Cardiovascular System

AuthorThomas E. Bush/David A. Morton III/David Traver/Sarah H. Bohr/Curtis J. Fisher/Kimberly V. Cheiken
Chapter 4
Cardiovascular System
Part I – Adults
§4.00 Cardiovascular System
§4.01 Category of Impairments, Cardiovascular System
§4.02 Chronic Heart Failure
§4.03 (Reserved)
§4.04 Ischemic Heart Disease
§4.05 Recurrent Arrhythmias
§4.06 Symptomatic Congenital Heart Disease
§4.07 (Reserved)
§4.08 (Reserved)
§4.09 Heart Transplant
§4.10 Aneurysm of Aorta or Major Branches
§4.11 Chronic Venous Insufficiency of a Lower Extremity
§4.12 Peripheral Arterial Disease
Part II – Children
§104.00 Cardiovascular System
§104.01 Category of Impairments, Cardiovascular System
§104.02 Chronic Heart Failure
§104.03 (Reserved)
§104.04 (Reserved)
§104.05 Recurrent Arrhythmias
§104.06 Congenital Heart Disease
§104.07 (Reserved)
§104.08 (Reserved)
§104.09 Heart Transplant
§104.10 (Reserved)
§104.11 (Reserved)
§104.12 (Reserved)
§104.13 Chronic Rheumatic Fever or Rheumatic Heart Disease
§104.14 (Reserved)
§104.15 (Reserved)
Part III – Forms
§4.02F Chronic Heart Failure
§4.03F Hypertension
§4.04F Ischemic Heart Disease
§4.04(CP)F Chest Pain Description
§4.05F Recurrent Arrhythmias
§4.06F Congenital Heart Disease
§4.07F Valvular Heart Disease
§4.08F Cardiomyopathies
§4.09F Cardiac Transplant
§4.10F Aneurysm of Aorta or Branches
§4.11F Chronic Venous Insufficiency
§4.12F Peripheral Arterial Disease
§104.13F Chronic Rheumatic Fever or Rheumatic Heart Disease
§104.14F Hyperlipidemia
§104.15F Kawasaki Syndrome
Long Forms on Digital Access only
§4.02F(L) Chronic Heart Failure
§4.03F(L) Hypertension
§4.04F(L) Ischemic Heart Disease
§4.04(CP)F(L) Chest Pain Description
§4.05F(L) Recurrent Arrhythmias
§4.06F(L) Congenital Heart Disease
§4.07F(L) Valvular Heart Disease
§4.08F(L) Cardiomyopathies
§4.10F(L) Aneurysm of Aorta or Branches
§4.11F(L) Chronic Venous Insufficiency
§4.12F(L) Peripheral Arterial Disease
§104.13F(L) Chronic Rheumatic Fever or Rheumatic Heart Disease
Form Reference:
See Forms 4.02, 4.03, 4.04, 4.04CP, 4.05, 4.06, 4.07, 4.08, 4.09,
4.10, 4.11, 4.12, 104.13, 104.14, 104.15 to solicit treating source medical
information relevant to the above adult and corresponding child listings.
Part I – Adults
§4.00 Cardiovascular System
[The applicable Listing of Impairments introduces each chapter and
is typeset in Helvetica. Author comments follow each Listing sub-
section and are typeset in Times.]
SSA Listing of Impairments
A. General
1. What do we mean by a cardiovascular impairment?
a. We mean any disorder that affects the proper functioning of
the heart or the circulatory system (that is, arteries, veins, capillar-
ies, and the lymphatic drainage). The disorder can be congenital
or acquired.
b. Cardiovascular impairment results from one or more of four
consequences of heart disease:
(i) Chronic heart failure or ventricular dysfunction.1
(ii) Discomfort or pain due to myocardial ischemia, with or
without necrosis of heart muscle.2
(iii) Syncope, or near syncope, due to inadequate cerebral perfu-
sion from any cardiac cause, such as obstruction of flow or
disturbance in rhythm or conduction resulting in inadequate
cardiac output.3
(iv) Central cyanosis due to right-to-left shunt, reduced oxygen con-
centration in the arterial blood, or pulmonary vascular disease.4
c. Disorders of the veins or arteries (for example, obstruction,
rupture, or aneurysm) may cause impairments of the lower extrem-
ities (peripheral vascular disease), the central nervous system, the
eyes, the kidneys, and other organs. We will evaluate peripheral
vascular disease under [listings] 4.11 or 4.12 and impairments of
another body system(s) under the listings for that body system(s).
