Aidan at 12:50, 14 May 2021

2021-05-14T12:50:55Z

Maintenance script: Imported from text file

2020-07-04T01:17:32Z

Imported from text file

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== Driving ==

=== Coronary Artery Disease (CAD) ===

{|
! Syndrome
! Private
! Commercial
|-
| STEMI
| 1 mo from D/C
| 3 mo from D/C
|-
| NSTEMI with sig LV damage
| 1 mo from D/C
| 3 mo from D/C
|-
| NSTEMI with PCI
| 48 h after PCI
| 7 days after PCI
|-
| NSTEMI without PCI
| 7 days after D/C
| 30 days after D/C
|-
| Unstable angina with PCI
| 48 h after PCI
| 7 days after PCI
|-
| Unstable angina without PCI
| 7 days after D/C
| 30 days after D/C
|-
| Stable angina or asymptomatic CAD
| No restriction
| No restriction
|-
| Stable CAD with PCI
| 48 h after PCI
| 7 days after PCI
|-
| CABG
| 1 mo after D/C
| 3 mo after D/C
|-
| Any, with 50% left main
|
| Disqualified until treated
|-
| Any, with 70% left main
| Disqualified until treated
|
|}

Minor/non-significant LV damage is the abscence of new wall motion abnormality

=== Dysrhythmias ===

{|
! Syndrome
! Private
! Commercial
|-
| VF without reversible cause
| 6 mo after event
| Disqualified
|-
| Unstable VT
| 6 mo after event
| Disqualified
|-
| VT or VF with reversible cause
| Until cause is treated
| Until cause is treated
|-
| Sustained VT, LVEF <30%
| 3 mo after event & controlled
| Disqualified
|-
| Sustained VT, LVEF ≥30%
| 4 wk after event & controlled
| 3 mo after event
|-
| NSVT
| No restriction
| No restriction
|-
| Paroxysmal SVT/AF with impaired LOC
| When controlled
| When controlled
|-
| SVT/AF without impaired LOC
| No restriction
| No restriction
|-
| Symptomatic SSS
| Until treated
| Until treated
|}

AF = atrial fibrillation or flutter

==== Heart Block ====

{|
! Syndrome
! Private
! Commercial
|-
| Isolated 1º HB
| No restriction
| No restriction
|-
| Isolated RBBB
| No restriction
| No restriction
|-
| Isolated LAFB
| No restriction
| No restriction
|-
| Isolated LPFB
| No restriction
| No restriction
|-
| LBBB
| If no impaired LOC
| If no impaired LOC*
|-
| Bifascicular block
| If no impaired LOC
| If no impaired LOC*
|-
| 2º HB, Mobitz I
| If no impaired LOC
| If no impaired LOC*
|-
| 1º HB with bifascicular block
| If no impaired LOC
| If no impaired LOC*
|-
| 2º HB, Mobitz II
| Disqualified
| Disqualified
|-
| Alternating LBBB & RBBB
| Disqualified
| Disqualified
|-
| Acquired 3º HB
| Disqualified
| Disqualified
|-
| Congenital 3º HB
| If no impaired LOC
| If no impaired LOC**
|}

* and no higher block on annual 24 h Holter ** and QRS ≤110, and no pauses ≥3 sec on annual 24 H holter

==== Pacemakers and ICDs ====

{|
! Syndrome
! Private
! Commercial
|-
| PPM
| 1 wk after implant*
| 1 mo after implant*
|-
| ICD for 1º prophylaxis
| 4 wk after implant
| Disqualified
|-
| ICD for symptomatic VF/VT
| 6 mo after event
| Disqualified
|-
| ICD for sustained VT
| 1 wk after implant
| Disqualified
|-
| ICD giving shocks
| 6 mo after event
| Disqualified
|}

* as well as no impaired LOC, normal sensing and capture, and no evidence of PPM malfunction

==== Other Dysrhythmias ====

{|
! Syndrome
! Private
! Commercial
|-
| Brugada, long QT, or arrhythmogenic RV cardiomyopathy
| Once investigated
| Disqualified
|-
| Cather ablation
| 48 h after D/C
| 1 wk after D/C
|}

=== Syncope ===

{|
! Syndrome
! Private
! Commercial
|-
| 1x vasovagal
| No restriction
| No restriction
|-
| Treated cause (e.g. with PPM)
| 1 wk after treatment
| 1 mo after treatment
|-
| Reversible cause (e.g. dehydration)
| After treatment
| After treatment
|-
| Situational syncope with avoidable trigger
| 1 wk after episode
| 1 wk after episode
|-
| 1x unexplained
| 1 wk after episode
| 12 mo after episode
|-
| Recurrent vasovagal in 12 mo
| 1 wk after episode
| 12 mo after episode
|-
| Recurrent unexplained in 12 mo
| 3 mo after episode
| 12 mo after episode
|-
| Due to arrhythmia
| See Dysrhythmia section
| See Dysrhythmia section
|}

