Peripheral vascular disease of the limbs can be disabling, but modern therapy often can restore adequate function. Effective preventive programs, supported by all concerned, should reduce mortality, morbidity, and early forced retirement in a highly cost-effective manner. Valvular, Myocardial, Pericardial, and Congenital Heart Disease Commercial drivers with many of the above conditions can be certified if free of significant cardiac impairment and not prone to disabling cardiac dysrhythmias. Echo-Doppler studies, exercise tolerance testing, and ambulatory monitoring have provided adequate data in many cases. Some prosthetic materials are acceptable, but need for anticoagulation is considered disqualifying.
Frequent followup is advisable and in some cases mandatory.
In these areas, diagnostic and therapeutic capabilities have advanced rapidly, but major concerns remain relative to sudden incapacitating e vents even with the best of both pharmacologic and instrumental approaches. Debate continues concerning the ability to permit pacemaker-dependent persons to qualify for commercial motor vehicle driving. Although therapeutic regimens can include a wide variety of pharmacologic agents without impairments contraindicating commercial motor vehicle driving, there are some agents that are particularly likely to compromise mental or cardiovascular capabilities. Guanethidine is also likely to produce unacceptable orthostatic hypotension, causing inadequate cerebral blood flow. Most patients requiring amiodarone have conditions incompatible with commercial driving responsibilities, and many patients on anticoagulants have conditions of unacceptably high risk.