Recommend not to certify if: The driver has: Symptoms of dyspnea, palpitations, or syncope. Pulmonary valve peak gradient greater than 50 mm Hg in the presence of a normal cardiac output. Right ventricular pressure greater than 50% systemic pressure. More than mild right ventricular hypertrophy noted by echocardiography. More than mild right ventricular dysfunction noted by echocardiography. More than moderate pulmonary valve regurgitation noted by echocardiography. Main pulmonary artery diameter more than 5 cm noted by echocardiography or other imaging modality. Monitoring/Testing The driver should have annual cardiology evaluations by a cardiovascular specialist who is knowledgeable in adult congenital heart disease and who understands the functions and demands of commercial driving. The driver should have an annual medical examination. To review the Congenital Heart Disease Recommendation Table, see of this handbook. Respiratory (b)(5) The commercial driver spends more time driving than the average individual. Driving is a repetitive and monotonous activity that demands the driver be alert at all times. Symptoms of respiratory dysfunction or disease can be debilitating and can interfere with the ability to remain attentive to driving conditions and to perform heavy exertion. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply may be necessary for performance) can be detrimental to safe driving. There are many primary and secondary respiratory conditions that interfere with oxygen exchange and may result in gradual or sudden incapacitation, for example: Asthma. Carcinoma. Chronic bronchitis. Emphysema. Obstructive sleep apnea. Tuberculosis. In addition, medications used to treat respiratory conditions, both prescription and those available without a prescription, may cause cognitive difficulties, compound the risk for excessive daytime sleepiness (EDS), or cause other forms of incapacitation.
Recommend not to certify if: The driver has: Symptoms of dyspnea, palpitations, or syncope. Pulmonary valve peak gradient greater than 50 mm Hg in the presence of a normal cardiac output. Right ventricular pressure greater than 50% systemic pressure. More than mild right ventricular hypertrophy noted by echocardiography. More than mild right ventricular dysfunction noted by echocardiography. More than moderate pulmonary valve regurgitation noted by echocardiography. Main pulmonary artery diameter more than 5 cm noted by echocardiography or other imaging modality. Monitoring/Testing The driver should have annual cardiology evaluations by a cardiovascular specialist who is knowledgeable in adult congenital heart disease and who understands the functions and demands of commercial driving. The driver should have an annual medical examination. To review the Congenital Heart Disease Recommendation Table, see of this handbook. Respiratory (b)(5) The commercial driver spends more time driving than the average individual. Driving is a repetitive and monotonous activity that demands the driver be alert at all times. Symptoms of respiratory dysfunction or disease can be debilitating and can interfere with the ability to remain attentive to driving conditions and to perform heavy exertion. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply may be necessary for performance) can be detrimental to safe driving. There are many primary and secondary respiratory conditions that interfere with oxygen exchange and may result in gradual or sudden incapacitation, for example: Asthma. Carcinoma. Chronic bronchitis. Emphysema. Obstructive sleep apnea. Tuberculosis. In addition, medications used to treat respiratory conditions, both prescription and those available without a prescription, may cause cognitive difficulties, compound the risk for excessive daytime sleepiness (EDS), or cause other forms of incapacitation.
proposed-changes-medical-examiners-handbook.docx