News Dedicated to a Healthy Workplace August 2012
DOT Medical Guidelines: Cardiovascular Disease
The Department of Transportation (DOT) Medical Examination is highly regulated and has potentially serious consequences for the driver, the examiner and the public. DOT medical guidelines outline health criteria commercial vehicle drivers must meet to qualify for certification. Specific guidelines for individuals with a history of cardiovascular disease are clearly defined. DOT recognizes three conditions, including different certification implications for each. This often causes confusion for drivers and their employers leading to delays in certification. The following is a summary of each cardiovascular condition and the rule it carries for certification. 

Acute Myocardial Infarction (Heart Attack) 
At the onset of an acute myocardial infarction, the individual should immediately be placed on temporary suspension from DOT certification. To regain certification, the individual must be at least two months past the time of their infarction and must be cleared by a cardiologist to return to work. Clearance involves meeting certain medical parameters regarding heart function including the heart's ability to adequately act as a pump (ie. cardiac output measurement). Such a determination usually requires specific testing that may or may not have been done routinely after the initial infarction. Patients seeking re-certification at BarnesCare shortly after their heart attack will need to provide this information to our medical staff before certification can be approved. For patients with a history of myocardial infarction, annual re-examination and certification renewal is required. As part of that re-examination, the patient must document having passed a heart stress test at least every two years. 

Percutaneous Coronary Intervention 
Percutaneous coronary intervention (PCI) is medical terminology for patients who have had a blockage of one or more of the heart arteries reopened or widened by use of a tube or catheter. The procedure either opens the artery by expanding a small balloon in the area of the narrowed blood vessel (called an angioplasty), or by placing a permanent hollow tube or "stent" in the narrowed area which forces open the vessel (called coronary stenting). Patients having undergone PCI procedures may return to commercial driving one week after their procedure but only with the approval of the heart specialist. Re-certification covers a period of three to six months, after which time a heart stress test is required before extension to a full-year certification can be given. Thereafter, annual renewal is required with heart stress testing performed at least every two years. Yearly evaluation by a heart specialist is recommended. 

Coronary Artery Bypass Surgery 
This surgery involves opening up the chest wall and ribs to expose the heart and then using veins from other parts of the body to bypass blocked areas of the heart arteries. Individuals are able to return to commercial driving if approved by the heart specialist and if at least three months have passed since the surgical correction. In addition, as with acute myocardial infarction, individuals are required to have a test for adequacy of cardiac output before re-certification. All individuals having undergone bypass surgery must have yearly certification renewals. In addition, annual heart stress testing is mandatory five years or more past surgery. 

At BarnesCare, our medical professionals conduct thousands of DOT medical examinations each year. Our providers have a thorough understanding of the regulations. “These medical guidelines can be quite complex,” says Scott C. Jones, DO, MPH, FAOCOPM, BarnesCare medical director. “The medical team at BarnesCare understands the DOT regulations and their importance in promoting driver health, wellness and public safety. We are always available to answer any questions or concerns you may have.”

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