Other Cardiovascular Diseases

Question 1

Describe what cardiomyopathy is.

Question 2

Name the three types of cardiomyopathy.

Answer 2

-Dilated
-hypertrophic
-restrictive

Question 3

Briefly describe dilated cardiomyopathy

Answer 3

Left ventricle becomes enlarged and cannot pump with much force

Question 4

Can a driver with dilated cardiomyopathy be certified?

Answer 4

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%

Question 5

When would a driver with dilated cardiomyopathy become an eligible for certification?

Answer 5

-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

Question 6

Briefly describe hypertrophic cardiomyopathy.

Answer 6

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

Question 7

Can a driver with a diagnosis of hypertrophic cardiomyopathy be certified?

Answer 7

-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.

Question 8

Briefly describe restrictive cardiomyopathy.

Answer 8

.Heart muscle becomes rigid and less elastic. Heart is then unable to adequately expand.

Question 9

Can a driver with restrictive cardiomyopathy be certified?

Answer 9

-No. Driver is disqualified due to variable levels of disease severity and uncertainty of prognosis.

Question 10

What do you do if a driver is found to have an enlarged heart on an echo study?

Answer 10

-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

Question 11

AAA is more common in males than females. In what years of life do the majority of these aneurysms occur?

Answer 11

-60th-70th years of life
-is usually asymptomatic

Question 12

Detection rate of AAA on physical exam is ____. Ultrasound has sensitivity and specificity of nearly _____.

Answer 12

31%
100%

Question 13

AAA is found in:
____ of individuals with coronary disease
____ of individuals with cerebrovascular disease
____ of individuals with peripheral vascular disease

Answer 13

5%
10%
20%

Question 14

Risk of rupture of AAA is related to size.
Aneurysms smaller than _______ really rupture.

Answer 14

4 cm

Question 15

Aneurysms sized _______ have a 1 to 3% per year rate of rupture.

Answer 15

4 cm to 5 cm
note: cardiovascular specialist should review any patient with AAA > 4 cm

Question 16

Aneurysms sized _______ have a 5 to 10% per year rate of rupture.

Answer 16

5 cm to 6 cm

Question 17

Aneurysms sized ______ have approximately 20% per year rate of rupture.

Answer 17

> 7 cm

Question 18

When should a driver with abdominal aortic aneurysm be disqualified?

Answer 18

-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.

Question 19

Under what circumstances can a driver with AAA be certified?

Answer 19

<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

Question 20

Under what circumstances can a driver with a AAA less than 4 cm be eligible for certification?

Answer 20

-Asymptomatic
-at least three months post surgical with clearance
-recertification is annual

Question 21

Under what circumstances can a driver with a AAA larger than 4 cm but less than 5 cm be eligible for certification?

Answer 21

-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

Question 22

Under what circumstances can a driver with a AAA 5 cm or larger be eligible for certification?

Answer 22

-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

Question 23

When is the major factor in determining risk for dissection or rupture of thoracic aneurysm?

Answer 23

Size of the aorta

Question 24

Growth rate of the thoracic aneurysm averages about _____ per year.

Answer 24

0.10 cm

Question 25

When can a driver with a thoracic aneurysm be qualified to drive a commercial motor vehicle?

Answer 25

-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

Question 26

When is a driver with a thoracic aneurysm disqualified?

Answer 26

-Aneurysm is greater than 3.5 cm

Question 27

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?

Answer 27

-At least three months waiting period after surgery
-clearance by cardiovascular specialist
-must have annual recertification

Question 28

When is a driver who has an aneurysm in a visceral or peripheral vein ineligible for certification?

Answer 28

-Ineligible if a cardiovascular specialist has recommended surgical repair

Question 29

_______________ is a primary predictor of rupture aneurysm.

Answer 29

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.