Congenital Heart Disease Flashcards
Congenital heart dz doesn’t automatically disqualify a driver. What affects qualification?
anatomic diagnosis
severity of the congenital defect
results of treatment
present Fitness status
possibility of functional impairment
risk of sudden death or incapacitation
Who is consulted to make decisions about the driver’s diagnosis, severity, and prognosis?
a cardiologist knowledgeable about adult congenital heart disease should Define the diagnosis, severity, and prognosis. These decisions are not made by the medical examiner.
What are common congenital heart diseases that may be encountered?
Ebstein anomaly
aortic congenital heart disease
atrial septal congenital heart diseases
ventricular septal congenital heart dz
patent ductus arteriosus
coarctation of the aorta
right ventricular outflow obstruction due to something other than valvular heart disease
tetralogy of fallot
transposition of the great vessels
What are the major causes of death in patients with congenital heart disease?
-heart failure
-sudden death
Does congenital heart disease automatically disqualify a driver?
No. Qualification is based on criteria such as:
* anatomic diagnosis
* severity of the congenital defect
* results of treatment
* present fitness status
* possibility of functional impairment
* risk of sudden death or incapacitation
What is Ebstein’s anomaly?
-Malformation of the tricuspid valve
-one or two of the three leaflets of the tricuspid valve adhere to the heart wall and move abnormally
-tricuspid valve is lower in the right atrium than normal
-often accompanied by atrial septal defect
Which congenital heart defect is most likely to be encountered in the clinical setting?
-Ebstein’s anomaly
-many patients who have it are asymptomatic
What are the guidelines for certification of pt with mild Ebstein’s anomaly?
Patient with mild Ebstein anomaly can be certified if they meet the following criteria:
-asymptomatic
-no symptomatic arrhythmia or accessory conduction
-no or only mild cardiac enlargement
-no or only mild right ventricular dysfunction
When is the patient who has mild Ebstein anomaly ineligible for certification?
-Intracardiac lesions
-right to left shunt; usually if the shunt is present, the patient will have cyanosis
-symptomatic arrhythmia or accessory conduction
-degree of cardiac enlargement or right ventricular dysfunction is more than mild
If a patient with mild Ebstein anomaly is certified, what are the guidelines for recertification?
-Must be recertified annually
-requires evaluation by cardiologist knowledgeable in adult congenital heart disease
-echocardiography required
Can a driver that has moderate to severe Ebstein anomaly be certified?
No
What are common congenital heart diseases that may be encountered?
- Ebstein anomaly
- aortic congenital heart disease
- atrial septal congenital heart diseases
- ventricular septal congenital heart dz
- patent ductus arteriosus
- coarctation of the aorta
- right ventricular outflow obstruction due to something other than valvular heart disease
- tetralogy of fallot
- transposition of the great vessels
Suppose the driver has a diagnosis of bicuspid aortic valve. Under what circumstances can this driver be certified?
When surgical intervention is successful
Suppose the driver has a diagnosis of bicuspid aortic valve. Under what circumstances is this driver ineligible for certification?
When surgical intervention is successful
Suppose the driver has a diagnosis of bicuspid aortic valve. Under what circumstances is this driver ineligible for certification?
Aortic transverse diameter is greater than 5.5 cm
How often can a driver who has bicuspid aortic valve be recertified if they meet requirements?
Annually
Some patients who have Marfan’s syndrome have weakness of the inner lining of the aorta. Under what circumstances can a driver with Marfan syndrome be certified?
No cardiovascular involvement
When is a driver with Marfan’s syndrome ineligible for certification?
-Aortic root enlargement
-moderate or severe aortic regurgitation
-anything worse than mild regurgitation related to mitral valve prolapsed
-LV dysfunction with ejection fraction less than 40% and no associated valve disease
If a patient with Marfan syndrome is certified, with what frequency should they be recertified?
Must be recertified annually
Patient with Marfan syndrome is certified, what kind of ongoing evaluation is required?
-Evaluation by cardiologist who is knowledgeable in adult congenital heart disease
-cardiology valuation must include aortic root imaging and echocardiography
What are common congenital heart diseases that may be encountered?
