INTRODUCTION: Aviation is a high-risk activity, particularly in pilots with cardiovascular (CV) disease. The occurrence of acute clinical events during flight may have catastrophic implications, justifying the relevance of cardiological evaluation in aviation medicine. However, evidence of the impact of CV diseases in this population is scarce. The aim of this study was to analyze the cardiac causes of disqualification among pilot candidates and pilots of the Portuguese Air Force (PoAF) over a period of 20 yr.

METHODS: Retrospective analysis of cardiac causes of disqualification between 1999–2018, both in PoAF candidates and pilots.

RESULTS: In this period, the overall number of candidates was 2529 and the number of PoAF pilots was 760. Among the candidates, 41% (N = 1047) were considered unfit, of which 4% (N = 39) were due to cardiac causes (all men aged 17–25), namely valvular diseases (N = 27) and conduction/heart rhythm disturbances (N = 12). Among the pilots, 2% (N = 18) were considered unfit, mainly due to cardiac disease (50%; N = 9)—all men with mean age of 47 ± 9 (30–60) yr old, all unfit due to acute myocardial infarction, none occurring during flight.

DISCUSSION: Cardiac diseases were an uncommon cause of disqualification among the pilot aviator candidates, but it was the main cause among the pilots of the PoAF over two decades, all due to acute myocardial infarction. Cardiac evaluation in aviation medicine is essential, focusing on CV risk stratification and preclinical detection of coronary artery disease.

Certo Pereira J, Monge J, Baptista A, Reis P, Dores H. Cardiac causes of disqualification in Portuguese Air Force pilots. Aerosp Med Hum Perform. 2025; 96(2):128–134.