Table of Contents

2.2.2 Ischaemic heart disease

In individuals with ischaemic heart disease, the severity rather than the mere presence of ischaemic heart disease should be the primary consideration in assessing fitness to drive. The health professional should consider any symptoms of sufficient severity to be a risk while driving. Those who have had a previous myocardial infarction or similar event are at greater risk of recurrence than the normal population, thus cardiac history is an important consideration. An electrocardiogram (ECG) should be performed if clinically indicated.

Exercise testing. The Bruce protocol is recommended for formal exercise testing. Nomograms for assessing functional capacity are shown in Figure 7 and Figure 8.

Suspected angina pectoris. Where chest pains of uncertain origin are reported, every attempt should be made to reach a diagnosis. In the meantime, the person should be advised to restrict their driving until their licence status is determined, particularly in the case of commercial vehicle drivers. If the tests are positive or the person remains symptomatic and requires antianginal medication to control symptoms, the requirements listed for proven angina pectoris apply.

Risk factors. Multiple risk factors interact in the development of ischaemic heart disease and stroke. These factors include age, sex, high blood pressure, smoking, total cholesterol:HDL ratio, diabetes, ECG changes, family history and sedentary lifestyle. The combined effect of these factors on risk of cardiovascular disease may be calculated using the Australian Cardiovascular Risk Charts (an electronic calculator is available at <www.cvdcheck.org.au>).

Routine screening for these risk factors is not required for licensing purposes, except where specified for certain commercial vehicle drivers as part of their additional accreditation or endorsement requirements. However, when a risk factor such as high blood pressure is being managed, it is good practice to assess other risk factors and to calculate overall risk. This risk assessment may be helpful additional information in determining fitness to drive, especially for commercial vehicle drivers (refer also to section 2.2.3 High blood pressure).

Figure 7: Bruce protocol nomogram for men

Figure 8: Bruce protocol nomogram for women