Cardiovascular System

• Author: David A. Morton III
• Pages: 399-608

4-1

Chapter 4

Cardiovascular System

Contents

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)

MEDICAL ISSUES IN SOCIAL SECURITY DISABILITY 4-2

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

4-3 CARDIOVASCULAR SYSTEM §4.00

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 subsection and are type-

set 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, capillaries, and the lym-

phatic 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 isch-

emia, with or without necrosis of heart muscle.2

(iii) Syncope, or near syncope, due to inadequate

cerebral perfusion 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 concentration in the arterial

blood, or pulmonary vascular disease.4

c. Disorders of the veins or arteries (for exam-

ple, obstruction, rupture, or aneurysm) may

cause impairments of the lower extremities

(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 cardiovascu-

lar impairments? 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 consul-

tative examinations for us. We use the abbrevia-

tion “MC” throughout this section to designate a

medical consultant.

b. Persistent means that the longitudinal clini-

cal record shows that, with few exceptions, the

required finding(s) has been present, or is expect-

ed 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 clini-

cal record shows that, within a consecutive

12-month period, the finding(s) occurs at least

three times, with intervening periods of improve-

ment of sufficient duration that it is clear that

separate events are involved.

d. Appropriate medically acceptable imaging

means that the technique used is the proper one

to evaluate and diagnose the impairment and is

commonly recognized as accurate for assessing

the cited finding.

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.)