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Heart Diseases and Driving

How a cardiologist assesses a driver before deciding fitness?
 

Internationally two groups of drivers are defined: Group 1 comprises drivers of ordinary motorcycles, cars, and other small vehicles without a trailer. Group 2 includes drivers of vehicles over 3.5 metric tonnes (3500k) or passenger carrying vehicles exceeding eight seats excluding the driver. For Group 2 drivers licensing requires an annual declaration of fitness, with regular Cardiological assessment, usually annually, exercise evaluation is likely to be necessary.

Which patients with angina cannot drive?
 

Angina pectoris (stable or unstable)
Disqualifying criteria Group 1 : Symptoms at rest or at the wheel; driving may be recommended once symptoms are controlled.
Disqualifying criteria Group 2 : Any history of and/or treatment for. If asymptomatic and requiring no anti-anginal medication (re-) licensing may be permitted subject to regular exercise evaluation.

Which patients suffering from heart attack (Myocardial infarction), or after bypass/angioplasty should be asked not to drive?
 

Disqualifying criteria Group 1 : None, once clinical recovery has taken place, usually 4 weeks following myocardial infarction (MI) or coronary artery bypass graft (CABG), and one week following percutaneous transluminal coronary angioplasty (PTCA).
Disqualifying criteria Group 2 : Not permitted until at least 6 weeks has elapsed from the index event. If asymptomatic and requiring no anti-anginal medication (re-) licensing may be permitted subject to regular exercise evaluation.

Which patients suffering from Peripheral vascular disease are restricted from driving?
 

Disqualifying criteria Group 1 : None.
Disqualifying criteria Group 2 : None, but associated coronary heart disease must be identified and evaluated.

Can all patient with high blood pressure drive?
 

Disqualifying criteria Group 1 : None.
Disqualifying criteria Group 2 : If the blood pressure at rest consistently exceeds 180 systolic and/or 100 mmHg diastolic.

 Can a patient with Aortic aneurysm or Marfan syndrome drive?
 

Disqualifying criteria Group 1 : None.
Disqualifying criteria Group 2 : If aortic transverse diameter >5.0 cm. (Re-) licensing may be permitted following satisfactory repair and provided that there is no other disqualifying condition.

What about patients with heart failure?
 

Disqualifying criteria Group 1 : Symptoms at rest or at the wheel. Driving may be permitted once symptoms are controlled.
Disqualifying criteria Group 2 : Any persisting symptoms. If asymptomatic (re-) licensing may be permitted provided that the left ventricular ( LV ) ejection fraction is >0.40 on contrast angiography (or equivalent), there is no disqualifying arrhythmia (see below) and the exercise requirements can be satisfied.

Can a patient with Heart and/or lung transplantation drive?
 

Disqualifying criteria Group 1 : Persisting symptoms. If asymptomatic (re-) licensing may be permitted provided that the exercise and arrhythmia requirements can be met.

Which patients with Valve disease including valve surgery should not drive?
 

Disqualifying criteria Group 1 : None
Disqualifying criteria Group 2 : Persisting symptoms. If asymptomatic (re-) licensing may be permitted provided that there is no other disqualifying condition and no history of systemic embolism. Following cerebral or recurrent systemic embolism whilst receiving anti-coagulant treatment (re-) licensing should not be permitt
ed.

Which patients with congenital heart disease not allowed to dive?
 

Disqualifying criteria Group 1 : None.
Disqualifying criteria Group 2 : Any complex or severe disorder. Minor disorders and those which have been successfully corrected may be (re-)licensed provided that there is no other disqualifying condition.

What about patients with Hypertrophic Cardiomyopathy?
  Disqualifying criteria Group 1 : None.
Disqualifying criteria Group 2 : Persisting symptoms. If asymptomatic (re-) licensing may be recommended for those with no family history of sudden cardiomyopathic death, no ventricular tachycardia on ambulatory electrocardiography and no hypotension on exercise testing.

Which patients with irregular heartbeats not allowed to drive?
 

Disqualifying criteria Group 1 : Any disturbance of cardiac rhythm, which is likely to cause disabling, symptoms, especially impairment of cerebral function.
Disqualifying criteria Group 2 : Driving will not permitted if the arrhythmia (i.e. non-sinus bradycardia, significant conduction defect, atrial flutter or fibrillation, narrow or broad complex tachycardia) has caused or is likely to cause disabling symptoms. Once the arrhythmia has been controlled (re-)licensing may be permitted provided that left ventricular ejection fraction is >0.40, ambulatory electrocardiography excludes ventricular tachycardia, and the exercise requirements can be met.

Which patients on Pacemaker implant or after Successful catheter ablation not allowed to drive?
 

Disqualifying criteria Group 1 : Within one week.
Disqualifying criteria Group 2 : Any persistent symptoms. (Re-)licensing may be permitted after at least 6 weeks has elapsed, and provided that there is no other disqualifying condition.

Which patients on ICD implant (a type of permanent pacemaker) be restriucted from driving?
  Disqualifying criteria Group 1 : Within 6 months if no arrhythmia recurrence and no disabling symptoms at time of ICD discharge. For drivers receiving 'prophylactic' ICD implant no restrictions are imposed.
Disqualifying criteria Group 2 : Permanent.

Which patients with history of Syncope (history of loss of consciousness) be disqualified from driving?
 

Disqualifying criteria Group 1 : Until cause identified and symptoms controlled.
Disqualifying criteria Group 2 : Requires specialist evaluation including a neurological review if appropriate. Following unexplained syncope, provocation testing and investigation for arrhythmia must be implemented. If the results are satisfactory (re-)licensing may be permitted after 3 months. Careful follow up is mandatory.

How a cardiac evaluation is done to evaluate the cardiac status of a commercial driver?
 

Exercise evaluation shall be performed on a bicycle or treadmill. Drivers should be able to complete 3 stages of the Bruce protocol or equivalent safely, without anti-anginal medication for 48 hours and should remain free from signs of cardiovascular dysfunction, such as angina pectoris, syncope, hypotension, ventricular tachycardia, and/or electrocardiographic ST segment shift (usually > 2mm horizontal or down-sloping) which accredited medical opinion interprets as being indicative of myocardial ischaemia. In the presence of established coronary heart disease, exercise evaluation shall be required at regular interval, usually annually

 
 
   

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