After a heart attack, a driver will need to be off work for at least two months. The driver will be required to provide the following documentation prior to certification:

  1.  Ejection Fraction of at least 40%.
  2.  Exercise Tolerance Test with acceptable results*.
  3.  Clearance by the cardiologist to return to work. Angina is not an automatic disqualifier but there are strict criteria. The angina has to be stable for at least 3 months, this means no pain at rest and no change in pattern of angina. The driver will also have to provide a note from the cardiologist stating the angina is stable, that medicine is well tolerated and the driver is cleared for driving.

* Abnormal Exercise Tolerance Test (ETT) is defined by an inability to exceed 6 METS (beyond completion of Stage II, or 6 minutes) on a standard Bruce protocol or the presence of ischemic symptoms and/or signs (e.g., characteristic angina pain or 1 mm ST depression or elevation in 2 or more leads), inappropriate SBP and/or heart rate responses (e.g., inability in the maximal heart rate to meet or exceed 85% of age-predicted maximal heart rate), or ventricular dysrhythmia.