- Ebstein anomaly
- aortic congenital heart disease
- atrial septal congenital heart diseases
- ventricular septal congenital heart dz
- patent ductus arteriosus
- coarctation of the aorta
- right ventricular outflow obstruction due to something other than valvular heart disease
- tetralogy of fallot
- transposition of the great vessels
Atrial septal defect is a common form of congenital heart disease. Suppose a driver only has a small defect. Under what circumstances can the driver with a small atrial septal defect be certified?
Patient is asymptomatic
When is a driver with a small atrial septal defect ineligible for certification?
-Experiencing symptoms such as dyspnea, palpitations, or a paradoxical embolus
-patient has pulmonary hypertension
-patient has right to left shunt
-pulmonary to systemic flow ratio is greater than 1.5 to 1
If a driver with a small atrial septal defect is certified, how often must they be recertified?
Must be recertified annually
What kind of monitoring is required if the driver with small atrial septal defect is certified?
-must be evaluated by cardiologist familiar with adult congenital heart disease
-must have an echocardiogram
Under what circumstances can the driver with a medium or large atrial septal defect be certified?
-Must be three months post surgery or four weeks after device closure of their defect
-asymptomatic
-must have clearance by cardiologist who is knowledgeable about adult congenital heart disease
Suppose the patient with a medium or large atrial septal defect has surgical repair of the defect. What is the minimum waiting period before you can certify them again?
-three months post surgery
-four weeks after device closure
When is a driver with a medium or large atrial septal defect ineligible for certification?
-Symptoms of dyspnea, palpitations, or a paradoxical embolus
-pulmonary hypertension
-right to left shunt
-pulmonary to systemic flow ratio greater than 1.5 to 1
If a driver with a medium or large atrial septal defect is certified, how often must they be recertified?
-Must recertify annually
-evaluation by cardiologist knowledgeable about adult congenital heart disease every two years
What kind of monitoring is required if the driver with medium or large atrial septal defect is certified?
- annual recertification
- evaluation by cardiologist knowledgeable about adult congenital heart disease is required silicone must have annual echocardiogram
Review: suppose driver with atrial septal defect has the diagnosis of small ostium primum. Under what circumstances can this driver be certified?
Certify if asymptomatic.
If the driver with small ostium primum is certified, how often must that driver be recertified?
-Recertify annually; must have evaluation by cardiologist knowledgeable about adult congenital heart disease
-echocardiography required
When is a driver with small ostium primum ineligible for certification?
-Symptoms of dyspnea, palpitations, or a paradoxical embolus
-echo-doppler demonstrates pulmonary artery pressure greater than 50% of systemic pressure
-echo-doppler demonstrates right to left shunt
-pulmonary to systemic flow ratio greater than 1.5 to 1
-heart block on EKG
-severity of mitral valve regurgitation is worse than mild
-left ventricular outflow tract obstruction with a gradient greater than 30 mmHg
Suppose a patient with a diagnosis of atrial septal congenital heart disease has of form known as sinus venosus atrial septal defect. Under what circumstances can this patient be certified?
-Small shunt that is hemodynamically insignificant
-at least three months post surgical intervention
-cardiology clearance by cardiologist knowledgeable about adult congenital heart disease
Suppose a patient with a diagnosis of atrial septal congenital heart disease has of form known as sinus venosus atrial septal defect. Under what circumstances is patient ineligible for certifitification ?
-Symptoms of dyspnea, palpitations, or a paradoxical embolus
-echo-Doppler shows pulmonary artery pressure greater than 50% of systemic pressure
-echo Doppler shows right to left shunt
-pulmonary to systemic flow ratio greater than 1.5 to 1
-heart block or sinus node dysfunction on EKG
How often does a patient who has sinus venosus atrial septal defect need to be recertified?
-Annually
-must have evaluation by cardiologist knowledgeable about adult congenital heart disease
-evaluation must include a Holter monitor
What are common congenital heart diseases that may be encountered?
- Ebstein anomaly
- aortic congenital heart disease
- atrial septal congenital heart diseases
- ventricular septal congenital heart dz
- patent ductus arteriosus
- coarctation of the aorta
- right ventricular outflow obstruction due to something other than valvular heart disease
- tetralogy of fallot
- transposition of the great vessels
Suppose the patient has a small ventricular septal defect. Under what circumstances can they be certified?
