Cardiac fitness for vocational driving
Standards of cardiovascular fitness for vocational drivers were revised in 1993 (Irvine and Petch, 1994). The revised guidelines apply to holders of Large Goods Vehicle (LGV) and Passenger Carrying Vehicle (PCV) licences (formerly HGV and PSV). In section A (reproduced here) angiography is no longer mandatory for those with coronary heart disease. Section E is also relevant and is reproduced. For details of sections B (Diseases of other arteries), C (Hypertension), D (Arrhythmia), F (Valvular heart disease), G (Cardiomyopathy) and H (Congenital Heart Disorders) see Irvine and Petch, 1994.
A person who has suffered or suffers from a disqualifying condition shown in bold, and/or is within the recommended period of unfitness to drive, should be advised to notify the Driver and Vehicle Licensing Agency and cease driving their vehicle. If able to meet the qualifying conditions in the relevant (re)licensing section(s) an application usually will be successful and the driver permitted continuing entitlement to drive. If unable to meet the qualifying conditions in the (re)licensing sections the licence will be recommended to be refused or revoked.
A. Coronary Heart Disease
(i) Angina Pectoris or Heart Failure (whether or not maintained symptom free by the use of medication)
(ii) within 3 months of: myocardial infarction or any episode of unstable angina; successful coronary artery bypass grafting; successful coronary angioplasty
(Re)licensing normally will be permitted 3 or more months after successful rehabilitation following the events in (ii) above, if there are no other disqualifying conditions, provided the applicant or driver can complete safely at least the first 3 stages of the standard Bruce treadmill protocol or equivalent, off cardioactive treatment for 24-hours and during the test remain free of symptoms and signs of cardiac dysfunction. The licence normally will be refused if he/she develops pathological ST segment shift during or after the test, fails to achieve or maintain a rise in systolic blood pressure, develops sustained ventricular tachycardia or other malignant arrhythmia, or develops symptoms attributable to peripheral vascular disease which limits the investigation.
If the identity of the chest pain is in doubt an exercise test should be carried out as above. Those with a locomotor disorder who cannot comply should notify the Driver and Vehicle Licensing Agency.
E. Electrocardiographic abnormality
The electrocardiogram shows pathological Q waves in three leads or more, or left bundle branch block (LBBB). (A pathological Q wave is defined as having a duration of 40 milliseconds or more and a depth of at least a third of the succeeding R wave).
(Re)licensing normally will be permitted provided there are no other disqualifying conditions, provided the exercise requirements in paragraph A are fulfilled. Pre-excitation may be ignored unless associated with a history of arrhythmia.
Further information about the qualifying conditions for any of the above heart disorders may be obtained from the Medical Advisor at the following address: Driver and Vehicle Licensing Agency, Medical Advisory Group, Longview Road, Morriston, Swansea SA99 1TU. Tel No: 01792 783686 Fax No: 01792 783789
Irvine, J. and Petch, M. (1994) Fitness to drive: updated guidelines for cardiovascular fitness in vocational drivers. Health Trends 26:38-40.