If you are a professional driver or an applicant driver, you may be required to prove your medical and cardiac fitness. Licensing authorities, such as the Driver and Vehicle Licensing Agency (DVLA), Transport for London (TfL) and the Public Carriage Office (PCO) may require you to undergo cardiac testing to ensure that you are medically fit and able to safely drive your vehicle.
Without these cardiac tests, you may not satisfy all the criteria set out in the driving license guidelines and may not have your license approved.
Professional drivers that may require a cardiac test include:
· Heavy Goods Vehicles (HGV) drivers.
· Bus drivers.
· Private hire drivers, including taxi drivers.
· Ambulance and other health service vehicle drivers.
· Fire engine drivers.
· Coastguard drivers.
· Police car drivers.
Any of the above drivers may be required to undergo a cardiac test and prove their cardiac fitness.
UK driving licenses are split into two groups:
· Group 1: Including cars and motorcycles.
· Group 2: Including large lorries(category C vehicles) and buses (category D vehicles).
The medical standards required for Group 2 drivers are considerably more stringent than Group 1 drivers. This could be because of the increased size and weight of Group 2 vehicles and the increased length of time typically spent driving these types of vehicles. To drive a Group 2 vehicle, you will likely need to submit an application and undergo a medical assessment, which will also need to be renewed at 45 years of age. A cardiac test may be part of this application and the renewal process.
Many licensing authorities and relevant bodies refer to the DVLA’s Group 2 requirements for professional drivers, even if you do not drive a Group 2 vehicle. Some relevant bodies, such as TfL or the police service may have specific medical requirements for their drivers, that include cardiac tests. Additionally, any professional driver who is diagnosed with a heart condition, such as coronary heart disease, angina or heart failure, or experiences a cardiac event, such as a heart attack, may be required to undergo a cardiac test with an accredited cardiologist before they are able to drive again or before they are approved to work as a professional driver.
The most common cardiac test that is required by DVLA, TfL, PCO and other licensing agencies is an exercise tolerance test. If you fail the exercise tolerance test, you may need to undergo a stress echocardiogram, either with medication that increases your heart rate, a treadmill stress echocardiogram or a myocardial perfusion scan. If you have a previous history of cardiac disease or valvular disease, you may be required to get an echocardiogram.
Please find below the explanations of all the necessary tests and in particular the exercise tolerance test.
Exercise Tolerance Test (ETT):
An ETT is a type of electrocardiogram test that measures the electrical activity of your heart while it is under physiological stress. The test will be done while you are exercising, as this is when your heart muscles contract faster and harder, your heart beats faster and there is an increased blood flow from your coronary arteries. An ETT shows how well your heart functions while you are exerting yourself and how effectively your blood flows through your coronary arteries.
An ETT can:
· Detect coronary heart disease.
· Assess the electrical activity of your heart.
· Assess your heart rate and your heart rhythm.
· Assess how effectively the blood circulates around your heart.
· Evaluate the overall function of your heart.
Even if your heart rate is normal during rest, some abnormalities can only be detected when you are exerting yourself, which is why an ETT is the most commonly requested cardiac test for professional drivers.
During your ETT, small electrodes are attached to your shoulders and chest and are then connected to an ECG machine. You will then be asked to exercise, either on a treadmill or an exercise bike. The exercise will begin slowly and gradually increase until it becomes more strenuous.
An echocardiogram, commonly referred to as an echo, may be required, particularly if you have had a heart attack or heart surgery. Drivers with certain heart conditions may also need to have an echocardiogram every three years.
An echocardiogram is a type of ultrasound scan. High-frequency sound waves are sent into your heart and bounce off different parts of your heart and the surrounding areas. This creates a moving picture of your heart.
An echo can show the structure of your heart and the surrounding blood vessels and the size of your heart. It assesses the overall function of your heart and your heart’s pumping ability. Echocardiograms are used to detect any structural or functional abnormalities, detect any damage to your heart and investigate a number of heart conditions, heart diseases, cardiac tumours and infections.
Treadmill Stress Echocardiogram:
A treadmill stress echocardiogram is similar to an ETT, except that instead of measuring the electrical impulses of your heart, it looks at any irregularities in the structure of your heart and the surrounding blood vessels.
A stress echocardiogram may be recommended if an ETT cannot be conducted (for example, if you have arthritis) or if the results of the ETT or echo were inconclusive.
During a treadmill stress echocardiogram, you will be given a heart ultrasound before exercising. You will then be asked to exercise on a treadmill until you reach your maximum exercise capacity. Once you have reached your maximum capacity, you will stop exercising and another echocardiogram will be done. This allows a direct comparison between your baseline and your post-exercise heart scan.