I get chest pain while working – Is this something to worry about as a truck driver?

The answer is yes.  Chest pains, or even pressure in your chest when you are active could potential mean you have a heart problem.  The most common cause of this symptom is a condition called “Angina.” Angina is usually due to your heart not having enough blood flow to the heart muscles.  It is typically caused by an obstruction or spasm of the arteries that supply blood to the heart muscle.   The primary reason is that you as a driver have coronary (heart) artery (blood vessel) obstruction or atherosclerosis.  The greatest reason for concern is that this is typically a sign that you could suffer a heart attack.  With the stresses, lifestyle and diet of the average truck driver this should serve as a warning that you may suffer a serious problem and should be a cause of concern for anyone not simply the truck driver.  The good news is that this condition can be controlled successfully and current medical therapies more often than not lead to a long and productive life. 

Are there different types of angina?

Although angina is in fact the reason for the chest pain, the condition can be classified in two different ways.  It is either considered stable or unstable.  Although both are of concern, angina that is unstable often indicates a need for urgent medical attention and the possibility of an impending heart attack. 

Unstable angina simply means that the condition that changes or is worsening.  It has at least one of three features:

1. It occurs at rest (or with minimal exertion), usually lasting more than 10 minutes.
2. It is severe and of new onset (i.e., within the priror 4 – 6 weeks).
3. It occurs with a crescendo pattern (very notably more severe, prolonged and/or more frequent than before).

Any driver that suffers chest pains that fit into any one or all of these categories should seek immediate medical attention and not drive until the condition is properly diagnosed and managed.

This brings us to stable angina.  This refers to the classic type of angina related to the lack or reduced blood flow to the heart muscle.  The typical person with stable angina is that the chest discomfort and associated symptoms are precipitated by some activity (running, walking, etc.) and with minimal or non-existent symptoms at rest.  These symptoms usually go away within several minutes after activity and recur when activity resumes. 

What kinds of treatment are typical for a driver that has angina?

The most common medical treatment is the use of nitroglycerin tablets that are placed under the tongue.  This medicine is a potent vasodilator (expands the blood vessel) and reduces the heart’s workload.  There are other medications that are typically prescribed by a doctor that can be also very helpful. 

Other treatments for angina seek to address the closing or clogging of the arteries and are more invasive.  They include balloon angioplasty, implanting a stent in the artery and coronary artery bypass grafting. 

• Balloon angioplasty is a procedure where a balloon attached to the end of a catheter is inserted in the coronary artery and expanded to widen the artery. 
• Putting in a stent (also known as percutaneous coronary intervention or PCI) occurs when a catheter is inserted into the coronary artery and a “stent” is opened to widen a narrowed artery and to help keep it open. 
• Coronary Artery Bypass Grafting (abbreviated CABG) is often referred to in terms relating to the number of arteries that were cleared of atherosclerotic buildup in the coronary arteries.  An example would be a “triple bypass”.  This is a more invasive surgical procedure used in the treatment of the causes of the angina. 

What are the FMCSA regulations & guidelines relating to angina:

The FMCSA has well defined guidelines realting to angina and the treatments frequently used to treat the condition.  They involve waiting periods, medical clearance requirements and special testing before a truck driver can be cleared to safely drive a truck.  Let’s look first at the condition itself and like we did in describing it, lets separate it into the two catagories:

1. Unstable angina – First and foremost the condition must be diagnosed and treated by a cardiologist and not simply a primary care provider.  If a medical examiner does not have a clear diagnosis or if he/she would suspect that the driver suffers from unstable angina they are required to disqualify the driver, have the condition properly diagnosed, and treated until it becomes stable. 

Additionally, once diagnosed as unstable, the FMCSA requires a 3 month waiting period even if the cardiologist feels the driver can return prior to driving prior to the completion of the waiting period.  The driver also needs to provide confirmation from the cardiologist that the driver is safe to return to driving, must have a successful exercise tolerance test (and a ETT once every 2 years following the diagnosis of angina) and have an annual exam by a cardiologist there after.  If the driver successfully completes all of those, then they can be certified by a DOT medical examiner for a period of 1 year (the maximum with this diagnosis).

• Stable angina – If the driver is initially diagnosed with stable angina, or the condition has become stable due to treatment (and the driver has successfully completed all requirements already described), then the driver can be certified with medical clearance by a cardiologist (confirming that the condition is stable) has a successful ETT within the past 2 years and tolerates their medication well, for a period of 1 year. 

How about the other treatments for drivers that have angina?

They all have their specific requirements that are mandated by the FMCSA.  Lets take a look one at a time:

1. Balloon angioplasty/Stent – These two can be grouped together and have the following requirements:
   1. The driver must be asymptomatic
   1. Tolerate their medications
   1. No resting angina
   1. Have an electrocardiogram showing no ischemic changes
   1. An exercise tolerance test (ETT) following the initial certification periodthat is satisfactory and have one every two years thereafter.
   1. Have clearance to return to work following the procedure by a cardiologist and have a yearly exam and clearance every year thereafter.

The initial certification that should be provided by a DOT medical examiner should be for 3 to 6 months, then they can be certified annually thereafter. 

• Coronary Artery Bypass Grafting (also known as CABG) – Again, this is a surgical procedure and the waiting period is longer.  To be certified the driver has the following requirements:
  • They must complete a waiting period of 3 months.
  • They must be fully healed and have a release to return to work without restrictions by a cardiologist.  Medical clearance from a cardiologist is required annually thereafter. 
  • They have to have an acceptable echocardiogram.
  • They must be asymptomatic and tolerate all medications and have no side effects from these medications that could interfere with driving a truck.
  • An ETT is not required for 5 years after the procedure.  After the initial 5 years however an ETT must be performed annually.

The maximum certification interval for the driver is 1 year following this procedure. 

Conclusions

Heart problems are very prevalent for drivers and the most common relate to atherosclerosis or hardening of the arteries.  The most common symptoms relating to this is angina.  Drivers are more effected due to the stresses associated with their profession, the sedentary lifestyle and certainly a poor diet.  Drivers that are more in tune with their health are less likely to suffer angina or the other conditions requiring treatment and therefore will be able to stay on the road.  Getting exercise, eating a more healthy diet and controlling their weight would be the best advise a driver can have and follow.