Angina Pectoris

Angina pectoris is at the lower end of the spectrum for risk of adverse clinical outcomes among individuals with coronary heart disease (CHD). The presence of this condition usually implies that at least one coronary artery has hemodynamically significant narrowing.

When evaluating the driver with angina, you should distinguish between stable and unstable angina. The presence of unstable angina may be a precursor to a cardiovascular episode known to be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure.

Stable angina

May be precipitated by a predictable pattern, including:

• Exertion.
• Emotion.
• Extremes in weather.
• Sexual activity.

Unstable angina

Has an unpredictable course characterized by:

• Pain occurring at rest.
• Changes in pattern (i.e., increased frequency and longer duration).
• Decreased response to medication.

Waiting period

Minimum — 3 months with no rest angina or change in angina pattern

NOTE: If more than one waiting period applies (because of multiple cardiac conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period.

Decision

Maximum certification period — 1 year

Recommend to certify if:

The driver:

• Has stable angina.
• Is asymptomatic.
• Tolerates medications.
• Has a satisfactory exercise tolerance test (ETT).

Recommend not to certify if:

The driver has had unstable angina within 3 months of examination.

Monitoring/Testing

The driver should obtain:

• Evaluation from a cardiovascular specialist who understands the functions and demands of commercial driving.
• Biennial ETT.

NOTE: If an ETT is inconclusive, an imaging stress test may be indicated.

Follow-up

The driver should have an annual medical examination.

Commercial Drivers With Known CHD Recommendation Tables (PDF) — Angina Pectoris