OAR 436-035-0380
Cardiovascular System
(1)
Impairments of the cardiovascular system are determined based on objective findings that result in the following conditions: valvular heart disease, coronary heart disease, hypertensive cardiovascular disease, cardiomyopathies, pericardial disease, or cardiac arrhythmias. Each of these conditions will be described and quantified. In most circumstances, the physician should observe the patient during exercise testing.(2)
Valvular Heart Disease: Impairment resulting from work related valvular heart disease is rated according to the following classes:(a)
Class 1 (5% Impairment) The worker has evidence by physical examination or laboratory studies of valvular heart disease, but no symptoms in the performance of ordinary daily activities or even upon moderately heavy exertion; and The worker does not require continuous treatment, although prophylactic antibiotics may be recommended at the time of a surgical procedure to reduce the risk of bacterial endocarditis; and The worker remains free of signs of congestive heart failure; and There are no signs of ventricular hypertrophy or dilation, and the severity of the stenosis or regurgitation is estimated to be mild; or In the worker who has recovered from valvular heart surgery, all of the above criteria are met.(b)
Class 2 (20% Impairment) The worker has evidence by physical examination or laboratory studies of valvular heart disease, and there are no symptoms in the performance of ordinary daily activities, but symptoms develop on moderately heavy physical exertion; or(c)
The worker requires moderate dietary adjustment or drugs to prevent symptoms or to remain free of the signs of congestive heart failure or other consequences of valvular heart disease, such as syncope, chest pain and emboli; or(d)
The worker has signs or laboratory evidence of cardiac chamber hypertrophy or dilation, and the severity of the stenosis or regurgitation is estimated to be moderate, and surgical correction is not feasible or advisable; or(e)
The worker has recovered from valvular heart surgery and meets the above criteria.(f)
Class 3 (40% Impairment) The worker has signs of valvular heart disease and has slight to moderate symptomatic discomfort during the performance of ordinary daily activities; and(g)
Dietary therapy or drugs do not completely control symptoms or prevent congestive heart failure; and(h)
The worker has signs or laboratory evidence of cardiac chamber hypertrophy or dilation, the severity of the stenosis or regurgitation is estimated to be moderate or severe, and surgical correction is not feasible; or(i)
The worker has recovered from heart valve surgery but continues to have symptoms and signs of congestive heart failure including cardiomegaly.(j)
Class 4 (78% Impairment) The worker has signs by physical examination of valvular heart disease, and symptoms at rest or in the performance of less than ordinary daily activities; and(k)
Dietary therapy and drugs cannot control symptoms or prevent signs of congestive heart failure; and(l)
The worker has signs or laboratory evidence of cardiac chamber hypertrophy or dilation; and the severity of the stenosis or regurgitation is estimated to be moderate or severe, and surgical correction is not feasible; or(m)
The worker has recovered from valvular heart surgery but continues to have symptoms or signs of congestive heart failure.(3)
Coronary Heart Disease: Impairment resulting from work related coronary heart disease is rated according to the following classes:(a)
Class 1 (5% Impairment) This class of impairment should be reserved for the worker with an equivocal history of angina pectoris on whom coronary angiography is performed, or for a worker on whom coronary angiography is performed for other reasons and in whom is found less than 50% reduction in the cross sectional area of a coronary artery.(b)
Class 2 (20% Impairment) The worker has history of a myocardial infarction or angina pectoris that is documented by appropriate laboratory studies, but at the time of evaluation the worker has no symptoms while performing ordinary daily activities or even moderately heavy physical exertion; and(c)
The worker may require moderate dietary adjustment or medication to prevent angina or to remain free of signs and symptoms of congestive heart failure; and(d)
The worker is able to walk on the treadmill or bicycle ergometer and obtain a heart rate of 90% of his or her predicted maximum heart rate without developing significant ST segment shift, ventricular tachycardia, or hypotension; or(h)
The worker has recovered from coronary artery surgery or angioplasty, remains asymptomatic during ordinary daily activities, and is able to exercise as outlined above. If the worker is taking a beta adrenergic blocking agent, he or she should be able to walk on the treadmill to a level estimated to cause an energy expenditure of at least 10 METS* as a substitute for the heart rate target. *METS is a term that represents the multiples of resting metabolic energy used for any given activity. One MET is 3.5ml/(kg x min).(i)
Class 3 (40% Impairment) The worker has a history of myocardial infarction that is documented by appropriate laboratory studies, or angina pectoris that is documented by changes on a resting or exercise ECG or radioisotope study that are suggestive of ischemia; or(j)
