Syncope

Syncope is a symptom, not a medical condition, that can present an immediate threat to public safety when causing the driver of a commercial motor vehicle to lose control of the vehicle.

As an example, syncope as a consequence of an arrhythmia while driving, places the driver and others around the driver at the time in serious jeopardy. Medications are available that are effective in managing ventricular arrhythmias and, although they are designed to prevent occurrences, they are not "fail-safe" and if an arrhythmia recurs, syncope may follow.

Recurrent, unexplained syncope and syncope from cardiac causes may herald a markedly increased future risk for sudden death.

As a medical examiner, you should ensure that:

• Diagnosis distinguishes between pre-syncope (i.e., dizziness, lightheadedness) and true syncope (i.e., loss of consciousness).
• The medications used by the driver do not predispose the driver to precipitous declines in blood pressure, syncope, fatigue, or electrolyte shifts and imbalances.
• Cardiac-based syncope is differentiated from other causes of syncope.
  • Conduction system diseases that cause syncope must be treated before the driver is considered for certification.
• Other forms of syncope, such as neurological-based conditions (e.g., migraine headache, seizures) are adequately evaluated.

You may refer to the Cardiovascular Advisory Panel Guidelines for the Medical Examination of Commercial Motor Vehicle Drivers for diagnosis-specific recommendations for:

• Hypersensitive carotid sinus with syncope.
• Neurocardiogenic syncope.

The complete text of the medical conference reports can be accessed from FMCSA Medical Reports.

Waiting period

No recommended time frame

You should not certify the driver until etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable.

If applicable, refer to the pacemaker guidelines.

Decision

Maximum certification period — 1 year

Recommend to certify if:

The driver:

• Has been treated for symptomatic disease.
• Is asymptomatic.
• Tolerates medications.
• Is at low risk for syncope/near syncope.
• Has clearance from an appropriate specialist (e.g., cardiologist, neurologist) who understands the functions and demands of commercial driving.

Recommend not to certify if:

The driver:

• Experiences syncope as a consequence of the disease process, regardless of the underlying condition.
• Is at high risk for syncope/near syncope, regardless of the underlying heart disease and/or treatment.

NOTE: Distinguish between treatments that reduce the risk for syncope and treatments where the driver remains at risk for syncope. Certification also depends on the risk for syncope and sudden incapacitation from the underlying heart disease that may remain even after successful treatment of the conduction system disease.

Monitoring/Testing

The driver should:

• Comply with medication and/or treatment guidelines, when appropriate.
• Have annual evaluation by a cardiovascular specialist who understands the functions and demands of commercial driving (refer to diagnosis-specific recommendations).

Follow-up

The driver should have an annual medical examination.

See the Supraventricular Tachycardias Recommendation Table (PDF) and Pacemakers Recommendation Table (PDF) for diagnosis-specific recommendations.