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Cardiovascular Disability Updating the Social Security Listings (2010) / Chapter Skim
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12 Valvular Heart Disease
Pages 191-198

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From page 191...
... the awarding of disability is appropriate for all patients with severe symptomatic aortic stenosis and for other types of severe Vhd associated with severe symptomatic impair ment. disease severity is determined by the echocardiogram and functional impairment by a careful history and physical examina tion and in some cases exercise testing.
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From page 192...
... VHD should be diagnosed based on clinical evaluation of the patient and assessment by Valvular Heart Disease Symptoms (e.g., angina, dyspnea, syncope) Echocardiography Severe mitral stenosis, Severe aortic regurgitation, or aortic stenosis mitral regurgitation • Three hospitalizations with hear t failure in 12 months, or • Inability to achieve 5 Disability metabolic equivalents of task on exercise test, or • Objective evidence of right hear t failure FIGURE 12-1 Determining listing-level disability for claimants with valvular heart Figure 12-1.eps disease.
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From page 193...
... < 0.6 Mitral Stenosis Mild Moderate Severe Mean gradient (mm Hg) <5 5–10 > 10 Pulmonary artery systolic pressure < 30 30–50 > 50 (mm Hg)
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From page 194...
... < 30 30–49 ≥ 0.40 Regurgitant orifice area (cm2) < 0.20 0.2–0.39 Additional Essential Criteria Left atrial size Enlarged Left ventricular size Enlarged NOTE: AR = aortic regurgitation; LA = left atrial/atrium; LVOT = left ventricular outflow tract; MR = mitral regurgitation.
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From page 195...
... Unlike other cardiac impairments, determining disability using measurements of functional criteria is not advised for symptomatic individuals with severe aortic stenosis, because there is risk to the patient in performing exercise tests. Furthermore, the severity of disease for patients with severe symptomatic aortic stenosis is sufficient to grant disability at the listing level without other indications of functional limitation, such as evidence of related heart failure.
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From page 196...
... • Unlike many diseases such as chronic lung disease or certain cancers, treatment for VHD can have a dramatic improving effect on a patient's functional status. For example, an individual may undergo medical testing revealing results that meet the recommended listing, but then receive treatment and on further testing, no longer meet the disability criteria at the listing level.
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From page 197...
... 2006. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines.
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Key Terms

  • aortic stenosis
  • valvular heart
  • mitral stenosis
  • severe symptomatic
  • heart failure

  • heart disease
  • aortic regurgitation
  • valve disease
  • severe mitral
  • listing level

  • left ventricular
  • severe aortic
  • enlarged left
  • functional limitation
  • mean gradient

  • objective evidence
  • warrant disability
  • blood flow
  • ventricular size
  • pulmonary artery

  • atrial size
  • left untreated
  • left atrial
  • artery systolic
  • regurgitant volume

  • contracta width
  • vena contracta
  • doppler vena
  • systolic pressure
  • severe valve


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