufficiency.

Comments: This is a normal echocardiogram. Nothing is seen that should preclude this person from any activity.

I asked about what "Trace Tricuspid Insufficiency" meant and the doctor said that it just means that the tricuspid valve does'nt close entirely in your heart and he said it should be nothing to worry about considering 95% of the population has the same diagnosis. I looked at in online at http://health.allrefer.com/health/tricuspi...ation-info.html and it said that it is found in 4 out of 100,000 people!?! I also remember that the nurse that administered the test said that it was very small what she saw, so im not sure what to do. But, to be sure since I want to fly for the USAF, do you see this interfering with my future as a USAF pilot? Thanks alot for your time!

[Guest P27:17]

You should be fine...

AFI 48-123:

A4.18.1.6. History of valvular heart disease to include pulmonic, mitral, and tricuspid valvular

regurgitation greater than mild, aortic regurgitation greater than trace, and any degree of valvular

stenosis. Mitral Valve Prolapse (MVP) and bicuspid aortic valve are also medically disqualifying.

Waiver guide:

IV. Waiver Considerations. The ACS considers trace AI without the murmur of AI, and in the presence of a normal three-leaflet valve, as a normal variant.

• Mild AI, in the presence of a normal trileaflet valve, is considered for FC I/IA and FC II waivers.

• Moderate AI is considered for FC IIA waiver only if the member is asymptomatic, left ventricular function and chamber dimensions are normal, and there is no evidence of aortic root dilation or significant dysrhythmia. FC III is similarly restricted to low performance aircraft.

• Severe AI, or AI associated with LV enlargement or dysfunction is disqualifying with no waiver recommended.

• Procedures performed during the ACS evaluation include a lipid panel, ECG, chest x-ray, echocardiogram, pulmonary function testing, 24-hour Holter, treadmill, and, for evaluees over the age of 35, thallium imaging and coronary artery fluoroscopy. Centrifuge evaluation is no longer required based on an ACS review showing no evidence of +Gz induced arrhythmias or decreased G tolerance.

Good luck

[Guest doctidy]

Agree w/ P27.

Present the information w/ your physical. You'll get the full blown cardiac w/u when you get to Brooks including a repeat echo. Nothing you can do. The cardiologist there would have caught it as well.

Have faith. If it is meant to be, it will happen.

[Milchstrasse]

Reviving this old thread for continuity sake.

4-5 years ago I had a suspected acute case of pericarditis. It quickly went away, and I have not any issues since. At that time, I was referred to a cardiologist for the follow-up. The full report said:

1. LV size, wall thickness and systolic function are normal, with an EF of 60%

2. There is trace mitral regurgitation (insufficiency).

3. There is minimal mitral valve prolapse.

4 There is trace tricusipid regurgitation present (insufficiency).

I was processing for a guard pilot slot at the time, but was DQ'ed for acute pericarditis within 6 months, and for mitral/aortic valve insufficiency.

Now I am being processed again for an identical slot, in a very different location, and these old results have come back to haunt me. From what I understand, we need a waiver first to get the MEPS physical to happen, and then will need another waiver for the FC1. The recruiter processing my packet has been very helpful, but I don't have a clear idea of what the waiver probabilities are here. Reading the regs, it sounds like the results from my echocardiogram are fairly normal but the waiver probability I was given was ~50/50.

If any one could chime in with better knowledge, I would be grateful.

[Guest]

The acute pericarditis does require a waiver, and would pass easily if that were your only condition. 1 is in the normal range. 2 combined with 3 is a slight concern and likely needs a waiver. 4 is not a major concern, no waiver needed.

Though you likely barely skirt the clearance standards for the mitral regurgitation and prolapse per DODI 6130.03 and AFI 48-123/MSD, the docs/techs will err on caution and push for one as a CYA measure, especially because you've got the h/o pericarditis as a kicker.

This waiver will require a Cardiology consults with a new ECG, Chest X-Ray, Echocardiogram, Holter Monitor, and probably a Stress Test. Know that you MUST provide the video/recording of the Echo to ACS for review. TELL THIS TO THE CARDIOLOGY OFFICE AND DEMAND YOU KEEP A COPY. DO NOT SEND THE ORIGINALS WITHOUT A BACKUP.

If you have the means to accomplish these exams and consult independently, and you are approaching your application window, it would likely be worthwhile to press forward and do it on your own, however that may not be possible depending on the cost and availability of a Cardiologist to you. Otherwise, MEPS may coordinate with Cardio consult for you, however the referral process will be lengthy, or they might not cover it at all and it'll all be on you, out of pocket.

I reviewed six similar waivers for IFC I's going back to 2012, and in comparison with your condition and extent, I'd wager your chances are much better than 50/50, maybe 90/10 because your case is so mild. However, if you have any other conditions that also need a waiver, those chances will rapidly drop.

Lastly, the biggest hurdle will definitely be scheduling and accomplishing the exams due to the mountain of red tape involved in this kind of stuff. Be proactive and firm about getting it done. Always be nice to the medical folks, but if something doesn't seem right, ask questions and get an explanation. Don't leave a specialists' office until you know what they are going to do, and an estimate for how long it will take.

By the time all exams are done and submitted, they can't be more than one year old, so timing is often key.

[Milchstrasse]

Excellent info. I have no other conditions that would require a waiver -- to my knowledge. Crossing my fingers that they won't find anything at Wright-Pratt (that is, if I get there).

I have a copy of the original echo on a DVD, just in case anyone wants to see it. I would like to see a cardiologists again, just to have the echo done-over, but I would need a referral, and to be frank, I'm currently on a gap of coverage as I transition from student to my civ job.

[stract]

at Wright-Pratt (that is, if I get there).

I would say your chances are slim of getting to Wright-Pratt.

[Milchstrasse]

Why's that? Did I say something dumb?

Edit: I said something dumb. Wright-Patterson*

Edited January 11, 2015 by Milchstrasse

[Milchstrasse]

Finally got to see the cardiologist this week, and the new report only noted "trivial tricuspid valve regurgitation" and "Left Atrium: Mildly dilated."

Measurement of the LA using the echo was 3.2cm. The LA diam. from the echo I had in 2010 measured 2.9cm. Wikipedia tells me that 3.2cm is normal. and mild is 4.1-4.6cm. Interestingly, the 2010 report had my Aorta diameter as 3.2cm, whereas the report I had this week was 2.8cm. It's as if the numbers just switched, and suddenly it's a problem.

Is this something that will cause me problems?

Edited April 2, 2015 by Milchstrasse

[jcj]

FAA AME here - the "trivial TR regurgitation" (I'm sure he used that word, but the actual term that probably should have been used in the report is "trace"). is no problem by FAA standards. I don't think the other is an issue either but I want to look at some stuff before I say for sure. These findings shouldn't be related since TR regurgitates into the right. atrium, not the left.

Remember FAA standards in many items =/= USAF standards but I think it wont be an issue. Of course as @deaddebate mentions the final call is the USAF Flight Surgeons.

Edited April 8, 2015 by jcj

[SSgtBOOM]

Not the same issue but I am currently a Boom Operator and due to family history and my father passing away suddenly due to an Ascending Aorta aneurysm rupturing.  My grandfather's on both sides also died from this.  I was sent in for an echo to get checked and I was found to have mild dilation of the ascending aorta of 3.9cm.  The flight doctor is sending me to see a cardiologist, and will be taking whatever they recommend for restrictions if any.

 

while I know that the dilation is mild, I am at a higher risk due to family history.  Am I looking at possibly being removed from flying status over this?