2. What do we consider in evaluating cardiovascular im-
pairments? The listings in this section describe cardiovascular
impairments based on symptoms, signs, laboratory findings, response
to a regimen of prescribed treatment, and functional limitations.
3. What do the following terms or phrases mean in these listings?
a. Medical consultant is an individual defined in §§404.1616(a)
and 416.1016(a). This term does not include medical sources who
provide consultative examinations for us. We use the abbreviation
“MC” throughout this section to designate a medical consultant.
b. Persistent means that the longitudinal clinical record shows
that, with few exceptions, the required finding(s) has been present,
or is expected to be present, for a continuous period of at least 12
months, such that a pattern of continuing severity is established.
c. Recurrent means that the longitudinal clinical record shows
that, within a consecutive 12-month period, the finding(s) occurs at
least three times, with intervening periods of improvement of suffi-
cient duration that it is clear that separate events are involved.
d. Appropriate medically acceptable imaging means that the tech-
nique used is the proper one to evaluate and diagnose the impairment
and is commonly recognized as accurate for assessing the cited finding.
e. A consecutive 12-month period means a period of 12 consecutive
months, all or part of which must occur within the period we are consid-
ering in connection with an application or continuing disability review.
f. Uncontrolled means the impairment does not adequately re-
spond to standard prescribed medical treatment.
B. Documenting Cardiovascular Impairment
1. What basic documentation do we need? We need sufficiently
detailed reports of history, physical examinations, laboratory studies,
and any prescribed treatment and response to allow us to assess the
severity and duration of your cardiovascular impairment. A longitu-
dinal clinical record covering a period of not less than 3 months of
observations and treatment is usually necessary, unless we can make
a determination or decision based on the current evidence.
2. Why is a longitudinal clinical record important? We will usu-
ally need a longitudinal clinical record to assess the severity and
expected duration of your impairment(s). If you have a listing-level
impairment, you probably will have received medically prescribed
treatment. Whenever there is evidence of such treatment, your lon-
gitudinal clinical record should include a description of the ongoing
management and evaluation provided by your treating or other med-
ical source. It should also include your response to this medical
management, as well as information about the nature and severity of
your impairment. The record will provide us with information on your
functional status over an extended period of time and show whether
your ability to function is improving, worsening, or unchanging.
3. What if you have not received ongoing medical treatment?
a. You may not have received ongoing treatment or have an ongo-
ing relationship with the medical community despite the existence of
a severe impairment(s). In this situation, we will base our evaluation
on the current objective medical evidence and the other evidence we
have. If you do not receive treatment, you cannot show an impairment
that meets the criteria of most of these listings. However, we may
find you disabled because you have another impairment(s) that in
combination with your cardiovascular impairment medically equals
the severity of a listed impairment or based on consideration of your
residual functional capacity and age, education, and work experience.
b. Unless we can decide your claim favorably on the basis of
the current evidence, a longitudinal record is still important. In rare
instances where there is no or insufficient longitudinal evidence, we
may purchase a consultative examination(s) to help us establish the
severity and duration of your impairment.
4. When will we wait before we ask for more evidence?
a. We will wait when we have information showing that your
impairment is not yet stable and the expected change in your impair-
ment might affect our determination or decision. In these situations,
we need to wait to properly evaluate the severity and duration of
your impairment during a stable period. Examples of when we might
wait are:
1 Ventricular dysfunction is a broad term meaning any kind of abnormality in the pumping (contracting or relaxing ability) of either or both of the heart’s
main pumping chambers—the right or left ventricles. Ventricular dysfunction must exist with heart failure and is also present after significant heart attacks and
many other disorders that affect the heart muscle.
2 The discomfort or pain referred to is angina pectoris (see §4.04.1.a). Necrosis means the death of a tissue. Necrosis of heart muscle means a heart attack
has occurred; the affected tissue will be replaced with scar tissue.
3 Syncope means loss of consciousness; cardiac arrhythmias impair the heart’s pumping ability and the brain might not receive adequate blood flow (cerebral
perfusion). (See listing 4.05 discussion.)
4 Central cyanosis refers to that which may be seen in the face and lips, in contrast to that in the more acral parts of the body like the finger-tips and toes.
The abnormalities mentioned can result in cyanosis as caused by abnormal deoxygenation of blood, and are associated with congenital heart disease (see listing
4.06 discussion.)

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