Heart failure, myocardiopathy, myocarditis and their influence on driving

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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.

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.

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.

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 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.