-Shunt is small and hemodynamically insignificant
-if patient has had surgical intervention, they must complete a three months minimum waiting period; must have favorable hemodynamic; must be cleared by cardiologist
If a patient with a small ventricular septal defect has surgical repair, what’s the minimum waiting period before they can return to work?
-three months minimum waiting period
-Also, must have favorable hemodynamics and must be cleared by cardiologist knowledgeable in adult congenital heart disease
How often does a driver who has a small ventricular septal defect have to recertify?
-Annually
-requires evaluation by cardiologist knowledgeable of adult congenital heart disease
Suppose the patient has a small ventricular septal defect. Under what circumstances is this driver in eligible for certification?
-Symptoms of dyspnea, palpitations, or a paradoxical embolus
-echo-Doppler shows pulmonary artery pressure greater than 50% of systemic pressure
-echo Doppler shows right to left shunt
-pulmonary to systemic flow ratio greater than 1.5 to 1
-heart block or sinus node dysfunction on EKG
Suppose the patient has a moderate to large ventricular septal defect. Under what circumstances can this driver be certified?
-At least three months post-surgical intervention
-no disqualifying criteria
-no serious dysrhythmia on 24 hour Holter monitor
-QRS must be less than 120 ms in duration; if the QRS is longer than hundred 20 ms, patient can be certified if HIS bundle studies show no infra-HIS or other serious electrophysiologic disorder
-cleared by cardiologist knowledgeable of adult congenital heart disease
For what period of time can a patient with moderate to large ventricular septal defect be certified/recertified?-
-Annually
-must have evaluation by cardiologist knowledgeable about adult congenital heart disease, including 24 hour Holter monitoring
When is a patient with moderate to large ventricular septal defect ineligible for certification?
-Uncorrected moderate to large VSD
-Symptoms of dyspnea, palpitations, or syncope
-pulmonary artery hypertension
-right to left shunt
-left ventricular enlargement or reduced function
-pulmonary to systemic flow ratio greater than 1.5 to 1
What are common congenital heart diseases that may be encountered?
Ebstein anomaly
aortic congenital heart disease
atrial septal congenital heart diseases
ventricular septal congenital heart dz
patent ductus arteriosus
coarctation of the aorta
right ventricular outflow obstruction due to something other than valvular heart disease
tetralogy of fallot
transposition of the great vessels
Suppose a driver has a diagnosis of small patent ductus arteriosus. Can this patient be certified?
Yes
For how long can a patient with a diagnosis of small patent ductus arteriosus be certified?
-One year
-must be recertified annually
Suppose a driver has a diagnosis of medium to large patent ductus arteriosus. Under what circumstances can this patient be certified?
-At least three months postsurgical
-no disqualifying factors
-cleared by cardiologist knowledgeable in adult congenital heart disease
Suppose a driver with a medium to large patent ductus arteriosus has surgical repair of the defect. What’s the minimum waiting period after surgery before the driver can be certified?
three months
Suppose a driver has a diagnosis of medium to large patent ductus arteriosus. Under what circumstances can this patient ineligible to be certified?
-Symptoms of dyspnea or palpitations
-pulmonary hypertension
-right to left shunt
-progressive left ventricular enlargement or decreased systolic function
Suppose a driver has a diagnosis of medium to large patent ductus arteriosus. How often should this driver be recertified?
-Annually
-requires evaluation by cardiologist knowledgeable of adult congenital heart disease
What are common congenital heart diseases that may be encountered?
- Ebstein anomaly
- aortic congenital heart disease
- atrial septal congenital heart diseases
- ventricular septal congenital heart dz
- patent ductus arteriosus
- coarctation of the aorta
- right ventricular outflow obstruction due to something other than valvular heart disease
- tetralogy of fallot
- transposition of the great vessels
Suppose a driver has a diagnosis of mild coarctation of the aorta. Under what circumstances can this driver be certified?
-Blood pressure well-controlled
-no associated disqualifying disease
If a driver has diagnosis of mild coarctation of the aorta, how often do they need to be recertified?
-annually
-must be evaluated by a cardiologist knowledgeable about adult congenital heart disease
Under what circumstances can a driver with moderate to severe coarctation of the aorta be certified?
-Only if perfectly repaired
For what period of time can a driver with moderate to severe coarctation of the aorta be certified?
