First-Class Medical Cardiovascular

FAR 67.111 — First-Class Medical Cardiovascular

FAR 67.111 sets cardiovascular standards for a first-class airman medical certificate, including disqualifying conditions and required ECG examinations.

In Plain English

FAR 67.111 lists the cardiovascular standards an applicant must meet to hold a first-class airman medical certificate — the class required for ATP privileges.

An applicant must have no established medical history or clinical diagnosis of any of the following:

Myocardial infarction (heart attack)
Angina pectoris
Coronary heart disease that has required treatment, or that has been symptomatic or clinically significant if untreated
Cardiac valve replacement
Permanent cardiac pacemaker implantation
Heart replacement

Applicants must also pass an electrocardiogram (ECG) showing no myocardial infarction or other clinically significant abnormality:

At the first application after age 35, and
Annually after age 40

The ECG must be dated no earlier than 60 days before the application and performed and transmitted using acceptable standards.

Why it matters: Cardiovascular events are a leading cause of in-flight incapacitation. Knowing these standards helps you anticipate when an ECG is required and which conditions trigger a special issuance review.

Regulation Text

14 CFR § 67.111

§ 67.111 Cardiovascular. Cardiovascular standards for a first-class airman medical certificate are: (a) No established medical history or clinical diagnosis of any of the following: (1) Myocardial infarction; (2) Angina pectoris; (3) Coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant; (4) Cardiac valve replacement; (5) Permanent cardiac pacemaker implantation; or (6) Heart replacement; (b) A person applying for first-class medical certification must demonstrate an absence of myocardial infarction and other clinically significant abnormality on electrocardiographic examination: (1) At the first application after reaching the 35th birthday; and (2) On an annual basis after reaching the 40th birthday. (c) An electrocardiogram will satisfy a requirement of paragraph (b) of this section if it is dated no earlier than 60 days before the date of the application it is to accompany and was performed and transmitted according to acceptable standards and techniques.

Oral Exam Questions a DPE Might Ask

Q1What cardiovascular conditions are disqualifying for a first-class medical certificate?

Per FAR 67.111, no established history or diagnosis of myocardial infarction, angina pectoris, clinically significant coronary heart disease, cardiac valve replacement, permanent pacemaker implantation, or heart replacement is permitted.

Q2When is an electrocardiogram required for a first-class medical?

FAR 67.111(b) requires an ECG at the first application after reaching age 35, and annually after reaching age 40.

Q3How recent must the ECG be when submitted with a first-class medical application?

Under FAR 67.111(c), the ECG must be dated no earlier than 60 days before the application date and performed and transmitted according to acceptable standards and techniques.

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Private Pilot Requirements

Including medical certificates

How to Become a Pilot

Medical class explained

Related Sections in Part 67

§ 67.1

Medical Certificate Applicability

§ 67.101

First-Class Medical Eligibility