General CHD recommendation summary The qualified driver with CHD should: Secure clearance from a cardiovascular specialist who understands the functions and demands of commercial driving. Tolerate cardiovascular medication and be: Knowledgeable about medications used while driving. o Free from side effects that compromise driving ability. o Compliant with the ongoing treatment plan. Acute Myocardial Infarction The first few months following an acute myocardial infarction (MI) pose the greatest risk of mortality, with the majority of deaths classified as sudden death. Current opinion among clinicians states that post-MI drivers may safely return to any occupational task provided there is no exercise-induced myocardial ischemia or left ventricular dysfunction. Waiting Period Minimum 2 months — Decision Maximum certification period 1 year — Recommend to certify if: The driver: Is asymptomatic. Tolerates medications. Has a satisfactory exercise tolerance test (ETT). Has a resting left ventricular ejection fraction (LVEF) greater than or equal to 40%. Has no electrocardiogram ischemic changes. Recommend not to certify if: The driver has: Rest angina or change in angina pattern within 3 months of examination. Ischemic changes on rest electrocardiogram (ECG). Intolerance to cardiovascular therapy.
General CHD recommendation summary The qualified driver with CHD should: Secure clearance from a cardiovascular specialist who understands the functions and demands of commercial driving. Tolerate cardiovascular medication and be: Knowledgeable about medications used while driving. o Free from side effects that compromise driving ability. o Compliant with the ongoing treatment plan. Acute Myocardial Infarction The first few months following an acute myocardial infarction (MI) pose the greatest risk of mortality, with the majority of deaths classified as sudden death. Current opinion among clinicians states that post-MI drivers may safely return to any occupational task provided there is no exercise-induced myocardial ischemia or left ventricular dysfunction. Waiting Period Minimum — 2 months Decision Maximum certification period — 1 year Recommend to certify if: The driver: Is asymptomatic. Tolerates medications. Has a satisfactory exercise tolerance test (ETT). Has a resting left ventricular ejection fraction (LVEF) greater than or equal to 40%. Has no electrocardiogram ischemic changes. Recommend not to certify if: The driver has: Rest angina or change in angina pattern within 3 months of examination. Ischemic changes on rest electrocardiogram (ECG). Intolerance to cardiovascular therapy.
proposed-changes-medical-examiners-handbook.docx