-annually
-must be evaluated by a cardiologist knowledgeable about adult congenital heart disease
Under what circumstances is a driver with moderate to severe coarctation of the aorta ineligible for certification?
-Coarctation has not been surgically repaired
What are common congenital heart diseases that may be encountered?
- Ebstein anomaly
- aortic congenital heart disease
- atrial septal congenital heart diseases
- ventricular septal congenital heart dz
- patent ductus arteriosus
- coarctation of the aorta
- right ventricular outflow obstruction due to something other than valvular heart disease
- tetralogy of fallot
- transposition of the great vessels
Suppose you have a driver who has congenital heart disease manifesting as right ventricular outflow obstruction caused by some kind of diagnosis other than valvular disease. Can this driver be certified?
Yes. They can be certified if they meet criteria similar to those required for individuals who have isolated pulmonary valve stenosis.
-Must be recertified annually
-must be evaluated by cardiologist who is knowledgeable about adult congenital heart disease
What are common congenital heart diseases that may be encountered?
- Ebstein anomaly
- aortic congenital heart disease
- atrial septal congenital heart diseases
- ventricular septal congenital heart dz
- patent ductus arteriosus
- coarctation of the aorta
- right ventricular outflow obstruction due to something other than valvular heart disease
- tetralogy of fallot
- transposition of the great vessels
Can a patient who has tetralogy of Fallot be certified?
- They can be certified if they have had surgical repair and excellent results of the surgery
-cannot have any significant pulmonary or tricuspid valve regurgitation
-no pulmonary stenosis
-no history of arrhythmias
-no residual shunt
-cannot be certified if the defects are not surgically corrected
What kind of follow-up is required for a driver has tetralogy of the low but has had surgical repair of their deficits?
-Must be recertified annually
-should be evaluated by cardiologist knowledgeable about adult congenital heart disease
-cardiac evaluation should include EKG, 24 hour Holter monitoring, exercise testing, and Doppler echo
What are common congenital heart diseases that may be encountered?
- Ebstein anomaly
- aortic congenital heart disease
- atrial septal congenital heart diseases
- ventricular septal congenital heart dz
- patent ductus arteriosus
- coarctation of the aorta
- right ventricular outflow obstruction due to something other than valvular heart disease
- tetralogy of fallot
- transposition of the great vessels
Can a patient who has transposition of the great vessels be certified?
Yes. Certify if they have had a Rastelli repair, are asymptomatic, and have excellent results after the surgery.
For what period of time should a person who has transposition of the great vessels be certified?
-Annually
-should be evaluated by cardiologist knowledgeable of adult congenital heart disease
Under what circumstances is a driver who has transposition of the great vessels ineligible for certification?
-Cannot be certified if defect has not been surgically corrected
-do not certify if surgery involved atrial switch repair or arterial switch repair
Under what circumstances can a driver who has had correction of transposition of the great vessels be certified?
-No disqualifying criteria
-completed a waiting period of at least three months
-prosthetic valve must meet requirements for that valve
-cleared by cardiologist
Under what circumstances is a driver who has had congenitally corrected transposition of the great vessels in eligible for certification?
-Symptoms of dyspnea, palpitations, syncope, or paradoxical embolus
-intracardiac lesion such as ventricular septal defect exists
-severity that is more than moderate of pulmonary stenosis with pulmonary ventricular pressure more than 50% of systemic pressure
-anything worse than mild right ventricular or left ventricular enlargement or dysfunction
-moderate or severe tricuspid valve regurgitation
-history of atrial or ventricular arrhythmia
-EKG shows heart block
-right to left shunt or significant residual left to right shunt
For what period of time can a driver who has had a driver who has had congenitally corrected transposition be certified?
-Annually
-should be evaluated by cardiologist knowledgeable of adult congenital heart disease
-cardiac evaluation should include echocardiography and 24 hour Holter monitor
Name forms of congenital heart disease that may show up in drivers.
- Ebstein’s anomaly
- aortic congenital heart disease
- atrial septal congenital heart disease
- sinus venosus atrial septal defect
- ventricular septal congenital heart diseases
- patent ductors arteriosus
- coarctation of the aorta
- tetralogy of Fallot
- right ventricular outflow obstruction
- transposition of the great vessels
