In this day and age driving becomes second nature to most of us from our late teens onwards, and many drivers would struggle to envisage a life without their car. When illness strikes often the furthest thing from a patient’s mind is whether or not they are fit to drive in the eyes of the law, and whether their condition is one which needs to be declared to the DVLA. Failure to inform the DVLA about a number of conditions could result in a £1,000 fine, and driving against medical advice could result in a prison sentence in the event of an accident. So, what are the rules?
Essentially the DVLA needs to know if a patient develops what they refer to as a “notifiable” condition, or if such a condition gets worse. The rules are different depending on the type of licence a person holds, and the rules for group 2 licence holders (bus and lorry drivers) are inevitably much stricter than for those in group 1 (car and motorcycle drivers). For the purposes of this article we are focussing on the requirements for group 1 licences, but the DVLA has an excellent website for further information on group 2 licences. We are also focussing solely on cardiac disorders in this article but there are a number of other notifiable conditions including (but not confined to) diabetes, epilepsy, stroke and visual impairment – if you are in any doubt, please contact the DVLA for further advice. Please note that the DVLA regularly revises its guidelines and the information below is correct as of January 2020.
In alphabetical order:
Angina is the term used to describe the symptoms caused by an inadequate blood supply to the heart, usually chest tightness. A patient with stable angina, i.e. symptoms which occur predictably with certain activities, may continue to drive, but if the angina has ever occurred with rest, emotion, or whilst driving, they must not drive until they have satisfactory symptom control. The DVLA need not be notified in either scenario.
An angiogram (also known as cardiac catheterisation) is an inpatient procedure where a fine catheter is passed through an artery in the wrist or groin to the arteries in the heart to identify any narrowings which may be obstructing blood flow to the heart muscle. If a lesion suitable for angioplasty (also known as stenting) is found, a small tube of mesh (the stent) can be expanded in the artery to reopen it and restore blood flow. This procedure can be undertaken both electively and in an emergency setting, at the time of a heart attack. In either case, as long as there are no complications, driving may resume one week post-procedure and the DVLA does not need to be notified.
Aortic aneurysm – thoracic or abdominal
An aneurysm is essentially a bulge in a blood vessel caused by a weakness in the vessel wall. If a large aneurysm bursts it can cause fatal internal bleeding and so the need or otherwise to stop driving depends on the size of the aneurysm. If the diameter is less than 6 cm then the DVLA need not be notified and driving can continue; between 6 cm and 6.4 cm the DVLA needs to be made aware and driving may be relicensed on an annual basis following medical review; and at 6.5 cm and above the patient must inform the DVLA and surrender their driving licence, although they may reapply for their licence after successful surgery.
Aortic stenosis is a narrowing of the aortic valve in the heart, which makes it harder for the heart to pump blood into the aorta, the vessel which supplies blood to the rest of the body. Patients with asymptomatic aortic stenosis may drive and the DVLA need not be notified, but if the valve stenosis is causing symptoms, the patient should stop driving and notify the DVLA.
An arrhythmia is an abnormal heart rhythm, and some are more serious than others. Many people with atrial fibrillation, the most common arrhythmia, are completely unaware of it whilst others can be very symptomatic with palpitations and lightheadedness. If the arrhythmia is likely to cause incapacity (i.e. loss of consciousness or distraction significant enough to provoke loss of control of the vehicle) then driving may only continue once the underlying cause is identified and treated, and the arrhythmia has been controlled for at least four weeks. The DVLA does not need to be informed unless the patient continues to suffer from episodes of incapacity.
An ablation is an inpatient procedure for the treatment of abnormal heart rhythms, which involves passing a fine catheter from the blood vessels in the groin up to the heart. A cardiologist can then precisely map the electrical activity of the heart and deliver a form of energy, usually radiofrequency, to the exact area responsible for the abnormal rhythm. Patients who undergo an ablation must not drive for two days post-procedure but the DVLA does not need to be notified and driving can then continue unaffected.
A cardiomyopathy is a condition whereby the heart muscle is structurally and functionally abnormal. There are three main types: hypertrophic, where a portion of the heart muscle is thickened; dilated, where the main pumping chamber of the heart becomes enlarged; and arrhythmogenic right ventricular, where the muscle of the other pumping chamber of the heart is affected. In all three cases the heart’s ability to pump normally is affected. Patients with hypertrophic and dilated cardiomyopathies may continue driving and the DVLA need not be notified. In the case of arrhythmogenic right ventricular cardiomyopathy the patient may continue driving if they have not had any symptoms associated with the condition, but they must not drive and should notify the DVLA if the arrhythmia is likely to cause incapacity.
