The Federal Aviation Administration updated its Guide for Aviation Medical Examiners on June 24, 2026, adding new disposition tables for several heart-related conditions affecting pilots and air traffic control specialists. The update applies to Item 36 (Heart) of the AME Guide and adds specific tables for heart murmur, congenital heart conditions, endocarditis, Wolff-Parkinson-White and other pre-excitation conditions, fibromuscular dysplasia, heart transplant, and hypertrophic cardiomyopathy. For pilots dealing with — or worried about — cardiac history affecting their medical certificate, the new guidance creates clearer pathways and sets specific documentation timelines.
The update is the second significant change to the AME Guide this spring. It comes less than a month after the FAA added new mental health counseling resources to Item 47 on May 27. Together, the two updates signal an FAA push to clarify and streamline two of the most complex areas of pilot medical certification.
What the New Cardiac Tables Cover
The disposition tables — published at faa.gov/ame_guide — give Aviation Medical Examiners structured criteria for handling specific cardiac diagnoses. Each table outlines when an AME can issue a medical certificate directly and when the case must be deferred to the FAA’s Aerospace Medical Certification Division (AMCD) for possible special issuance.
The new and updated tables cover seven specific conditions:
Heart murmur. Low-grade or non-pathologic murmurs that don’t interfere with flight duties may be issued directly by the AME. Other murmurs require FAA review. The update also revised the broader murmur examination guidance.
Congenital heart conditions. Includes specific handling for uncomplicated patent foramen ovale (PFO) findings, which in many cases can now be issued at the AME level when symptomatic criteria are met. Other congenital conditions still require FAA review.
Endocarditis. Bacterial or other inflammation of the heart’s inner lining. The new table specifies the documentation requirements for pilots with this history seeking re-certification.
Wolff-Parkinson-White and other pre-excitation conditions. Electrical conduction abnormalities that can cause rapid heart rhythms. The new table outlines the testing and monitoring requirements for medical certification.
Fibromuscular dysplasia. A condition affecting the artery walls. The new table provides specific criteria for AME action versus FAA deferral.
Heart transplant. Among the most consequential of the new tables, with separate guidance for first-class, second-class, third-class, and air traffic control specialist applicants.
Hypertrophic cardiomyopathy. A genetic condition causing thickened heart muscle. The new table outlines documentation requirements and pathways for medical certification.
In addition to the new disposition tables, the FAA published a new link to medication guidance and made several related administrative changes throughout Item 36.
What’s Actually Changing — and What Isn’t
The update is a guidance change, not a regulatory change. The medical standards for first-, second-, and third-class certificates under 14 CFR Part 67 remain unchanged. What’s changing is how AMEs handle specific cardiac conditions: which can be issued at the local AME level versus which must be deferred to the FAA.
For most cardiac conditions, the new tables still call for FAA review. The pathway typically involves:
Current detailed clinical progress notes. The AME must have recent records from the pilot’s treating cardiologist or primary care physician.
Echocardiogram. Required for most of the conditions listed in the new tables.
Cardiac monitoring. Holter monitors, event monitors, or other ambulatory cardiac monitoring may be required depending on the condition.
Stress testing or other diagnostic workup. Additional records or testing as the specific condition warrants.
Several of the tables specify time windows for the supporting medical information. In many cases, clinical notes, echocardiograms, and cardiac monitoring must be completed no more than 90 days before the AME exam. This is a meaningful detail: pilots planning their renewal cycle should coordinate testing with their cardiologist to fall within that window.
For pilots, the change provides a clearer FAA pathway for several heart-related medical histories that previously fell under broader, less-specified cardiac guidance.
Why This Matters for Pilots With Cardiac History
Cardiac conditions are one of the most common medical complications pilots face — particularly older pilots in the GA community. According to FAA aeromedical statistics, cardiovascular issues are among the most frequent causes of medical certificate deferrals and special issuance applications.
The updated guidance offers several practical benefits for affected pilots:
Predictability. Pilots and their treating physicians now have specific guidance about what documentation the FAA expects and how the AME will handle their case. This is a significant improvement over open-ended “case-by-case review” approaches.
Documentation efficiency. Knowing exactly what records, testing, and timelines the FAA requires lets pilots gather the right materials before the AME exam — rather than discovering mid-process that something is missing.
Faster AME-level issuance for some conditions. Pilots with non-pathologic heart murmurs or uncomplicated PFO findings may now receive direct AME issuance instead of being deferred. For many pilots, that’s the difference between flying within weeks and waiting months for an FAA special issuance.
Clearer pathways for serious conditions. Heart transplant patients, for example, now have a structured guidance pathway with class-specific criteria. The pathway doesn’t make certification easy — heart transplant remains one of the most consequential conditions a pilot can present — but it does make the process more predictable.
