Other Cardiovascular Diseases Flashcards
Describe what cardiomyopathy is.
Name the three types of cardiomyopathy.
-Dilated
-hypertrophic
-restrictive
Briefly describe dilated cardiomyopathy
Left ventricle becomes enlarged and cannot pump with much force
Can a driver with dilated cardiomyopathy be certified?
Driver can be certified if they have only non-sustained ventricular tachycardia and they have left ventricular ejection fraction equal to or greater than 40%
When would a driver with dilated cardiomyopathy become an eligible for certification?
-Nonsustained VTEC but left ventricular ejection fraction is less than 40%
-sustained VTEC with any left particular ejection fraction
-syncope or near syncope with any left ventricular ejection fraction
Briefly describe hypertrophic cardiomyopathy.
Heart muscle becomes thickened. It then stiffens and has difficulty pumping blood out of the heart.
-Some individuals have a benign course
-in some patients, sudden death is the first definitive manifestation that they have this disease
Can a driver with a diagnosis of hypertrophic cardiomyopathy be certified?
-Driver is disqualified if diagnosis of hypertrophic cardiomyopathy is confirmed by echo.
-This is because the disease has variable degrees of severity and an uncertain prognosis.
-If you get an echo study on a driver for any reason and they have hypertrophy, you cannot certify the driver until they are examined by the cardiologists. The cardiologist must rule out hypertrophic cardiomyopathy in must understand the physical and other demands placed on a commercial motor vehicle driver.
Briefly describe restrictive cardiomyopathy.
.Heart muscle becomes rigid and less elastic. Heart is then unable to adequately expand.
Can a driver with restrictive cardiomyopathy be certified?
-No. Driver is disqualified due to variable levels of disease severity and uncertainty of prognosis.
What do you do if a driver is found to have an enlarged heart on an echo study?
-Driver cannot be certified until examined by cardiologist who understands demands placed on commercial motor vehicle drivers
-diagnoses such as restrictive cardiomyopathy or hypertrophic cardiomyopathy must be ruled out
AAA is more common in males than females. In what years of life do the majority of these aneurysms occur?
-60th-70th years of life
-is usually asymptomatic
Detection rate of AAA on physical exam is ____. Ultrasound has sensitivity and specificity of nearly _____.
31%
100%
AAA is found in:
____ of individuals with coronary disease
____ of individuals with cerebrovascular disease
____ of individuals with peripheral vascular disease
5%
10%
20%
Risk of rupture of AAA is related to size.
Aneurysms smaller than _______ really rupture.
4 cm
Aneurysms sized _______ have a 1 to 3% per year rate of rupture.
4 cm to 5 cm
note: cardiovascular specialist should review any patient with AAA > 4 cm
Aneurysms sized _______ have a 5 to 10% per year rate of rupture.
5 cm to 6 cm
Aneurysms sized ______ have approximately 20% per year rate of rupture.
> 7 cm
When should a driver with abdominal aortic aneurysm be disqualified?
-AAA 5 cm or greater in size
-driver is disqualified if there is a recommendation
to operate on the aneurysm. Driver remains disqualified until the aneurysm has been repaired and satisfactory recovery period has passed.
-Driver is symptomatic, regardless of AAA size
-cardiovascular specialist has recommended surgical repair, regardless of AAA size
- AAA is>4cm but < 5 cm, and driver does not have medical clearance for commercial driving from a cardiovascular specialist
-AAA increases in size > 0.5 cm in six months
-driver has not completed three-month post surgical repair waiting period
-driver has had surgical repair, but does not have medical clearance for commercial driving from a cardiovascular specialist
-Absence of recommendation for surgical repair does not qualify the driver. (AAA size of 5 cm or greater automatically disqualifies the patient.) Examiner must determine on a case-by-case basis whether or not to certify the driver.
Under what circumstances can a driver with AAA be certified?
<4 cm and driver is asymptomatic
> 4 cm but smaller than 5 cm, but driver is asymptomatic and cardiovascular specialist has given driver clearance for commercial driving
-AAA has been surgically repaired and meets post AAA repair guidelines
Under what circumstances can a driver with a AAA less than 4 cm be eligible for certification?
-Asymptomatic
-at least three months post surgical with clearance
-recertification is annual
Under what circumstances can a driver with a AAA larger than 4 cm but less than 5 cm be eligible for certification?
-Asymptomatic
-at least three months post surgical with clearance
from cardiovascular specialist for the demands of commercial motor vehicle driving
-annual recertification is required; must have ultrasound to evaluate change in size of the aneurysm
Under what circumstances can a driver with a AAA 5 cm or larger be eligible for certification?
-Cannot be qualified unless driver meets all the stipulations below:
-has had surgical repair the aneurysm
-has completed a three-month post surgical waiting.
-Is cleared by a cardiovascular specialist
-any time aneurysm size increases more than 0.5 cm in six months, driver is no longer eligible for certification
When is the major factor in determining risk for dissection or rupture of thoracic aneurysm?
Size of the aorta
Growth rate of the thoracic aneurysm averages about _____ per year.
0.10 cm
When can a driver with a thoracic aneurysm be qualified to drive a commercial motor vehicle?
-Aneurysm is 3.5 cm smaller less
-driver has had surgery, they must complete a waiting period of at least three months and be cleared by cardiovascular specialist
-must have annual recertification
When is a driver with a thoracic aneurysm disqualified?
-Aneurysm is greater than 3.5 cm
Drivers can have aneurysms that develop in visceral and peripheral arteries and veins. If these aneurysms rupture, it can lead to sudden incapacitation and death. When are these drivers eligible for certification?
-At least three months waiting period after surgery
-clearance by cardiovascular specialist
-must have annual recertification
When is a driver who has an aneurysm in a visceral or peripheral vein ineligible for certification?
-Ineligible if a cardiovascular specialist has recommended surgical repair
_______________ is a primary predictor of rupture aneurysm.
aneurysm size
Certification of driver with aneurysm is dependent on aneurysms size and location, presence of symptoms, history surgical repair, and completing any required post-surgical waiting period.
