2010 BC Guide in Determining Fitness to Drive

Individuals who have undergone valve replacement surgery are subject to a certain irreducibleincidence of late complications such as thromboembolism, dehiscence, infection and mechanicalmalfunction.Congestive heart failureCongestive heart failure usually is a chronic, progressive condition in which the heart is unableto pump the quantity of blood required to meet the body's needs. It is generally the result ofheart disease but may be secondary to non-cardiac conditions such as fluid overload and anemia.The severity of congestive heart failure can be assessed by measuring the fraction of blood beingpumped out of the left ventricle with each beat. This is expressed as a ratio called the leftventricle ejection fraction (LVEF). Healthy individuals generally have an LVEF greater than55%.The New York Heart Association (NYHA) functional classification system provides a simple,clinical measure for assessing the degree of heart failure. This system describes the effect ofcardiovascular disease on an individual’s general physical activity, according to the categoriesshown in the following table.CategoryIIIIIIIVDescriptionNo symptoms and no limitation in ordinary physical activity.Comfortable at rest.Mild symptoms and slight limitation during ordinary activity.Comfortable at rest.Marked limitation in activity due to symptoms, even during less-thanordinaryactivity. Comfortable only at rest.Severe limitations. Experiences symptoms even while at rest.CardiomyopathyCardiomyopathy refers to a change in the size, strength or flexibility in the heart muscle. Thesechanges can reduce the amount of blood being pumped out of the heart, and may lead tocongestive heart failure. Cardiomyopathy is associated with an increased risk of arrhythmias.Abnormal blood pressureHypertension (high blood pressure) is the most common and most important risk factor fordeveloping cardiovascular disease and stroke. Hypotension (low blood pressure) is less commonthan hypertension. Individuals with hypotension may experience syncope.161