The DVLA does not need to be notified if a patient suffers a heart attack. Driving can resume one week later if an emergency angioplasty was performed at the time (see above), or four weeks later if there was no angioplasty, provided the subsequent heart function is satisfactory (this would be determined by an echocardiogram, an ultrasound of the heart) and no further intervention by way of angioplasty or surgery is indicated.
Heart failure develops when the heart can no longer pump blood efficiently round the body. There are a number of reasons that heart failure can develop, including a heart attack, severe valve disease, or a heart muscle problem, and symptoms are typically shortness of breath and fluid retention. If the patient has asymptomatic heart failure they can continue driving and need not notify the DVLA. If they develop symptoms which might impair their ability to drive, they still do not need to notify the DVLA but must stop driving until their symptoms come under control. Patients considered to be NYHA class IV who are symptomatic from significant heart failure must not drive and do need to notify the DVLA.
Heart surgery including bypass surgery and valve surgery
The most common heart operations in adults are coronary artery bypass grafting (CABG) and heart valve surgery. Coronary artery bypass grafting is undertaken in patients who have significant narrowings in one or more coronary arteries which are not amenable to angioplasty (see above). Lengths of vein (from the leg) or artery (typically the internal mammary artery, on the undersurface of the chest wall) are attached at one end to the aorta, the main blood vessel in the body, and to a point beyond the blockage in the diseased coronary artery at the other.
Narrowing or leaking of one or more of the heart valves (see below) can be treated with an operation to repair the damaged valve, or replace it if repair is not possible. There is also now a minimally invasive technique available called TAVI (transcatheter aortic valve implantation), which allows doctors to replace the aortic valve without the need to open the chest, but this is a very complex procedure currently reserved for patients deemed high risk for surgery. Conventional valve surgery involves opening the chest to access the valve and, if repair is not possible, take out the damaged valve and replace it with a prosthetic valve, either made from metal or animal tissue.
Both CABG and valve operations require the heart to be “put on bypass” using a heart-lung machine to support the circulation and oxygenate the blood whilst the heart is stopped for the surgery to be performed. Provided there are no complications, driving can resume four weeks after surgery and the DVLA need not be notified.
Heart valve disease
The chambers of the heart are separated by one-way valves which sustain efficient flow of blood from one chamber to the next and into the main blood vessels. The two main types of valve disease are narrowing, which makes it harder for the heart to pump blood through the valve; and leakage (known as regurgitation), where blood leaks back through the valve and the heart therefore pumps inefficiently. Valve disease is generally asymptomatic in the early stages but as the heart begins to feel the strain, symptoms such as breathlessness, fluid retention and reduced exercise capacity may begin to materialise. Patients with heart valve disease, even those with symptoms, may continue driving and need not notify the DVLA.
High blood pressure is a very common problem and is associated with a significantly increased risk of stroke or heart attack. There are many medications available to treat high blood pressure and therefore reduce cardiovascular risk, but it can sometimes take a couple of weeks before the medication has its full effect. A patient with high blood pressure may continue to drive unless medication causes any side-effects which may impair their ability to drive. The DVLA need not be notified. Patients diagnosed with malignant hypertension (systolic readings of 180 and above, and/or diastolic readings of 110 and above) associated with organ damage should not drive until their blood pressure has come under adequate control, but still need not notify the DVLA.
ICD (internal cardioverter-defibrillator) implantation
Some heart rhythms, notably ventricular fibrillation (VF) or ventricular tachycardia (VT), can be fatal, because they prevent the heart muscle from pumping in a coordinated way. If there is no forceful pumping action from the heart, the patient is unable to sustain a blood pressure, leading to loss of conciousness and the brain being starved of oxygen. ICDs recognise these rhythms and if they continue beyond a preset time interval the device attempts to return the heart to normal rhythm either by pacing it (see below) or delivering a shock. Anyone with an ICD must inform the DVLA, and restriction on driving is dependent on a number of factors, including whether or not the patient suffered loss of consciousness associated with an arrhythmia prior to implantation, and whether the patient receives any shocks from the device after implant. Your cardiologist will be able to advise you about any driving restrictions in your individual case.
Pacemaker implantation or battery change
One of the most common indications for a permanent pacemaker is to prevent excessive slowing of the heart beat which might otherwise cause dizzy spells and blackouts. The generator is about the size of a small match box and is typically placed via a small incision on the front of the chest; this contains the battery to power the device and the software necessary to provide an appropriate heart rate. From this, one, two or three leads are passed through the veins to the heart, transmitting impulses to make the heart beat as necessary. The DVLA must be notified about pacemaker implantation but driving can resume one week post-procedure.