The worker has either a fixed or dynamic focal obstruction of at least 50% of a coronary artery, demonstrated by angiography; and(k)
The worker requires moderate dietary adjustment or drugs to prevent frequent angina or to remain free of symptoms and signs of congestive heart failure, but may develop angina pectoris or symptoms of congestive heart failure after moderately heavy physical exertion; or(l)
The worker has recovered from coronary artery surgery or angioplasty, continues to require treatment, and has the symptoms described above.(m)
Class 4 (78% Impairment) The worker has history of a myocardial infarction that is documented by appropriate laboratory studies or angina pectoris that has been documented by changes of a resting ECG or radioisotope study that are highly suggestive of myocardial ischemia; or(n)
The worker has either fixed or dynamic focal obstruction of at least 50% of one or more coronary arteries, demonstrated by angiography; and(o)
Moderate dietary adjustments or drugs are required to prevent angina or to remain free of symptoms and signs of congestive heart failure, but the worker continues to develop symptoms of angina pectoris or congestive heart failure during ordinary daily activities; or(p)
There are signs or laboratory evidence of cardiac enlargement and abnormal ventricular function; or(q)
The worker has recovered from coronary artery bypass surgery or angioplasty and continues to require treatment and have symptoms as described above.(4)
Hypertensive Cardiovascular Disease: Impairment resulting from work related hypertensive cardiovascular disease is rated according to the following classes:(a)
Class 1 (5% Impairment) The worker has no symptoms and the diastolic pressures are repeatedly in excess of 90 mm Hg; and(b)
The worker is taking antihypertensive medications but has none of the following abnormalities: (1) abnormal urinalysis or renal function tests; (2) history of hypertensive cerebrovascular disease; (3) evidence of left ventricular hypertrophy; (4) hypertensive vascular abnormalities of the optic fundus, except minimal narrowing of arterioles.(c)
Class 2 (20% Impairment) The worker has no symptoms and the diastolic pressures are repeatedly in excess of 90 mm Hg; and(d)
The worker is taking antihypertensive medication and has any of the following abnormalities: (1) proteinuria and abnormalities of the urinary sediment, but no impairment of renal function as measured by blood urea nitrogen (BUN) and serum creatinine determinations; (2) history of hypertensive cerebrovascular damage; (3) definite hypertensive changes in the retinal arterioles, including crossing defects or old exudates.(e)
Class 3 (40% Impairment) The worker has no symptoms and the diastolic pressure readings are consistently in excess of 90 mm Hg; and(f)
The worker is taking antihypertensive medication and has any of the following abnormalities: (1) diastolic pressure readings usually in excess of 120 mm Hg; (2) proteinuria or abnormalities in the urinary sediment, with evidence of impaired renal function as measured by elevated BUN and serum creatinine, or by creatinine clearance below 50%; (3) hypertensive cerebrovascular damage with permanent neurological residual; (4) left ventricular hypertrophy based on findings of physical examination, ECG, or chest radiograph, but no symptoms, signs or evidence by chest radiograph of congestive heart failure; or (5) retinopathy, with definite hypertensive changes in the arterioles, such as “copper” or “silver wiring,” or A-V crossing changes, with or without hemorrhages and exudates.(g)
Class 4 (78% Impairment) The worker has a diastolic pressure consistently in excess of 90 mm Hg; and(h)
The worker is taking antihypertensive medication and has any two of the following abnormalities;(A)
diastolic pressure readings usually in excess of 120 mm Hg;(B)
proteinuria and abnormalities in the urinary sediment, with impaired renal function and evidence of nitrogen retention as measured by elevated BUN and serum creatinine or by creatinine clearance below 50%;(C)
hypertensive cerebrovascular damage with permanent neurological deficits;(D)
left ventricular hypertrophy;(E)
retinopathy as manifested by hypertensive changes in the arterioles, retina, or optic nerve;(F)
history of congestive heart failure; or(G)
The worker has left ventricular hypertrophy with the persistence of congestive heart failure despite digitalis and diuretics.(5)
Cardiomyopathy: Impairment resulting from work related cardiomyopathies is rated according to the following classes:(a)
Class 1 (5% Impairment) The worker is asymptomatic and there is evidence of impaired left ventricular function from physical examination or laboratory studies; and(b)
There is no evidence of congestive heart failure or cardiomegaly from physical examination or laboratory studies.(c)
Class 2 (20% Impairment) The worker is asymptomatic and there is evidence of impaired left ventricular function from physical examination or laboratory studies; and(d)
Moderate dietary adjustment or drug therapy is necessary for the worker to be free of symptoms and signs of congestive heart failure; or(e)
The worker has recovered from surgery for the treatment of hypertrophic cardiomyopathy and meets the above criteria.(f)
Class 3 (40% Impairment) The worker develops symptoms of congestive heart failure on greater than ordinary daily activities and there is evidence of abnormal ventricular function from physical examination or laboratory studies; and(g)
