Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and I'd like to welcome you to my podcast station and to the Healthy Heart Network. Today I'm delighted to have the opportunity to speak with a good friend, colleague and expert in cardiac rehabilitation, Dr. Alistair Begg, who's based in Adelaide and has a special interest in seeing people get through heart attacks and not have any further problems. Nice to see you, Alistair. Nice to be here, Warrick, and glad I can join you today on this fine day. Look, really appreciate you making the time. Today, I'd like to talk about people getting back to life after their event. Do you want to give us a little bit of an introduction into just where people are after they've had some sort of cardiac event? Sure, Warrick. Well, look, when having a cardiac event... it's not usually a planned event in people's lives. It's something that just comes out of the blue, almost like a car accident or a trauma. So when we see people after their cardiac event, they need some special treatment. They need a bit more sort of than just the average. They need people to really understand what they've been through and a lot more about what their journey is all about. And part of that is looking to the future and trying to prevent future problems. future-proofing them from further heart attacks or heart surgery or whatever else might be in their future. So that's where we're really going in this podcast today. Look, Alistair, I thought I'd shoot a few questions at you, which are some of the questions that come up pretty regularly in my own consulting room and see what your experience is with some of those questions. One of the first things that people will often ask is, how soon can I drive after a heart event? Can you help me with that? Sure, Warrick. Well, look, driving is one of those things that really depends on what heart event you've had. The national guidelines in Australia stipulate that if you have a private driver's licence, that after a heart event such as... heart surgery, you actually can't drive for four weeks after a bypass. And that is mandated through some national guidelines that we all follow. When we talk about driving, obviously, just for the people listening, there is a distinction between private vehicle driver's licence and commercial. That makes a bit of sense if you think about it. It means the criteria needed to be able to drive, say, a bus full of children to school or a lorry that's carrying petrol is a higher criteria. And I guess that makes sense. You talked about four weeks off if you're a private driver for someone who's had a heart attack. Is it different if you've had a stent or a heart attack without a stent, Alistair? Look, the guidelines are a bit different for stents because really stents are more minor surgery. They don't involve the sort of restrictions in terms of chest movement. And it really all depends on the capacity to operate the vehicle. If someone has a pacemaker, for instance, they're not allowed to drive for two weeks after the... The pacemaker. So it does depend on how much limitation there is of chest movement. And that's why we recommend someone not driving for, say, two weeks after a pacemaker, whereas four weeks after open heart surgery. And sometimes people can black out with a heart problem. Presumably, if you have a blackout, you can't drive. Well, is there a guide around that that you're aware of or can share, Alistair? Well, look, there are guidelines, Warrick, and it really does depend on the patient because it depends on the classification of the blackout. And the best thing is really to talk to your cardiologist about that because if it's a simple faint, it might only be a 24-hour cessation of driving. But if there's an underlying cardiac issue, then it may be much longer than that. And it really depends, once again, on the cause and whether that... cause has been fixed so if someone has a cause and then they have a pacemaker and that cause has been fixed then they can go back to driving within say two weeks so it really does depend on the cause and that is a bit more complex so it's always best to talk to the cardiologist about that but you may find there's actually a more prolonged period when there's an uncertainty about whether that problem will come back again so if i can summarize As best as possible, some of the information you've shared, it sounds like there are Australian or national guidelines to help us know what to do in particular situations. But it seems that different situations require different consideration, whether you've had a heart attack or a stent or a bypass or blacked out may all be slightly different, is it? a fair thing to say, Alistair? Yeah, I think that's right, Warrick. I mean, there really are a variety of different situations that lead to blackouts. Sometimes they can be cardiac and sometimes they can be perhaps more a neurological problem or a problem with the brain. So it really does depend on whether the cardiologist thinks it's a primary problem with the heart or whether it might be some problem with the brain, because often the two can be hard to differentiate. Let's stick with the driving for now because obviously someone who's had a heart event would want to know if they can remain mobile. We talked about private vehicle licences. If someone's had a heart attack or a stent or a bypass and their job, their profession is driving, for example, a truck driver or a bus driver. Will those people be able to get back to work one day, Alistair? Sure. Well, looking at the OSTROADS guidelines, after a heart attack, a private vehicle driver can't drive for two weeks, whereas someone that's got a commercial vehicle driver