MODULE 3 HTN & Cardiac

Question 1

Stage 1 HTN (140-159 / 90-99) Recs

Answer 1

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).

Question 2

Stage 2 HTN (160-179 / 100-109) Recs

Answer 2

ONE TIME 3 month certification granted and treatment required, annually thereafter as long as well controlled.

Question 3

Stage 3 HTN ( Greater or equal to 180/110)

Answer 3

DO NOT CERTIFY , until BP is normalized

Then every 6 months after

(at least 3 months after surgical correction if applicable).

Question 5

What happens if patient is able to come off HTN meds and has normal BP?

Answer 5

You CAN certify for up to 2 years

Question 6

Disqualifying Cardiac Symptoms?

Answer 6

Syncope, Dyspnea, Collapse, or Congestive Cardiac Failure.

Question 7

Does Bypass Surgery or Pacemaker Implantation Disqualify?

Answer 7

NOPE.

Implantable Defibrillators ARE Disqualifying.

Question 8

Implanted Devices (Pacemaker vs Defibrillators)

Answer 8

Pacemaker can be okay, Defib’s are automatic DQ

Question 9

Is it wise to discuss abnormal physical exam findings with drivers?

Answer 9

Yes, you should do that. Just don’t talk about the outcome of the CDME too soon.

Question 10

Driver’s on Warfarin Certification Recs

Answer 10

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.

Question 11

Warfarin DQ Recs

Answer 11

INR not being monitored, not therapeutic, underlying disease is disqualifying and/or Driver has CVA Disorder

Question 12

Echocardiogram Recs for Qualification

Answer 12

LVEF > 50% , NO Pulmonary HTN

Question 13

Exercise Stress Test Recs for Qualification

Answer 13

> 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

Question 14

CHD (cardiac heart disease) Risk Equivalent

Answer 14

Annual Certifications

Question 15

Abdominal Aortic Aneurysms Recs

Answer 15

< 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)

Question 16

Thoracic Aneurysms Recs

Answer 16

Q = < 3.5cm

Or 3 month post surgery with vascular clearance and annual cert thereafter

Question 17

Peripheral Vascular Disease Recs

Answer 17

DQ if having claudication/pain at rest

can certify 3 months post surgery if sxs have improved

Question 18

Acute DVT Recs

Answer 18

DQ if symptomatic

Annual recert

Question 19

Chronic Thrombotic Dz Recs

Answer 19

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

Question 20

Pulmonary Emboli Recs

Answer 20

DQ if symptomatic

Qualify if 3 months from Diagnosis and appropriately treated

Annual recert

Question 21

Myocardial Infarction (CAD) Recs

Answer 21

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

Question 22

Can a driver use an in-hospital post-MI echo to pass initial cert following a heart attack?

Answer 22

Yes, and then Biennial TTE is required and clearance from cadiology

Question 23

Angina Pectoris Recs

Answer 23

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

Question 24

Timeframe for Exercise Stress Test be performed after Percutaneous Coronary Intervention

Answer 24

within 3-6 months , and biennially

Question 24

Driver who undergoes Percutaneous Coronary Interventions

Answer 24

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

Question 25

Coronary Artery Bypass

Answer 25

Waiting Period - 3 mos
Max Cert - 1 year

Qualifying:
-No sxs
-tolerates meds
-LVEF 40% or better
-Cardiology clearance
-Healed sternum

Question 26

Driver comes in 5+ years post CABG…

Answer 26

Annual ETT or imaging stress test required

Question 27

Mild vs Moderate vs Severe Aortic Stenosis

Answer 27

Mild: AVA > 1.5cm

Mod: AVA between 1-1.5cm

Severe: AVA less than 1cm

Question 28

Aortic Stenosis Recs Based on Severity

Answer 28

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)

Question 29

Hypertrophic or Restrictive Cardiomyopathy Recs

Answer 29

DQ

Question 30

Heart Transplantation Recs

Answer 30

1 year waiting period , max cert is every 6 months with cardiology clearance