• Hermann H Klein, Udo Sechtem, and Hans-Joachim Trappe.
• Helios Klinikum Warburg, Idar-Oberstein, Germany; Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart; Medical Clinic II-Cardiology and Angiology, Marienhospital Herne, Ruhr University Bochum.
• Dtsch Arztebl Int. 2017 Oct 13; 114 (41): 692702692-702.

BackgroundMedical students are taught little or nothing about the medical considerations related to the driving of motor vehicles. Physicians treating patients with cardiovascular disease need to acquire competence in traffic medicine in order to be able to advise them about their fitness to drive.MethodsWe present the current governmental regulations and recommendations concerning fitness to drive in patients with cardiovascular disease. We also review pertinent publications that were retrieved by a selective search in PubMed with the search terms "cardiovascular disease and traffic accidents" and "cardiovascular disease and traffic deaths" for the decade 2007-2016, as well as further publications collected by us individually.ResultsCardiovascular disease can make a driver lose control of a vehicle without warning and thereby lead to an accident. The main pathophysiological mechanisms of sudden loss of control are disturbances of brain perfusion (e.g., syncope with or without cardiac arrhythmia, sudden cardiac death due to ventricular fibrillation or asystole, stroke, aneurysm rupture) and marked general weakness (e.g., after major surgery or in cardiac insufficiency).ConclusionPatients with cardiovascular disease should be advised by their physicians about their fitness to drive, and the discussion should be documented in writing. Because of the German law on the confidentiality of medical data, only the affected patient should receive this information, with very few exceptions.

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