How Pilots Should Use the New Guidance
For pilots with current or past cardiac history considering medical certification:
Review the relevant Item 36 table. The FAA’s AME Guide is publicly available at faa.gov/ame_guide. Pilots can review the disposition table relevant to their specific condition before their AME exam.
Coordinate testing within the 90-day window. If the table requires recent clinical notes, echocardiogram, or cardiac monitoring, schedule those tests close to the AME appointment — within the specified time window — to avoid having to redo them.
Bring complete records to the AME exam. Pilots can save significant time by arriving with a complete package: clinical notes from the treating cardiologist, recent echocardiogram report, any cardiac monitoring data, medication list, and a detailed cardiac history.
Consider consulting an AME with cardiac expertise. Not all AMEs handle cardiac cases with equal depth. AMEs who frequently work with cardiac patients are typically faster at processing the documentation and identifying potential issues before submission.
Use AOPA’s medical resources. AOPA Pilot Protection Services offers consultation for complex medical certification issues. Pilots facing a deferral or special issuance can benefit from professional guidance through the process.
The Broader Push: AME Guide Modernization
The cardiac update is part of a broader effort by the FAA to clarify and modernize the AME Guide. The Item 36 cardiac update follows the Item 47 (Psychiatric Conditions) mental health counseling update published on May 27, 2026.
Together, the two updates signal an FAA approach to medical certification that’s becoming more transparent, more structured, and more aligned with current medical practice. The mental health update explicitly encouraged pilots to seek counseling and added resources for both pilots and their therapists. The cardiac update gives AMEs clearer disposition criteria and gives pilots better visibility into what the FAA expects.
The pattern matters for the broader pilot population. The FAA’s medical certification process has historically been seen as opaque — particularly for pilots with any medical history. Each AME Guide update that adds structured, transparent guidance is a step toward a system pilots can navigate more confidently.
The legislative backdrop also matters. The Mental Health in Aviation Act of 2025 — which would require the FAA to revise its medical certification regulations within two years to encourage voluntary disclosure and reduce barriers to treatment — passed the Senate Commerce Committee in April 2026 and is awaiting further action. While the cardiac update isn’t directly tied to that legislation, it reflects the same direction of travel: more transparency, more structured guidance, more predictable pathways.
The Bottom Line
For pilots with cardiac history, the June 25 AME Guide update is a positive development. It doesn’t change the underlying medical standards — pilots with serious cardiac conditions still face FAA review and special issuance pathways — but it does make the process more transparent and more predictable.
For AMEs, the new disposition tables are a practical tool for handling complex cardiac cases with greater consistency and confidence.
And for the broader pilot community, the update — combined with the mental health guidance from May 27 — signals that the FAA is actively working to make its medical certification process more navigable. For an industry that has long lamented the opacity of FAA aeromedical decisions, these are meaningful steps in the right direction.
Pilots with cardiac concerns should review the relevant Item 36 disposition table at faa.gov/ame_guide before their next medical exam and coordinate with their cardiologist to gather the required documentation within the FAA’s specified timelines.
Frequently Asked Questions
What did the FAA add to the AME Guide on June 25, 2026? The FAA updated Item 36 (Heart) of its Guide for Aviation Medical Examiners with new disposition tables for several cardiac conditions: heart murmur, congenital heart conditions, endocarditis, Wolff-Parkinson-White and other pre-excitation conditions, fibromuscular dysplasia, heart transplant, and hypertrophic cardiomyopathy. The tables specify when an AME can issue a medical certificate directly and when a case must be deferred to the FAA for possible special issuance.
Do the new cardiac tables change FAA medical certification standards? No. The underlying medical standards under 14 CFR Part 67 remain unchanged. The new disposition tables provide structured guidance for AMEs on how to handle specific cardiac conditions — clarifying which cases can be issued at the AME level and which require FAA review and possible special issuance.
Can a pilot with a heart murmur get a medical certificate? In many cases, yes. Low-grade or non-pathologic heart murmurs that don’t interfere with flight duties may now be issued directly by the AME under the updated guidance. More complex murmurs still require FAA review.
What documentation do pilots need for cardiac medical certification? Common requirements under the new tables include current detailed clinical progress notes from the treating physician, an echocardiogram, cardiac monitoring data, and any additional testing relevant to the specific condition. In many cases, supporting medical information must be completed no more than 90 days before the AME exam.
Where can pilots access the FAA AME Guide? The FAA’s Guide for Aviation Medical Examiners is publicly available at faa.gov/ame_guide. Pilots can review the disposition tables under Item 36 (Heart) and other sections before their AME exam to understand what documentation and testing will be required.
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