Acute Myocardial Infarction

The first few months following an acute myocardial infarction (MI) pose the greatest risk of mortality, with the majority of deaths classified as sudden death. Current opinion among clinicians states that post-MI drivers may safely return to any occupational task provided there is no exercise-induced myocardial ischemia or left ventricular dysfunction.

Waiting period

Minimum — 2 months

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:

• Is asymptomatic.
• Tolerates medications.
• Has a satisfactory exercise tolerance test (ETT).
• Has a resting left ventricular ejection fraction (LVEF) greater than or equal to 40%.
• Has no electrocardiogram ischemic changes.

NOTE: For an initial certification following an MI, an in-hospital post-MI echocardiogram showing an LVEF greater than or equal to 40% is sufficient.

Recommend not to certify if:

The driver has:

• Rest angina or change in angina pattern within 3 months of examination.
• Ischemic changes on rest electrocardiogram (ECG).
• Intolerance to cardiovascular therapy.

Monitoring/Testing

The driver should obtain:

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

NOTE: Drivers in a rehabilitation program can receive comprehensive secondary prevention therapy.

Follow-up

The driver should have an annual medical examination.

Commercial Drivers With Known CHD Recommendation Tables (PDF) — Post-Myocardial Infarction