Will a cardiologist clear me, a seaman with heart disease, for fitness‑for‑duty?

Fitness-for-Duty Clearance for Seamen with Heart Disease

Whether a cardiologist will clear you for work as a seaman depends entirely on the specific type and severity of your heart disease, your current cardiac function, and your ability to safely perform the physical demands of maritime work—not all heart disease automatically disqualifies you.

Cardiologist's Role in Occupational Fitness Assessment

The cardiologist serves as the essential consultant for complex occupational fitness decisions when cardiovascular disease is present. 1 A thorough cardiological evaluation will include:

• Assessment of exercise capacity through formal exercise testing 1
• Evaluation of cardiac structure and function by echocardiography, including measurement of ejection fraction (EF) 1
• Electrocardiogram (ECG) to identify conduction abnormalities or ischemic changes 1
• Cardiopulmonary exercise testing to evaluate your ability to augment cardiovascular function during increasing exercise intensity 1
• Assessment for exercise-induced arrhythmias or ischemia 1

Clearance Criteria Based on Cardiac Function

Your likelihood of clearance follows a structured framework based on objective cardiac function:

Normal or Near-Normal Function (EF ≥50%)

• You can likely be cleared for full maritime duties if your ventricular function is normal or near-normal 1
• This assumes no other high-risk features such as severe valvular disease, uncontrolled arrhythmias, or exercise-induced symptoms 1

Mildly Diminished Function (EF 40-50%)

• Clearance may be possible with restrictions to low- and medium-intensity physical activities 1
• The cardiologist will need to determine if your specific maritime role falls within safe physical intensity limits 1

Moderately to Severely Diminished Function (EF <40%)

• Clearance is unlikely for physically demanding maritime work 1
• Only very low-intensity occupational activities might be considered safe 1

High-Risk Conditions That Preclude Clearance

Certain cardiac conditions represent absolute or strong relative contraindications to physically demanding work:

• Severe symptomatic left ventricular dysfunction 1
• Exercise-induced serious ventricular arrhythmias demonstrated on testing 1
• Unstable angina or recent acute coronary syndrome (generally within 6 days) 1
• Severe aortic stenosis (mean gradient >40 mmHg) carries high risk of sudden death with exertion 2
• Uncontrolled hypertension (SBP >180 mmHg or DBP >120 mmHg with end-organ damage) 1
• Cyanotic congenital heart disease with clinical instability 1

Special Considerations for Maritime Work

Maritime occupations present unique challenges that the cardiologist must consider:

• Remote location with limited medical access means higher-risk conditions are less acceptable 3, 4
• Physical demands vary widely by specific maritime role—deck work differs substantially from administrative duties 1
• Environmental stressors including temperature extremes, which may affect cardiac medications 4
• Duration at sea affects risk tolerance, as prolonged voyages limit evacuation options 3

The Evaluation Process

Before your cardiologist can make a clearance decision, you must undergo:

1. Complete clinical assessment including detailed history of cardiac symptoms, particularly exertional chest pain, syncope, dyspnea, or palpitations 1, 2
2. Resting 12-lead ECG 1, 2
3. Echocardiography with Doppler to assess chamber sizes, valvular function, and ejection fraction 1, 2
4. Exercise stress testing (preferably cardiopulmonary) to evaluate exercise capacity, blood pressure response, oxygen saturation, and arrhythmia provocation 1, 2
5. Assessment of any additional cardiac risk factors including hypertension, diabetes, and medication side effects 1

Common Pitfalls to Avoid

• Do not assume stable symptoms mean safe clearance—objective exercise testing is mandatory to reveal exercise-induced problems 1
• Asymptomatic patients may have unexpectedly low exercise tolerance or dangerous blood pressure responses during formal testing 2
• Missing exercise-induced arrhythmias can be catastrophic in remote maritime settings 1
• Failing to account for medication effects in hot or cold maritime environments 4

Documentation Requirements

The cardiologist should provide written documentation that includes:

• Specific cardiac diagnosis with severity grading 1
• Objective test results (EF, exercise capacity, arrhythmia burden) 1, 2
• Clear statement of fitness or specific activity restrictions 1
• Recommendations for follow-up intervals and monitoring 1

Practical Recommendation

Bring copies of any previous cardiac testing (ECGs, echocardiograms, stress tests) to your cardiologist appointment, as baseline comparisons significantly improve the accuracy of fitness assessment. 1, 3 The cardiologist's decision will be based on current guidelines that prioritize your safety and the safety of your crewmates, balancing your right to work against the realistic risks posed by your specific cardiac condition in the maritime environment. 1