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.
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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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I have a artificial valve, 2009 was diagnosed with afib. What can I do to get my medical card? Cardiologist seems confused at what the testing doctor is requesting. I have never had any restrictions for driving at any time.
Ask your medical examiner to review the Cardiovascular recommendation tables with you and your cardiologist to see where you are and what tests and criteria are recommended
I was put on medical hold after my CDL exam because of my coronary history. The examiner requested info from my cardiologist. The info was sent and my cardiologist gave his okay for me to drive. The examiner overruled his opinion and did not recertify me. Can I appeal this?
Thanks
A driver has a right to a second opinion. If you work for someone else, that employer may choose which examiner opinion to accept. If 2 different determinations are submitted to the national registry by different examiners, FMCSA may wish to investigate why this is.
Hi my husband is a cdl driver an had a mild heart attack in 2008 and had one stent put in. He goes to the cardiologist every year since for a annual checkup ekg and renewal of prescriptions. He had his last stress test in 2015 and the Dr. said he was good until next year 2020. The Dr. filled out the required paperwork stating that my husband was cleared to drive along with the ekg results and faxed them to the DOT examiners office. My question is will my husband pass the Dot physical not having a current stress test done ?
There is no regulation or rule as to when the last stress test needs to be done but guidance is 5 years after a stent or bypass.
Stress test and echocardiogram is recommended every 2 years in a person with CAD , MI or stent
They found a aneurism in the aorta 3.2 an I disqualify me
It’s not an automatic disqualified but your examiner will have to evaluate your overall condition to make a determination
I have a 2.5 Aneurysm but the doctor won’t give me my passing test drive the truck can I do anything
Ask your medical examiner to review the Cardiovascular recommendation tables with you and your cardiologist to see where you are and what tests and criteria are recommended
I was diagnosed with CHF,DVT,and Cardiomyopathy in March of 2017.My condition has been stabilized with meds and my last EKG results were good.Im looking into a trucking career and want to know if this will disqualify me from getting a dot card.
Only your certified medical examiner can determine whether you are qualified or not. The job of commercial driving is considered at least moderately physically demanding. Many cases of cardiomyopathy are disqualified. All else needs to be well controlled and advisable to be able to pass an exercise stress test at 6 METS, which is a certain level of maximal effort, as well as other testing that may be required by your examiner, such as lab tests, ECHO cardiogram and certainly a full cardiology clearance from a cardiologist who understands the role and demands of a commercial driver.
I was just diagnosed with a brain aneurysm. Having nausea, dizziness, headache. I felt unsafe driving. My boss let me go. Going today for more tests.
Was wondering how serious this is and does it disqualify me.
Any medical condition which interferes with safe driving may disqualify a driver. After treatment and the condition is improved a driver would need to get a new exam with the certified medical examiner who can make a certification determination or order further testing and reports from treating providers.