Cardio Intro and Testing Flashcards
Name disqualifying cardiovascular diagnoses.
A CURRENT diagnosis of any of the following is disqualifying:
1.Acute MI
2.Angina pectoris
3.Coronary insufficiency
4.thrombosis
5.any cardiovascular dz accompanied by syncope, dyspnea, collapse, or congestive cardiac failure (formerly called CHF)
Ex: PSVT is benign, but if it causes syncope, it is medically disqualifying until corrected
Note: a patient who previously had one or more of the above diagnoses, but who has recovered, waiting the req waiting period, and able to handle the demands of current driving can be certified.
Presence of which vessel diseases should prompt investigation for additional cardiovascular disease?
-Aneurysm and treatments
-peripheral vascular disease and treatments
-venous disease and treatments
When you request a specialist evaluation, what should you remember to describe in detail for them, in addition to the patient’s disease process?
Give the specialist information about current relevant certification regulations. Spell out the different tasks that person will have to do as a commercial motor vehicle driver; the job involves a lot more than simply driving a large vehicle:
-strenuous exertion is req to load, unload, or secure load will
This way, the specialists can do their evaluation with an eye for whether or not the patient’s disease affects ability of the patient to carry out duties associated with driving a commercial motor vehicle.
There is such a thing as the New York heart Association symptom classification system. Describe the four classes. Why do we need to know the classes?
Class I: no symptoms at rest or with exertion. Individual has no limited activity.
Class II: no symptoms as a result of ordinary activities, but there are some limitations on activities.
Class III: individual has marked limitation of activity and symptoms occur with every day activities.
Class IV: symptoms even at rest. Individual has severe limitation of activity.
Drivers with class II, III, or IV symptoms should be disqualified.
Does the DOT expect the medical examiner to send patients for routine screening for cardiovascular disease?
No. Routine screening is neither endorsed nor rejected. Reasons why include:
-limited ability to predict cardiovascular disease events
-cost of cardiovascular disease testing can be substantial
-cardiovascular disease test lacks sensitivity and specificity
having said this, the examiner can ask for additional testing, especially when assessment findings suggest the presence of undiagnosed cardiovascular disease or progression of diagnosed cardiovascular disease.
What are the two main types of tests used to assess a driver who has known cardiovascular disease?
- Exercise tolerance test
- imaging studies
What are the two most common reasons that an exercise tolerance test would be requested?
-Evaluate work load capacity
-detect cardiac abnormalities
What are two main drawbacks of exercise tolerance testing?
-Inadequate sensitivity and specificity
-results don’t help you to detect the location of ischemia
What are the indications for requesting imaging studies?
-Presence of abnormal resting EKG
-nondiagnostic standard stress test
What are the advantages of cardiac imaging studies?
-Can detect location of ischemia
-superior sensitivity and specificity compared to the standard stress test
What are the disadvantages of cardiac imaging studies?
-Expensive
-insurance does not always cover the cost
The phrase metabolic equivalent expenditure is a way of trying to assign a quantitative description to effort involved in performing physical labor.
For example, sedentary activities have a very low metabolic equivalent, described as being less than two METS. Lifting light objects which weigh less than 10 pounds and doing activities such as sitting or walking very slowly also require less than two METS.
What kind of intensity is required for commercial motor vehicle drivers? How many metabolic equivalents (METS) do commercial motor vehicle drivers need to be able to produce?
Activity level: heavy or very heavy work
representative activities: rapidly climbing stairs; recall that to get into their truck, they have to be able to climb a mini-ladder
lifting: must be able to lift heavy objects that weigh more than 50 pounds
commercial motor vehicle drivers must be able to work at > 6 METS
In both persons with and without cardiovascular disease, increasing work capacity ________ risk of cardiovascular disease.
decreases
What kind of information do you get from the results of an exercise tolerance test (also known as a stress test)?
-Exercise tolerance test measures a patient’s metabolic expenditures, also known as METS
-is used to eval. workload capacity and detect cardiac abnormaities
-provides info about:
Aerobic capacity
Arrhythmias
Blood pressure
Heart rate
Identifies ischemic changes on the EKG
Checks for symptoms that manifest during exercise
Describe what would be considered to be normal results from an exercise tolerance test.
Driver should:
-attain a HR > 85% predicted maximum rate, unless on beta blockers
-attain workload capacity > 6 METs
-have SBP rise at least 20 mm Hg without angina
-no EKG findings that demonstrate:
* ST segment depression > 1 mm
* ST segment elevation > 1 mm
* Ventricular dysrhythmia
