Heart Disease and Commercial Driver Certification Guidelines.

Drivers, If you have or had any history of cardiovascular disease (heart disease), that includes angina (chest pain), myocardial infarction (MI) or heart attack, please read the following requirements when you come in for your DOT physical exam.  If you’ve had any procedures for these medical conditions, including angioplasty, stents, or bypass surgery, you will need to familiarize yourself with the following FMCSA guidelines.  Please share them with your treating doctor as you will need to provide us with medical records and clearance letters from your doctor.  Remember, only a FMCSA approved DOT medical examiner can certify you physically and provide you with a medical examiner’s certificate.

Here are the Cardiovascular guidelines (please share with your treating doctor):

Angina (chest pain)

• Minimum of 3 months with no resting angina or change in angina pattern or decreased response to medication.
• stable angina
• asymptomatic.
• tolerating medications.
• satisfactory ETT (exercise tolerate test)
• evaluation and clearance from a cardiovascular specialist who understands the functions and demands of commercial driving.  Satisfactory ETT every two years.  If an ETT is inconclusive, an imaging stress test may be indicated.

MI (myocardial infarction or heart attack)

*video:  http://www.nlm.nih.gov/medlineplus/ency/anatomyvideos/000037.htm

• minimum 2 month waiting period post MI
• asymptomatic
• tolerating medications and cardiovascular therapy
• satisfactory ETT (post MI aprox.4-6 wks).
• Left Ventricular Ejection Fraction (LVEF) greater than or equal to 40%
• no resting ECG ischemic changes
• no angina at rest, or change in angina pattern within 3 months of examination
• satisfactory ETT every 2 years.**
• clearance by cardiovascular specialist who understands the functions and demands of commercial driving such as load/unloading cargo, tarping trailers, inspecting brake lines and putting on tire chains.

PCI (Percutaneous Coronary Intervention)

“Angioplasty with or without stents”

videos:  http://www.nlm.nih.gov/medlineplus/ency/anatomyvideos/000096.htm

shorter video:  http://www.nlm.nih.gov/medlineplus/ency/anatomyvideos/000008.htm

• mandatory 1 week waiting period
• asymptomatic at examination.
• tolerating medications.
• no injury to the vascular access site.
• no incomplete healing or complication at vascular access site.
• no resting angina.
• no ischemic electrocardiogram (ECG) changes.
• following initial certification to drive, the driver should have a satisfactory ETT 3 to 6 months post-percutaneous coronary intervention and bring results to a 6-month follow-up examination.
• clearance from a cardiovascular specialist who understands the functions and demands of commercial driving.  Satisfactory ETT every two years.  If an ETT is inconclusive, an imaging stress test may be indicated.

CABG (Coronary Artery Bypass graft)

video:  http://www.nlm.nih.gov/medlineplus/ency/anatomyvideos/000065.htm

• minimum waiting period of 3 months post CABG
• healed sternum.
• LVEF greater than or equal to 40%.
• asymptomatic status with no angina
• tolerating medications, no orthostatic symptoms.
• yearly exam and clearance by cardiologist.
• no current diagnosis of coronary heart disease (CHD) or cardiovascular disease (CVD) that exhibits syncope, dyspnea, collapse, or congestive heart disease that interferes with the safe operation of a commercial motor Vehicle (CMV).

The following is required yearly beginning 5 years post CABG:

• still with no current diagnosis of CHD or CVD that exhibits syncope, dyspnea, collapse, or congestive heart disease that interferes with the safe operation of a CMV.
• responding to medication and have been advised regarding use and side effects that may interfere with operation of a CMV
• beginning 5 years post-surgery, must have a satisfactory ETT yearly.  Imaging stress test if indicated.  Have a LVEF equal to or greater than 40%.  Recommendation that driver can safely operate a CMV.

Please refer to the FMCSA 2007 Cardiovascular Guidelines  and the 2009 cardiovascular Recommendation Tables for more information).

*videos:  From MedlinePlus.  A service of the US National Library of Medicine, National Institute of Health (NIH).