Cardiovascular questions that come up on DOT exams:
With history of unrepaired aortic aneurysm or thoracic aneurysm, am I to require ultrasound at the yearly recert? what about echocardiogram every 2-3 years with aortic valve replacement?
With an unrepaired aortic aneurysm you will need to monitor and re-certify annually. The driver is disqualified if a thoracic aneurysm is greater than 3.5 cm, so you will need to see the cardiologists’ consult letter and ECHO that shows the aneurysm is asymptomatic and smaller than 3.5 cm.
There should be a 3 month waiting period after aortic valve replacement in an asymptomatic driver with a cardiology clearance and a post discharge ECHO cardiogram. The guidelines do not specify frequency of ECHO post surgically, this would be at the discretion of the medical examiner in consultation with the treating cardiologist. An ECHO every 2-3 years is recommended for those with mild to moderate aortic valve disease/regurgitation, so this would seem to be a reasonable interval for a stable post-surgical patient.
With history of coronary artery disease, do I order yearly EKG or just go with the letter from the cardiologist consult?
As the medical examiner, you are responsible for appropriate certification of the driver. If you feel the cardiology consultation addresses satisfactory monitoring of the cardiac condition, that is your discretion. There should be at least a baseline copy of an EKG in the chart which can be requested from the cardiologist or the PCP if already performed.
If the driver is on anticoag treatment, I know I recert based on the INR results I am given, but I can’t ensure the driver will continue to check them. I am thinking this is not my role and the problem would show up at the next recert?
The issue here is whether you feel the driver is compliant with treatment or just coming under control before the DOT exam. If I feel the driver is non-compliant, I will generally use my discretion as the medical examiner to require a shorter time period for re-certification. With INRs, I’ll want to see that the driver is being monitored on a regular basis, monthly according to current FMCSA guidelines. If at the yearly recertification exam I see that there are only 6 or 7 monthly results over the previous year, I will issue a 3 mo certificate. If I get all 3 months’ INR’s on the next re-cert exam, I’ll extend to 6 mos, then a year. If the driver knows he is just going to have to come back in more often for recertifications, he/she may as well go in for their monthly INRs !
Could you please clarify a Coumadin/CVA question for me? One section states if a driver in on anticoagulant therapy, their can be if they are having monthly INR’s & results are within range. But the CVA quidelines state anticoagulant’s are automatic disqualifiers due to the increased bleeding risk. Here are my questions:
1) Why is Coumadin (with good theraputic control) qualified to safely drive in one situation but not another
2) Which situations, on anticoagulants, are and are not qualifiers for DOT clearance. Please clarify reasoning.
3) What about the other anticoagulants (Plavix, Xarelto, Pradaxa, etc) usage that does not have monitoring parameters (ie, INR monitoring)?
As with many medications, you have to consider the underlying condition. After CVA it is disqualifying, but other conditions that are currently stable, e.g. Atrial Fibrillation, DVT, the driver may be qualified with proper clearance from the treating physician(s) and monitored INRs. The other anticoagulants aren’t specifically addressed by FMCSA. The medical examiner will need to assess based on the underlying condition and supporting documentation from the treating physicians.
Is there a brief course of study for cardiologists so that they can be
documented to “understand the functions and demands of commercial driving”?
No, but you can send them the cardiovascular section from the ME Handbook (you can send the specific section) and you may also want to send them the cardiovascular tables.
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Related articles
I had afib surgery a week ago can I get a dot exam to get cleared to drive agian
It depends on the type of surgery. If you had open heart surgery there is a 3 month waiting period to fully heal from surgery, you need to be stable on any cardiac medications and if still anti-coagulated with Coumadin (warfarin) you will need to have INRs in the normal range (the blood test for Coumadin therapy.) In addition, the cardiologist who is familiar with the duties of a commercial driver and FMCSA regulations has to provide a clearance letter to the medical examiner.
If you had a non-invasive catheter surgery, the waiting period may be as little as a week, assuming all other criteria are met, and there are no other cardiac or other medical conditions that would prevent certification.
I had a aorta valve replacment 10 yrs. ago.i have a echocardiogram every year. is it reguired by DOT to have a stress test each year?
Ernest, you should continue to have the ECHO every year, which needs to show at least a 40% ejection fraction. You don’t specifically need a stress test every year for the valve condition, but if you have coronary artery disease, your medical examiner may require a stress test and/or other appropriate cardiac testing, along with a letter/statement from your cardiologist that s/he is knowledgeable regarding the DOT/FMCSA commercial driver regulations and that you are cleared for the job of commercial driving from their standpoint.
Details for your examiners/cardiologist can be found in the Cardiovascular Recommendation Tables
I have a 4.0 cm ascending aortic aneurysm. I can’t get a surgeon to repair it since it is small and I am only 47 y/o. DOT guidelines stop me 3.5 cm. How can I drive again, being this is all I have done for 22 years.
These are DOT guidelines, not rules. It is up to your medical examiner to weigh all the factors to render a determination. Get a letter from your Cardiac surgeon indicating he is familiar with the DOT guidelines but does not feel you require surgery at this time, and that there is no imminent danger of aortic rupture, but that s/he will follow up with you every 6 months and give the examiner an update. The examiner may give you a 6 month certification to see if you are stable, then according to the surgeon follow up.
If your examiner is unwilling, get a second opinion from another certified examiner.
can I pass a dot physical while on plavix
Plavix is not a disqualifying medication. It is up to your medical examiner to assess your underlying cardiac condition to determine medical certification.