MODULE 3 HTN & Cardiac Flashcards
Stage 1 HTN (140-159 / 90-99) Recs
Certify for up to 1 year and annually thereafter (as long as BP is normal on next visit).
IF NOT, certify for up to 3- months until it gets under control. No limit to the 3 month certifications, but should document why you keep doing it).
Stage 2 HTN (160-179 / 100-109) Recs
ONE TIME 3 month certification granted and treatment required, annually thereafter as long as well controlled.
Stage 3 HTN ( Greater or equal to 180/110)
DO NOT CERTIFY , until BP is normalized
Then every 6 months after
(at least 3 months after surgical correction if applicable).
What happens if patient is able to come off HTN meds and has normal BP?
You CAN certify for up to 2 years
Disqualifying Cardiac Symptoms?
Syncope, Dyspnea, Collapse, or Congestive Cardiac Failure.
Does Bypass Surgery or Pacemaker Implantation Disqualify?
NOPE.
Implantable Defibrillators ARE Disqualifying.
Implanted Devices (Pacemaker vs Defibrillators)
Pacemaker can be okay, Defib’s are automatic DQ
Is it wise to discuss abnormal physical exam findings with drivers?
Yes, you should do that. Just don’t talk about the outcome of the CDME too soon.
Driver’s on Warfarin Certification Recs
Should be stable at least 1 month on medication.
MAX cert period is 1 year, and driver should be able to provide copy of INR results and monthly monitoring.
Warfarin DQ Recs
INR not being monitored, not therapeutic, underlying disease is disqualifying and/or Driver has CVA Disorder
Echocardiogram Recs for Qualification
LVEF > 50% , NO Pulmonary HTN
Exercise Stress Test Recs for Qualification
> 6 METs capacity
Attain HR greater or equal to 85% of predicted (unless on BB’s)
Have a rise in Systolic BP greater or equal to 20 mm Hg w/o Angina
No Significant ST depressions
CHD (cardiac heart disease) Risk Equivalent
Annual Certifications
Abdominal Aortic Aneurysms Recs
< 4.0cm and Asymptomatic = QUALIFY (with annual cert)
4 - 5cm and Asymptomatic = Qualify IF cleared by vascular surgery and surgery NOT recommended
5cm or bigger, or symptomatic = DQ
3 month waiting period post surgery and cleared by Vascular (annual cert thereafter)
Thoracic Aneurysms Recs
Q = < 3.5cm
Or 3 month post surgery with vascular clearance and annual cert thereafter
Peripheral Vascular Disease Recs
DQ if having claudication/pain at rest
can certify 3 months post surgery if sxs have improved
Acute DVT Recs
DQ if symptomatic
Annual recert
Chronic Thrombotic Dz Recs
Don’t certify until etiology is confirmed and treatment is shown to be effective, safe and stable
Max Cert is 2 years
DQ if symptomatic
Pulmonary Emboli Recs
DQ if symptomatic
Qualify if 3 months from Diagnosis and appropriately treated
Annual recert
Myocardial Infarction (CAD) Recs
Must be 2 months post incident
-Asymptomatic, Tolerates Meds, Good EXERCISE Stress Test, LVEF 40% or more, no EKG ischemic changes
Max Cert Period 1 year
Can a driver use an in-hospital post-MI echo to pass initial cert following a heart attack?
Yes, and then Biennial TTE is required and clearance from cadiology
Angina Pectoris Recs
3 month waiting period.. with no sxs at rest or change in pattern
Max cert is 1 year
RECS
-Stable angina, no sxs at rest, tolerates meds, satisfactory Exercise Stress Test (Biennially)
-If stress Test equivocal, further testing recommended
Timeframe for Exercise Stress Test be performed after Percutaneous Coronary Intervention
within 3-6 months , and biennially
Driver who undergoes Percutaneous Coronary Interventions
Waiting period 1 week minimum
Initial Cert up to 6 months, and then Max cert 1 year
Should be symptom free, tolerate meds, no access site injuries, no EKG ischemia
Coronary Artery Bypass
Waiting Period - 3 mos
Max Cert - 1 year
Qualifying:
-No sxs
-tolerates meds
-LVEF 40% or better
-Cardiology clearance
-Healed sternum
Driver comes in 5+ years post CABG…
Annual ETT or imaging stress test required
Mild vs Moderate vs Severe Aortic Stenosis
Mild: AVA > 1.5cm
Mod: AVA between 1-1.5cm
Severe: AVA less than 1cm
Aortic Stenosis Recs Based on Severity
Qualify IF:
Mild and no sxs (Annual recert and Echo every 5 years)
Mod and No Sxs or 3 months s/p surgery (annual recert and echo every 1-2 years)
Severe = DQ (or at least 3 months past surgery)
Hypertrophic or Restrictive Cardiomyopathy Recs
DQ
Heart Transplantation Recs
1 year waiting period , max cert is every 6 months with cardiology clearance