=== Valvular Disease ===

{|
! Syndrome
! Private
! Commerical
|-
| AS
| NYHA I or II with no impaired LOC
| Asymptomatic, NYHA I, AVA ≥1cm, EF ≥35%
|-
| AR/MS/MR
| NYHA I or II with no impaired LOC
| No impaired LOC, NYHA I, EF ≥35%
|-
| Mechanical valve BioMVR or MV repair with AF
| 6 wk from D/C No embolic, on A/C
| 3 mo from D/C No embolic, on A/C, NYHA I, EF ≥35%
|-
| BioAVR BioMVR or MV repair without AF
| 6 wk after D/C No embolic
| 3 mo after D/C No embolic, NYHA I, EF ≥35%
|}

=== Heart Failure ===

{|
! Syndrome
! Private
! Commercial
|-
| NYHA I
| No restriction
| EF ≥35%
|-
| NYHA II
| No restriction
| EF ≥35%
|-
| NYHA III
| No restriction
| Disqualified
|-
| NYHA IV
| Disqualified
| Disqualified
|-
| Receiving inotropes
| Disqualified
| Disqualified
|-
| LVAD
| Disqualified
| Disqualified
|-
| Heart transplant
| 6 wk after D/C NYHA I or II, on stable Rx
| 6 mo after D/C EF ≥35%, NYHA I No evidence of ischemia on testing
|}

=== Hypertrophic Cardiomyopathy ===

* Private: no impaired LOC
* Commercial: LV wall thickness <30 mm, no syncope, no NSVT on annual 24 h Holter, no FHx sudden death at young age, and no hypotension with exercise

== Flying ==

{|
! Condition
! NYHA
! Travel
|-
| Angina
| I/II
| No restriction
|-
| Angina
| III
| Supplemental oxygen required
|-
| Angina
| IV
| Only if medically necessary and accompanied
|-
| Recent MI
| I
| 1 to 2 weeks for repatriation if uncomplicated and revascularized 6 to 8 weeks for elective travel
|-
| Heart failure
| I/II
| Unrestricted
|-
| Heart failure
| III
| Supplemental oxygen required
|-
| Valvular disease
| I/II
| Unrestricted; supplemental oxygen if pulmonary hypertension
|-
| Valvular disease
| III
| Supplemental oxygen required
|-
| Valvular disease
| IV
| Only if medically necessary and accompanied
|-
| Congenital
| I/II
| Unrestricted; supplemental oxygen if PaO2 <70 mmHg
|-
| Congenital
| III
| Supplemental oxygen required
|-
| Congenital
| IV
| Only if medically necessary and accompanied
|-
| Recent CABG/valve surgery
| I/II
| 4 days post-surgery if Hb ≥90 and flight <2 h 7 days post-surgery if Hb ≥90 and flight ≤2 h
|-
| PCI/ASD closure
| I/II
| 1 day postprocedure If PCI, following CAD guidelines, above
|-
| Post-arrhythmia procedure
| I/II
| Well-controlled SVT: unrestricted 1 day post-procedure for SVT 2 days post-procedure for ventricular arrhythmias
|-
| Post-arrhythmia procedure
| III/IV
| Uncontrolled hemodynamically significant ventricular arrhythmias should not fly
|-
| Post-PPM/ICD/loop recorder
| I/II
| 1 day post-implant if no pneumothorax, and device is functioning
|-
| ICD patients
| I/II
| 1 mo following last shock associated with severe presyncope or syncope
|}

=== DVT Prophylaxis ===

Routine precautions include:

* Avoid stasis, move around cabin, isometric calf exercises
* Avoid dehydration, alcohol, and caffeine

{|
! Patient Population
! Recommendations
|-
| Flight <12 h
| Routine
|-
| Flight ≥12 h, low risk
| Routine
|-
| Flight ≥12 h, moderate risk
| Routine with pressure stockings or ASA 160-325 mg 4 h before flight
|-
| Flight ≥12 h, high risk
| Routine with pressure stockings or LMWH 2 h before flight
|}

* '''Moderate risk:''' patients aged >75 years, women >45 on estrogen, pregnant or post-partum women, age <45 years with heterozygous FVL or prothrombin mutations, patients with varicose veins, heart failure, MI within 6 weeks, or lower limb trauma within 6 weeks
* '''High risk:''' previous VTE, major surgery within 6 weeks, active malignancy, gross obesity or marked immobility due to neuromuscular or cardiorespiratory disease, people age >45 with antithrombin/protein C/protein S deficiency, people age >75 with cardiac or pulmonary disease

== Further Reading ==

* [https://ccs.ca/images/Guidelines/Guidelines_POS_Library/DF_CC_2003_ES.pdf CCS Consensus Conference 2003: Assessment of the cardiac patient for fitness to drive and fly – Executive summary]

[[Category:Guidelines]]
[[Category:Cardiology]]

Drive + Fly - Revision history

Aidan at 12:50, 14 May 2021

Maintenance script: Imported from text file