Rule 375-3-5-.03. Cardiovascular Function

Certain cases of heart disease, hypertensive vascular disease, peripheral vascular disease, and aneurysms will cause the suffering individual to be reviewed under this section.

1. (a) Heart disease--Organic heart disease is divided into three groups. A fourth group deals with certain arrhythmias.

   1. 1. Group A--A driver is in Group A when:

      1. (i) he has asymptomatic heart disease; and
      2. (ii) the single or double masters' two step test does not produce symptoms, or alterations of the ECG; and
      3. (iii) prolonged exertion, emotional stress, hurrying, hill climbing, recreation, or daily activities do not produce pathological symptoms, and
      4. (iv) signs of congestive heart failure are not present.

   2. 2. Group B--A driver is in Group B when he has organic heart disease and one or more of the following:

      1. (i) walking one or two level blocks, climbing one flight of stairs, or the performance of usual activities produces symptoms, or
      2. (ii) master's Two Step Test produces symptoms and ECG changes indicative of anoxia, or
      3. (iii) emotional stress, hurrying, hill climbing, recreation, or similar activities produce pathologic symptoms, or
      4. (iv) signs of congestive failure, if present, or relieved by therapy.

   3. 3. Group C--A driver is in Group C when he has organic heart disease with symptoms at rest, and one or both of the following:

      1. (i) The performance of any of the activities of daily living beyond the personal toilet or its equivalent produces increased discomfort, or
      2. (ii) Signs of congestive failure, if any present, are resistant to therapy.

   4. 4. Group D--This group includes individuals with cardia arryhthmias. While some of these ailments, such as chronic asymptomatic atrial fibrillation usually do not present notable impairments, other such as paroxysmal atrial flutter do present a high risk of catastrophe. Hence, consideration must be based on their risk factor, which can be arrived at only by evaluating each disease entity.

      Class C Class M Class B A Yes Yes Individual          Consideration B Yes No No C Unsafe-No No No D Individual Individual Individual    Consideration Consideration Consideration    Class A Periodic Limited       Reevaluation License A Individual Yes No    Consideration       B No Yes Yes C No Yes Yes D Individual Yes Yes    Consideration

2. (b) Cardiac Pacemakers--Individuals with implanted pacemakers to control heart rate should not be recommended for Class M, A or B licenses. They may reasonably be given a medical review at yearly intervals by a physician familiar with cardiac pacemakers.

3. (c) Hypertensive Vascular Disease--A repeatedly elevated diastolic pressure over 90 mm Hg. in an untreated individual is, for purposes of these guidelines assumed, to be diagnostic of hypertension. Transient headaches from this disease must be judged on an individual basis to determine their severity, frequency, and subsequent interference with the individual's driving ability.

   1. 1. Group A--Diastolic pressure repeatedly over 90 mm. Hg. and none of the following:

      1. (i) abnormalities of urinalysis or urinary function tests;
      2. (ii) history of hypertensive cerebrovascular damage;
      3. (iii) evidence of left ventricular hypertrophy; or
      4. (iv) hypertensive abnormalities of the optic fundus.

   2. 2. Group B--A repeatedly elevated diastolic pressure over 90 mm. Hg. and any one of the following:

      1. (i) proteinuria and abnormalities is the urinary sediment but no impairment to the renal function;
      2. (ii) evidence of left ventricular hypertrophy, or
      3. (iii) definite hypertensive changes in the retinal arterioles without hemorrhages.

   3. 3. Group C--A repeatedly elevated diastolic pressure over 90 mm. Hg. and any two of the following:

      1. (i) diastolic pressure usually in excess of 120 mm. Hg.;
      2. (ii) proteinuria and abnormalities in the urinary sediment, with evidence of impaired renal function;
      3. (iii) hypertensive cerebrovascular damage with permanent neurological residuals;
      4. (iv) left ventricular hypertrophy;
      5. (v) retinopathy of arterioles, with hemorrhages and exudates. (Keith-Wagner Retinopathy, Stage III)

   4. 4. Group D--Repeatedly elevated diastolic pressure over 120 mm. Hg. and any two of the following:

      1. (i) diastolic pressure usually in the range of 140mm. Hg. or more;
      2. (ii) proteinuria and abnormalities of the urinary sediment with evidence of nitrogen retention;
      3. (iii) hypertensive cerebrovascular damage with permanent neurological impairment;
      4. (iv) left ventricular hypertrophy;

      5. (v) retinopathy of arterioles with papilledema (Keith-Wagner Retinopathy, Stage IV)

         Class C Class M Class B A Yes Yes Yes B Yes No No C Individual No No    Consideration       D Individual No No    Consideration          Class A Periodic Limited       Reevaluation License A Yes Yes No B No Yes Yes C No Yes Individual          Consideration D No NO NO

4. (d) Vascular Disease Affecting the Extremities. The importance of this category to the ability to drive safely depends on the impairment of the functional use of the affected extremity or extremities. This category is divided into three groups. Presence of vascular disease is presumed to have been diagnosed by existing conventional methods. Loss of pulses or arterial calcification is not considered an impairment to driving.

   1. 1. Group A--A driver is in Group A when he has vascular disease and:

      1. (i) experiences either intermittent claudication or pain at rest, or
      2. (ii) experiences only transient edema.

   2. 2. Group B--A driver is in Group B when he has vascular disease with any one of the following:

      1. (i) intermittent claudication occurring on walking more than 50 yards;
      2. (ii) vascular damage evidenced by healed amputation of any number of digits of one extremity or amputations at or above the wrist or ankle of one extremity with evidence of persistent vascular disease;
      3. (iii) healed or persistent superficial ulceration, and
      4. (iv) moderate to marked edema which is only partially controlled by elastic supports.

   3. 3. Group C--A driver is in Group C when he has vascular disease with one of the following:

      1. (i) intermittent claudication of walking less than 50 yards, or severe and constant pain at rest;
      2. (ii) vascular damage evidenced by amputations of 3 or more digits of each of two extremities, with persistent vascular disease;

      3. (iii) persistent, widespread, or deep ulceration involving any number of extremities.

         Class C Class M Class B A Yes Yes Yes B No No No C Individual No No    Consideration          Class A Periodic Limited       Reevaluation License A Yes Yes No B No Yes Yes C No No Yes

5. (e) Aneurysms. Each case should be given individual consideration. The following recommendations are intended to be very general.

   1. 1. Femoral and Popliteal Aneurysms. Persons with such conditions should be advised that long periods of sitting are dangerous. After such advice, however, they should be able to drive private automobiles safely. They should not be recommended for Classes M, A, or B licenses.
   2. 2. Aortic and Central Nervous Systems Aneurysms. In general, such individuals usually should not be recommended for a Class C or M license. None should be recommended for Class A or B licenses.

Authority: Authority O.C.G.A. Secs. 40-5-4, 40-5-34.

History. Original Rule entitled "Cardiovascular Function" adopted. F. Apr. 18, 2006; eff. May 8, 2006.