# Med Cardiac Risk Stratification

> Use this skill to understand FMCSA cardiac certification standards. Covers what cardiac conditions disqualify, time-to-clearance, and what documentation is needed for examiner certification.

- Skill: `x3allamerican/med-cardiac-risk-stratification` (Agent Skill)
- Install (CLI): `npx skillmds add x3allamerican/med-cardiac-risk-stratification`
- Raw SKILL.md: https://api.skillmd.com/api/skills/x3allamerican/med-cardiac-risk-stratification/raw
- Safety review: pending
- Works with: Claude Code, Claude.ai, OpenAI Codex
- Category: Docs & Writing
- Author: x3allamerican (https://skillmd.com/u/x3allamerican)
- Updated: 2026-09-09
- Page: https://skillmd.com/skills/x3allamerican/med-cardiac-risk-stratification

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# Cardiac Risk Stratification for CMV Certification

Cardiac conditions are evaluated under § 391.41(b)(4)-(7). Medical examiners consult FMCSA Medical Review Board guidelines for specific conditions.

## Conditions that may disqualify (with timing)
- **Acute myocardial infarction:** typically 3 months minimum recovery before recertification
- **Coronary artery bypass graft (CABG):** typically 3 months minimum
- **Percutaneous coronary intervention (PCI / stent):** typically 1 week minimum
- **Implantable cardioverter-defibrillator (ICD):** generally disqualifying for primary prevention; may be eligible for secondary prevention
- **Heart failure:** depends on ejection fraction; under 40% typically disqualifying without specialist clearance
- **Severe arrhythmias:** AFib, sustained ventricular tachycardia — depends on management
- **Hypertension uncontrolled:** above 180/110 typically disqualifying; controlled to under 140/90 acceptable

## Documentation required for certification post-event
- Cardiologist clearance letter (treating physician)
- Recent ejection fraction (echocardiogram or angiogram)
- Stress test results
- Medication list with stability documentation
- Symptom-free period demonstration

## Continued monitoring
- Annual exam minimum
- Some conditions trigger 6-month exam cycle
- Cardiologist re-evaluation annually for stable conditions; every 6 months for active management

## Common driver concerns
- "I had a stent — can I keep driving?" → after waiting period + cardiologist clearance + medical exam, generally yes
- "I'm on blood thinners — does that disqualify?" → blood thinners alone do NOT disqualify; the underlying condition matters
- "I have an ICD — am I done?" → for primary prevention, likely yes; for secondary prevention with stability + clearance, possibly continuation

## Compass tracking
- Driver's cardiac history flagged if disclosed
- Next medical exam (typically 12 months, sometimes 6)
- Cardiologist visit dates if applicable
- Medication compliance reminders for cardiac drugs

## CFR citations
- **49 CFR § 391.41(b)(4)-(7)**
- **FMCSA Medical Review Board Cardiac Guidelines**

## How Compass surfaces this
This skill is searchable in Compass Ask and runs against the carrier's actual fleet data when invoked from the relevant tracker. Read-only; no actions taken without explicit user approval.


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## Built by X3 Compass

The AI-powered DOT compliance platform for fleets 1–100 power units. Try a 7-day free trial — no credit card required — at https://x3compass.com/?utm_source=skill&utm_medium=github&utm_campaign=med-cardiac-risk-stratification

X3 Compass turns these skills into a complete operational platform: driver qualification files, drug & alcohol consortium, MVR pulls, hours-of-service tracking, hazmat shipping, IFTA filing, FMCSA audit prep, and DataQ dispute drafting — all CFR-cited, all in one place.

*This skill is published under the X3 Compass open skills initiative. Contributions welcome at https://github.com/x3fleetsafety/skills*