National Registry of Certified Medical Examiners (NRCME) DOT Practice Exam

A driver with congestive heart failure is asymptomatic. What is the minimum left ventricular ejection fraction required for certification?

1. 40%

2. 45%

3. 50%

4. 55%

The correct answer is: 40%

The minimum left ventricular ejection fraction (LVEF) required for certification of a driver with congestive heart failure who is asymptomatic is 40%. This threshold is established in the guidelines that address cardiovascular conditions in the context of commercial driving. An LVEF of 40% indicates a reduction in cardiac function but does not necessarily manifest as symptoms in all patients, especially those who are well-managed. The guidelines emphasize that as long as the driver is asymptomatic and meets this minimum LVEF requirement, he or she may be deemed fit for duty, highlighting the importance of both cardiac function and symptomatology in the certification process. By establishing a cutoff of 40%, the regulations balance safety concerns with the ability of drivers who may have underlying heart conditions to operate a vehicle safely. Higher LVEF thresholds exist to allow for a wider margin of safety, but they are not the minimum criteria, making the 40% figure critical for allowing certification for asymptomatic individuals.