Cardiovascular fitness for STCW medicals

Cardiovascular disease is the leading cause of medical-certificate failure among senior officers. Practical guidance on hypertension, cholesterol, and stress-test performance.

STCW A-I/9 medical assessment includes cardiovascular fitness evaluation — mandatory ECG over 40 in most flags, often treadmill stress testing over 50. Untreated hypertension (>150/90) + high LDL cholesterol are the primary reasons for medical-certificate limitations or refusals. Coronary artery disease + arrhythmias are increasingly common in the 45+ officer demographic.

Practical steps

• Annual BP check ashore during vacation — if consistently >140/90, see GP for evaluation.
• LDL cholesterol <130 mg/dL target; statins are STCW-medical-compatible if well-controlled.
• Regular aerobic exercise (30 min brisk walk 5x/week) is protective and interviewers-favourable.
• Smoking cessation is the single largest cardiovascular risk reduction — every quit-attempt is worth it.
• Sleep apnoea evaluation if snoring + daytime sleepiness — untreated OSA is a common cause of stress-test failure.

When to escalate

• Chest pain, shortness of breath, or palpitations onboard — treat as cardiac emergency; TMAS consultation + MEDEVAC criteria.
• STCW medical showing new hypertension or dyslipidaemia — treatment ashore before next medical to avoid limitation.
• Any diagnosis of coronary artery disease, arrhythmia, or heart failure — cardiac specialist review before next STCW medical; may require specific fitness assessment.

Last verified 3 months ago