Structural Heart Disease in Aircrew

INTRODUCTION: Heart muscle diseases are challenging for the aeromedical examiner due to their heterogeneous nature and widely varying natural history. The diagnosis of heart muscle disease is likely to have a significant impact on flying privileges, with the risk assessment requiring careful testing and careful follow up. Consideration must also be given to the treatments used in each individual, as these may also pose an aeromedical risk. In athletic aircrew, differentiating athletic adaptation from a cardiomyopathy is essential to decide if flying restrictions are necessary. CASE PRESENTATION: This article provides insights into the appropriate investigation of aircrew with suspected or proven heart muscle disease, to assist with licensing decisions. Four case vignettes are presented (myocarditis, hypertrophic cardiomyopathy, dilated cardiomyopathy, and athletic heart) to give a broad overview of the commonest areas of heart muscle disease seen in aircrew. The relevant features of evaluation, treatment, and aeromedical relevance are provided in a brief discussion of each case. DISCUSSION: This paper presents the most current recommendations for assessing aircrew with heart muscle disease and cardiomyopathy with data derived from current aeromedical and clinical literature, as well as the expert consensus of the NATO Working Groups on Occupational Cardiology (HFM WG 251, 316) D'Arcy J, Syburra T, Broekhuizen L, Holdsworth D, Guettler N, Bron D, Manen O, Davenport E. Structural heart disease in aircrew. Aerosp Med Hum Perform. 2026; 97(2):116-122.