Following on from my article about flying with various heart conditions I am following up with an article on driving and heart conditions. This is an extremely common question posed by patients to their cardiologist i.e. ‘Is it safe for me to drive with this heart condition?’. Driving is an important and sometimes essential part of our lives and patient’s jobs often depend on the ability to drive. Having restrictions imposed on patients because of certain heart conditions can have an impact on a patient’s quality of life and lead to numerous problems. Imagine having your driving licence taken away from you for something out of your control, such as your heart health and the impact that could have? Similar to the restrictions on flying there are a myriad of different heart conditions and it would be impossible to list all of them and the potential restrictions that they can carry. Additionally, the type of licence held by the patient also carries a number of restrictions. Patients with a Group 2 licence (HGV drivers) will have more severe restrictions imposed than those with a standard Group 1 licence (ordinary motor vehicles). A full list of the various heart conditions and their associated restrictions are listed on the DVLA website
https://www.gov.uk/guidance/assessing-fitness-to-drive-a-guide-for-medical-professionals
Additionally, if a patient holds a licence for a taxi the restrictions will vary according to the local council who issue the licence.
Driving with heart problems – the top 5 heart conditions
I have created a list of the top 5 heart conditions and the driving restrictions associated with them. The advice given in the article is a guide and clarification should always be sought with your cardiologist. Additional heart tests are often required to clarify the diagnosis of the particular heart condition and confirm the length of time driving may be affected.
Fainting or blackout
Many people will have suffered a blackout or faint at some point in their lives.
The vast majority of these would have been due to a simple faint and there are no particular restrictions on driving if it is established that the diagnosis was a simple faint (also known as vaso-vagal syncope). It may be helpful to see a cardiologist to establish whether this was a simple faint or if further heart tests are required. If the faint occurs while standing then this is one of the indications the loss of consciousness was a simple fainting episode and there are not normally any driving restrictions for this. There may be certain ‘triggers’ or circumstances that have provoked the fainting such as standing for a prolonged period of time, being in pain, being hot or feeling hot, or viewing something such as blood or gore. If the faint occurs while sitting this may suggest a different cause, possibly a problem with the heart rhythm or heart rate.
If the cause of the blackout is suspected to be related to an abnormal heart condition then further heart tests will be required such as a 12 lead ECG, echocardiography and ambulatory ECG monitoring.
If no underlying diagnosis has been made there is a possibility of a 12-month ban from driving. For patients who hold an HGV licence, the criteria are much stricter and patients may be banned from driving even for what appears to be a simple fainting episode until further heart tests are conducted and a formal diagnosis confirmed.
Heart attack and angina
If a patient has suffered a heart attack immediate driving after the event is forbidden. Patients who are unfortunate to suffer a heart attack usually have coronary angiography and angioplasty to treat the heart attack. If the heart attack has been successfully treated with coronary angioplasty and stent insertion patients may drive 1 week after the event and do not need to inform the DVLA for a standard group 1 car licence. The one proviso mentioned by the DVLA is the patient must have an echocardiogram that shows a left ventricular ejection fraction of at least 40%.
For patients who have a group 2 licence (HGV drivers) and taxi drivers, the conditions for re-issue of the licence are much more stringent. Patients must be able to complete the DVLA exercise ECG requirements, which is the ability to walk for 9 minutes on a treadmill at 3 stages each of which has a progressively steeper incline. In addition, the patient would need to demonstrate that they have an ejection fraction of at least 40% on a transthoracic echocardiogram.
For patients with angina, an ordinary group 1 licence may allow them to continue to drive provided they are not having rest symptoms. For group 2 licences (HGV and taxi licence) the exercise ECG requirements will apply and 9 minutes of exercise on an exercise ECG must be completed.
Patients who have had coronary artery bypass graft surgery driving can resume 4 weeks after the operation. Again HGV and taxi drivers the usual exercise ECG requirements must be met along with the requirements for echocardiography to show an ejection fraction of at least 40%.
Heart failure
Heart failure is a broad term that covers a number of different conditions including cardiomyopathies (heart muscle diseases). For patients who hold a group 2 (HGV) licence, the heart function (ejection fraction) must be at least 40% for the licence to remain. For a standard group 1 (car) licence there are no restrictions on driving as long as the condition is stable and there are no symptoms likely to distract the driver.
Hypertension
For patients with hypertension (high blood pressure), there are no driving restrictions for a group 1 licence. The DVLA do mention that any treatment for hypertension must not have any side effects that affect safe driving. For patients with hypertension who have a group 2 licence (HGV) the systolic blood pressure must be below 180 mmHg and the diastolic below 100 mmHg.
Pacemaker implant
For patients with a pacemaker, there are no restrictions on having a group 1 or group 2 licence provided the pacemaker is subjected to regular checks in a clinic. If the pacemaker battery has to be replaced there is a 1-week mandatory ban from driving for a group 1 (car) licence and a 6-week ban for a group 2 (HGV) licence.
For any conditions that haven’t been covered, there is a comprehensive list with the DVLA. If there is any doubt it is worth speaking with your cardiologist about what is allowed and further heart tests may be required to clarify the requirements set out by the DVLA.