can't drive for four weeks. So there's a clear difference between someone just having a private vehicle licence and someone who has a commercial vehicle licence, such as driving a bus or a big truck. As a road user myself, that's pretty reassuring. I'd want to make sure that someone driving a large vehicle or a vehicle with many people on board certainly is in as good condition as possible. Apart from that longer time away from driving for a commercial vehicle driver, are there any special tests or any particular criteria that those... drivers need before getting back to their profession? Well, often we'll be asked as cardiologists to do some further tests on patients. And often that involves doing an ultrasound of the heart and assessing the pumping of the heart. Because if you've got a commercial vehicle, you have to have a pumping of the heart. So-called ejection fraction has to be above a certain level to qualify for commercial vehicle and also there needs to be some sort of functional testing such as on a treadmill to try and determine that that person is safe to return to driving a commercial vehicle. So there's a higher level of clearance required for those people driving commercial vehicles versus private. That's good to know Alistair and just for the sake of our listeners, ejection fraction is a word that we use to describe how well the heart expels blood with each pump. If you think of the heart as a muscular sac, let's say for simple numbers, it holds 100 mils before it starts its contraction. When it contracts, it expels 60 mils into the body. We would call that an ejection fraction of 60%. And Alistair is talking about making sure that ejection fraction, is pretty close to the normal range for our commercial vehicle drivers. Correct me if I'm wrong, Alistair, but my recollection is that these commercial vehicle drivers, once they've had that assessment, then need to have that assessment undertaken on a yearly basis to continue their driver's licensing for a commercial vehicle. Is that correct? Yeah, look, the guidelines say that a conditional licence can be considered subject to annual review by the cardiologist, and the cardiologist used those tests to make that assessment as to whether that person is fit to continue with their commercial licence. I think this is a really important issue. Driving is one of the things that really allows people to maintain their independence. You've referred to the Australian or AustRoads, Australian National Transport Guidelines, which exist. I often say to patients that it's really important to try and follow those guidelines because if you breach them, having been advised of them, You may not be covered for liability if you are in an accident. Do you have that conversation with patients as well? I do because, I mean, I think you need to make people aware that these are guidelines that are national guidelines and doctors and licensing authorities refer to them frequently and we expect people to follow those if they're going to be driving safely. And, of course, if... they're not doing the right thing and they have a problem, then there's certain situations where their insurance won't cover them. So I think it's an extra safeguard to try and reinforce that message. So a terribly important issue for patients to try and, after some sort of hard event, to get back into the driver's seat to maintain their independence. work for people who work professionally. It is really important to understand there is a national guideline and it is an important aspect of rounding off what to do after a hard event. Did you want to add anything else, Alistair? Because we might wind it up now and look forward to our next opportunity to talk. Have you got anything you'd like to add? Look, one question that sometimes comes up is about seatbelts too, Warrick, and I think it's important that people don't think just because they've had heart surgery that they can skip the seatbelt issue because it's very important that they do wear a seatbelt. You know, sometimes it's necessary to put some sort of padding around the seatbelt so it doesn't hurt the chest after a bypass, but that's also a question that frequently comes up. And I guess people who have a pacemaker perhaps who are passengers, if the pacemaker's in the left shoulder, then passengers in countries where we drive with the driver on the right-hand side may have a seatbelt over the pacemaker. And I guess in countries where the passenger sits on the left-hand side, then pacemakers may get in the way as well. What's your advice with pacemakers and seatbelts? Well, it's a similar type of thing. putting some padding around the seatbelt can be a good way to cushion the rubbing of the seatbelt against the pacemaker as well. I guess it would be an absolute shame to save someone from a heart attack only to have them die in a car accident, which is a bit morbid, but it seems a sensible thing to do to make sure you're looking after yourself safely in all aspects of your life. Thanks, Warrick. Well, look, It's always a pleasure to talk with you about these sort of things, and I hope the patients listening benefit from our discussions. Alistair, thank you again for joining me. I think this has been a really interesting conversation, and it's about something that people often are asking about. Take care, Alistair. Thank you. And to my listeners, thank you so much for your time. I hope you found this informative and interesting. If you have any questions, as always, drop me a note on members at drWarrickbishop.online. I, of course, wish you the very best until next time, and please don't die from a heart attack. Goodbye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
