Heart failure, myocardiopathy, myocarditis and their influence on driving

Heart failure, myocardiopathy, myocarditis and their influence on driving Heart failure, myocardiopathy, myocarditis and their influence on driving play

In Spain, there are over 130,000 deaths and more than five million hospitalisations caused by cardiovascular disease every year, making it the main cause of death and hospitalisation among the population.

Forty per cent of Spaniards are in danger of suffering from cardiovascular disease, because they suffer from two or more life-style-related risk factors and have no symptoms.
These modifiable risk factors are dyslipidemia, arterial hypertension, smoking, diabetes, obesity, sedentary lifestyle and poor eating habits.

Heart failure

This includes disorders that weaken ventricular function, conditions that reduce ventricular input, and irregularities in output caused by excess pressure.

Left-sided heart failure causes shortness of breath, orthopnea, cough and paroxysmal nocturnal dyspnoea.

Right-sided heart failure causes dyspepsia, right hypochondrial pain, constipation and lower limb oedema.

In either case, fatigue, oliguria, nocturia, anorexia, mental confusion and syncope can all occur, because of poor efficiency.

Congestive heart failure (CHF) has serious effects on the lungs with rales, peripheral oedema, hepatomegaly and ascites, with distension of the jugular vein.

  • The NYHA (New York Heart Association) functional evaluation classification divides cardiovascular patients into four groups:
    • Class I. There are no limitations on ordinary physical activities.
    • Class II. Symptoms appear with ordinary physical activity.
    • Class III. Marked limitation of physical activity. Less-strenuous-than-ordinary activities trigger the appearance of symptoms.
    • Class IV. Symptoms occur even while resting, worsening with even the slightest activity.
  • Medical treatment of heart failure is based on diuretics, inotropes and vasodilators, and should be painstakingly controlled according to the cause of the heart failure and response to the therapy.  Pharmacological treatments can cause side effects.
    • Digoxin often causes digitalis intoxication, with digestive symptoms such as anorexia, nausea, vomiting, and diarrhoea, neurological symptoms such as looseness, visual disturbances, delirium and psychosis, and cardiac symptoms with arrhythmia.
    • Isosorbide dinitrate and its derivatives, and topical and sublingual nitroglycerine, can cause headaches, vertigo and hypotension that interfere with driving.
    • Prazosin and captopril can cause hypotension.
    • Hydralazine is often associated with headaches, fever, eruptions, etc.

Advice on Heart failure

  • Vehicles driving can be considered to be a form of minor physical exertion. Therefore, the symptoms will rarely interfere with driving, except in serious cases in classes III and IV. -{}-
  • Patients should be warned of the side effects of their prescribed medication, which could make it seriously dangerous for them to drive.
  • Patients with chronic heart failure should drive only short distances.
  • For unavoidable longer journeys, it is advisable to travel with a companion, comply with medication and meal schedules, eat a salt-free diet while on the road, avoid rush hours and hot conditions, make frequent stops, and walk around to prevent any worsening of lower limb oedema.
  • If at any time while driving the patient feels ill, the patient should be recommended to stop as soon as possible and ask for help. Under no circumstances should the patient drive himself to hospital.
  • If the specialist recommends preventative medication in case symptoms appear, remind the patient to carry them with him inside the car.
  • The same applies to a copy of the cardiology report, which should be kept in a visible location or near the driver in case he needs to ask for help in an emergency.
  • But it must also be taken into account that a patient with heart failure whose symptoms do not interfere with driving, could nevertheless be suffering from a disease that is causing the heart failure, and which could cause sudden, serious arrhythmia with partial or total loss of consciousness and sudden death.
  • Patients with serious heart failure, or poorly compensated heart failure, or who have few symptoms but are at risk of syncope and sudden death, must not drive.
  • It is true that the severity of the dyspnoea is indicative of the decrease in ventricular function, which is the cause of serious arrhythmia.
  • Therefore, an evaluation of the dyspnoea is usually a reliable indictor of risk.
  • Drivers who suffer from dyspnoea and symptoms of low cardiac output are less alert and are at greater risk of being involved in an accident, therefore they must not drive.

Cor pulmonale

Among the symptoms are dyspnoea, cough, tiredness, foot oedema and cyanosis, meaning driving is difficult because of a marked detrimental effect on levels of alertness and concentration.

The specialist will evaluate at what point in the progression of the disease the patient should be advised not to drive, making reference to this in a report.

Myocardiopathy and myocarditis

  • Dilated myocardiopathy produces congestive heart failure and lead to intense arrhythmia and peripheral embolisms by caused by thrombi of the left ventricle.
  • Restrictive myocardiopathy causes congestive heart failure, with predominant leg oedema and ascites, and can also present signs of left ventricular failure.
  • Obstructive hypertrophic myocardiopathy is characterised by stress-induced dyspnoea, angina, arrythmia and presyncope. There is a risk of sudden death.
  • Myocarditis can become worse, leading to chronic dilated myocardiopathy with congestive heart failure, and can be accompanied by pericarditis.

Advice on Cor Pulmonale

  • Patients with dyspnoea must not drive.
  • The specialist will evaluate at what point in the progression of the disease the patient should be advised not to drive, making reference to this in a report.

Advice on Myocardiopathy and myocarditis

  • Driving depends on functional cardiac capacity, the presence of arrhythmia, and the risk of embolism.
  • The specialist will issue information regarding the level of risks of driving at each check up, and whenever necessary will advise against doing so.

Advice on Restrictive myocardiopathy

  • Driving depends on functional cardiac capacity.
  • Patients suffering from congestive heart disease and left ventricular failure must not drive.
  • The specialist will give information of the level of risk at the wheel at each check up, and whenever necessary will advise against driving.

Advice on Obstructive hypertrophic myocardiopathy

  • The patient must not drive, except in cases where he or she has symptoms and is being strictly controlled by medical or surgical treatment, and will only do so on the advice of the specialist throughout the follow up of the disease.
  • When there is risk of sudden death the patient must not drive.

Advice on Myocarditis

  • Driving is not advised until the symptoms have remitted without leaving sequelae.