Moderate dietary restriction or the use of drugs is necessary to minimize the worker’s symptoms, or to prevent the appearance of signs of congestive heart failure or evidence of it by laboratory study; OR(h)
The worker has recovered from surgery for the treatment of hypertrophic cardiomyopathy and meets the criteria described above.(i)
Class 4 (78% Impairment) The worker is symptomatic during ordinary daily activities despite the appropriate use of dietary adjustment and drugs, and there is evidence of abnormal ventricular function from physical examination or laboratory studies; or(j)
There are persistent signs of congestive heart failure despite the use of dietary adjustment and drugs; or(k)
The worker has recovered from surgery for the treatment of hypertrophic cardiomyopathy and meets the above criteria.(6)
Pericardial Disease: Impairment resulting from work related pericardial disease is rated according to the following classes:(a)
Class 1 (5% Impairment) The worker has no symptoms in the performance of ordinary daily activities or moderately heavy physical exertion, but does have evidence from either physical examination or laboratory studies of pericardial heart disease; and(b)
Continuous treatment is not required, and there are no signs of cardiac enlargement, or of congestion of lungs or other organs; or(c)
In the worker who has had surgical removal of the pericardium, there are no adverse consequences of the surgical removal and the worker meets the criteria above.(d)
Class 2 (20% Impairment) The worker has no symptoms in the performance of ordinary daily activities, but does have evidence from either physical examination or laboratory studies of pericardial heart disease; but(e)
Moderate dietary adjustment or drugs are required to keep the worker free from symptoms and signs of congestive heart failure; or(f)
The worker has signs or laboratory evidence of cardiac chamber hypertrophy or dilation; or(g)
The worker has recovered from surgery to remove the pericardium and meets the criteria above.(h)
Class 3 (40% Impairment) The worker has symptoms on performance of greater than ordinary daily activities despite dietary or drug therapy, and the worker has evidence from physical examination or laboratory studies, of pericardial heart disease; and(i)
Physical signs are present, or there is laboratory evidence of cardiac chamber enlargement or there is evidence of significant pericardial thickening and calcification; or(j)
The worker has recovered from surgery to remove the pericardium but continues to have the symptoms, signs and laboratory evidence described above.(k)
Class 4 (78% Impairment)(l)
The worker has symptoms on performance of ordinary daily activities in spite of using appropriate dietary restrictions or drugs, and the worker has evidence from physical examination or laboratory studies, of pericardial heart disease; and(m)
The worker has signs or laboratory evidence of congestion of the lungs or other organs; or(n)
The worker has recovered from surgery to remove the pericardium and continues to have symptoms, signs, and laboratory evidence described above.(7)
Arrythmias: Impairment resulting from work related cardiac arrhythmias* is rated according to the following classes:(a)
Class 1 (5% Impairment) The worker is asymptomatic during ordinary activities and a cardiac arrhythmia is documented by ECG; and(b)
There is no documentation of three or more consecutive ectopic beats or periods of asystole greater than 1.5 seconds, and both the atrial and ventricular rates are maintained between 50 and 100 beats per minute; and(c)
There is no evidence of organic heart disease. * If an arrhythmia is a result of organic heart disease, the arrhythmia should be rated separately and combined with the impairment rating for the organic heart disease.(d)
Class 2 (20% Impairment) The worker is asymptomatic during ordinary daily activities and a cardiac arrhythmia* is documented by ECG; and(e)
Moderate dietary adjustment, or the use of drugs, or an artificial pacemaker, is required to prevent symptoms related to the cardiac arrhythmia; or(f)
The arrhythmia persists and there is organic heart disease.(g)
Class 3 (40% Impairment) The worker has symptoms despite the use of dietary therapy or drugs or of an artificial pacemaker and a cardiac arrhythmia* is documented with ECG; but(h)
The worker is able to lead an active life and the symptoms due to the arrhythmia are limited to infrequent palpitations and episodes of light-headedness, or other symptoms of temporarily inadequate cardiac output.(i)
Class 4 (78% Impairment) The worker has symptoms due to documented cardiac arrhythmia* that are constant and interfere with ordinary daily activities; or(j)
The worker has frequent symptoms of inadequate cardiac output documented by ECG to be due to frequent episodes of cardiac arrhythmia; or(k)
The worker continues to have episodes of syncope that are either due to, or have a high probability of being related to, the arrhythmia. To fit into this category of impairment, the symptoms must be present despite the use of dietary therapy, drugs, or artificial pacemakers.(8)
For heart transplants an impairment value of 50% is given. This value is combined with any other findings of impairment of the heart.
Source:
Rule 436-035-0380 — Cardiovascular System, https://secure.sos.state.or.us/oard/view.action?ruleNumber=436-035-0380.