Drivers suffer heart problems just like all others within the general population. One type of heart problem that can effect drivers is an arrhythmia or irregular heartbeat. There are many different types of arrhythmia and they can occur at different times during the cardiac cycle or during its heart beat. When an arrhythmia occurs it can cause a number of symptoms including syncope or passing out. It can also cause other types of complications that could not only effect driving but lead to other heart issues and potentially lead to an increased chance of things like a stroke or heart attack.
A-Fib or Artrial fibrillation is one type of arrhythmia and is the most common and well known to truck drivers. It is an abnormal heart rhythm characterized by the rapid and irregular beating of the atrial chambers of the heart. It often begins as short periods of abnormal beating, which become longer or continuous over time. Often times there are no real noticeable symptoms, but occasionally there may be heart palpitations, fainting, lightheadedness, shortness of breath or chest pain. All of these symptoms would be a concern for the truck driver, and certainly the medical examiner considering certification.
The professional truck driver is at greater risk for developing heart problems in general but in this case A-Fib. Risk factors include a sedentary lifestyle and lack of exercise, use of tobacco and alcohol, high blood pressure and diabetes. All or common in the trucking world.
How is it diagnosed?
Typically when a driver reports the symptoms to their primary care provider, the provider will order a series of tests in particular an electrocardiogram and blood tests, a chest Xray to name a few. It may even include the use of ambulatory Holter monitoring to monitor the heart rate and rhythm for a short duration (usually around 24 hours). From here the specific type of arrhythmia can be determined, in the case atrial fibrillation.
Once diagnosed the provider will determine the most effective method of treatment which will take into account the proper method of controlling the condition (often based on its severity) as well as treatments prescribed to prevent some of the adverse side effects associated with the condition.
How is it treated?
The greatest concern for those suffering from A-Fib is the increased risk for having a stroke. This increased risk is present with or without the existence of other circulatory issues or heart problems. As a consequence most who suffer A-Fib will be prescribed an anticoagulant or blood thinner. Examples of these medications include such things as Cumadin, Warfin, Prodaxa and others.
Other approaches to the treatment of A-Fib include lifestyle modification, the prescription of medications to help control the heart rate and a non-surgical approach known as cardioversion. Cardioversion is an attempt to switch an irregular heartbeat to a normal heartbeat using electrical or chemical means.
If these approaches do not work, then the cardiologist can consider something know as a catheter ablation. This is a surgical procedure performed to restore the heart’s normal rhythm by destroying, or electrically isolating, specific parts of the atria (heart chamber).
Some drivers that suffer from A-Fib need a pacemaker. The pacemaker does not treat the A-Fib however itself. Its purpose is to treat a slow heart rate that happens in some people that have A-Fib.
What are the FMCSA requirements for drivers who suffer from A-Fib?
Although many of the treatments associated with treatment of A-Fib may have specific FMCSA requirements, let’s begin our review of these requirements with A-Fib itself and the most common approaches associated with its treatment:
- Those who suffer from A-Fib may have a waiting period attached to its treatment, the most common being anticoagulation therapy. In this case the waiting period is 1-month. The driver must also have regular blood work to measure the effectiveness of the anti-coagulation therapy if the medication requires this (called an INR).
- In the event the driver has ablation then the waiting period is also 1 month.
- The heart rate must be controlled as determined by a cardiologist.
- All medications including the anti-coagulant if prescribed must be well tolerated.
- The driver cannot have any other disqualifying underlying disease that would lead to disqualification.
- They must have clearance from a cardiologist
If the driver is at risk for syncope (sudden loss of consciousness), has a compromised cerebral function (those that suffer from A-Fib are at greater risk for dementia), or have had a sudden death resuscitation would be disqualified from driving.
If the driver satisfies all of the above requirements they can be certified for a period of 1 year.
Pacemakers & implantable defibrillators
As mentioned, drivers that suffer A-Fib may be provided with a pacemaker to help increase the drivers heart rate. In this case, the FMCSA has some specific guidelines associated with the implantable treatments. To begin with there is a waiting period based on the underlying disease that leads to the slowness of the heart rate which varies from 1 month to 3 months. This waiting period and the required medical clearance from a cardiologist must be met in addition to any relating to the A-Fib.
One last thing, regardless of the reason for the a cardiologist implanting an ICD (implantable cadioverter-defibrillator), even if it is in combination with a pacemaker, that driver will be disqualified due to the chance that the ICD were to go off which would lead to a loss of consciousness.
What do drivers need to provide medical examiners to ensure certification?
First and the most, important thing the truck driver can do is to be compliant with treatment. Don’t miss your doctor’s appointments, be complaint with your treatment, especially taking your prescribed medications.
Secondly, as a professional truck driver that suffers from A-Fib or any other condition that has a regulation or guideline or may disqualify you or delay certification, always prepare for your recertification examination beginning at least 3 months prior to when the exam is due. This will allow you enough time to obtain all testing needed (remember the blood work….INR if you are taking an anti-coagulant that requires this test), and the medical clearance required from your cardiologist. Don’t wait to the last minute!
