Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Aortic Insufficiency


Related Terms

  • Acute Aortic Insufficiency
  • Aortic Incompetence
  • Aortic Regurgitation
  • Chronic Aortic Insufficiency
  • Chronic/Acute Aortic Insufficiency

Differential Diagnosis

  • Bacterial endocarditis
  • Cardiac conditions associated with heart murmur
  • Congestive heart failure (CHF)
  • Mitral stenosis
  • Mitral valve prolapse
  • Myocardial infarction (MI)
  • Pulmonic regurgitation
  • Tricuspid stenosis
  • Ventricular septal defect

Specialists

  • Cardiovascular Internist
  • Thoracic Surgeon

Comorbid Conditions

  • Connective tissue disorders
  • Coronary artery disease
  • Diabetes
  • Hypertension
  • Obesity

Factors Influencing Duration

Disability varies with severity of disease at initial diagnosis, contributing underlying heart disease, whether the individual undergoes surgery, complications after surgery, age of the individual, and response to treatment.

Medical Codes

ICD-9-CM:
396.3 - Mitral Valve Insufficiency and Aortic Valve Insufficiency
746.4 - Congenital Insufficiency of Aortic Valve; Bicuspid Aortic Valve; Congenital Aortic Insufficiency

Overview

Aortic insufficiency (AI) is a condition characterized by the reverse flow of blood from the main artery of the body (aorta) into the major pumping chamber of the heart (left ventricle). This may occur due to the incomplete closure of the aortic valve that lies between the aorta and left ventricle (aortic regurgitation), or may result from narrowing of the aortic valve (stenosis). This blood backflow results in enlargement of the left ventricle due to the increased volume of blood it must pump. Over time, the muscles of the left ventricle become thicker and the left ventricular chamber will dilate, eventually causing heart failure.

AI may be asymptomatic for years before onset of symptoms, and may occur acutely or chronically. Acute AI may be caused by chest trauma or infections such as rheumatic fever or infective endocarditis, trauma, and tearing (dissection) of the aorta. Chronic AI may be caused by congenital defects (bicuspid aortic valve) and systemic diseases that widen the proximal aorta (aortic root disease) such as hypertension, systemic lupus erythematosus, Reiter's syndrome, ankylosing spondylitis, and Marfan syndrome.

Incidence and Prevalence: There are 5 million individuals with some form of valvular heart disease in the US (Saidinejad). Aortic insufficiency affects approximately 5 out of every 10,000 people (Keller). Two percent of individuals have a congenitally bicuspid aortic valve, and aortic stenosis is present in 3% to 5% of all congenital heart defects (Seib). International statistics reflect those of the US.

Source: Medical Disability Advisor



Causation and Known Risk Factors

AI is most common in males between 30 and 60 years of age (Keller). Symptoms may appear at any age, although aortic stenosis worsens with advancing age due to degenerative calcification of the aortic valve. Adult individuals with congenitally bicuspid aortic valves have increased risk for development of AI between 40 and 70 years of age (Seib). All races are equally affected.

Source: Medical Disability Advisor



Diagnosis

History: Individuals with mild AI often have no symptoms. Those with more severe AI may report shortness of breath with activity (dyspnea with exertion), fatigue, swelling at the ankles (edema), dizziness, heart arrhythmias, or chest pain (angina pectoris).

History of possible causes should be noted. It is also important to note the first occurrence of the heart murmur, keeping in mind that the murmur is sometimes overlooked because of its soft, high-pitched quality.

Physical exam: The blood pressure often has a wide range of measurement. The characteristic murmur is confined to the filling phase of the cardiac cycle (diastole). Other murmurs may be present due to associated mitral valve disease and/or aortic valve narrowing (stenosis).

Tests: A chest x-ray and echocardiogram with Doppler flow velocity measurements are usually done initially and periodically afterwards in individuals with chronic AI, the frequency depending on the severity of the disease. These tests assess the size of the heart and the severity of the AI. The chest x-ray and echocardiogram help to diagnose or rule out heart failure. Cardiac catheterization and aortic angiography are usually done before repair of the valves. Echocardiography is a simple and sensitive way to diagnose an aortic dissecting aneurysm, one of the acute causes of AI. Nuclear studies and/or echocardiography are useful in monitoring an individual with aortic insufficiency while looking for new ventricular dilatation, and can also provide information regarding cardiac function.

Source: Medical Disability Advisor



Treatment

Mild cases of aortic insufficiency require no treatment. More severe cases may be treated with medications to strengthen the contraction of the left ventricle (digitalis preparations), medications to remove excess fluid (diuretics), and medications to reduce the workload of the heart (vasodilators or unloading agents).

Elective surgical repair or replacement of the valve is usually indicated in symptomatic individuals with chronic AI. Emergent repair or replacement is done for acute, severe AI due to aortic valve endocarditis or a dissecting aneurysm of the aorta. If severe AI is due to aortic stenosis, the valve may be opened by catherization (balloon valvotomy), or repaired by open-heart surgery. Whenever possible, repair of the valve is performed. However, unlike mitral valve insufficiency where repair rather than replacement is often possible, repair of the aortic valve is limited because of the high diastolic pressure in the aorta.

If aortic valve repair is not possible, the valve may be surgically replaced by a donor valve, mechanical valve, or by pulmonary autograft (Ross procedure). The Ross procedure is normally performed in children or young adults, and involves replacement of the insufficient or stenotic aortic valve with the individual's own pulmonary valve, which is then replaced by a donor pulmonary valve.

Source: Medical Disability Advisor



Prognosis

Longevity is usually not affected in individuals with mild degrees of AI. Those with more severe degrees of AI, however, require properly timed surgery. The overall operative mortality is about 4% to 10%, although in low-risk individuals, it is only 1% to 2% (Saidinejad). Age, associated coronary atherosclerosis, and impaired overall function of the left ventricle are associated with increased risk. Long-term survival is approximately 75% after 5 years, and 50% after 10 years (Saidinejad). Among survivors, heart size often decreases dramatically following surgery and is associated with significant symptomatic improvement.

Sudden death from AI occurs in approximately 0.2% of individuals each year (Saidinejad).

Source: Medical Disability Advisor



Complications

The primary complication of AI is heart failure. As with aortic stenosis and other valvular problems, acute or subacute bacterial endocarditis is a possible complication of dental work and other medical procedures that allow bacteria to enter the bloodstream. It is preventable by administering appropriate antibiotics orally or intravenously just before dental work or when certain endoscopic procedures are performed.

Other complicating factors of AI include pregnancy, as some anticoagulant medications used to treat AI may cause harm to the fetus.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

No work restrictions or accommodations are necessary for asymptomatic individuals. For those experiencing dyspnea with exertion and/or fatigue, reassignment to a position with less strenuous demands may be necessary. For those who have had timely surgery, work restrictions may lessen postoperatively. Individuals who have received mechanical prosthetic valves normally need to take blood thinners and may need reassignment to other duties if their work prior to surgery carried any significant risk of injury. Activities requiring isometric muscular effort, such as lifting heavy weights, should be avoided.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual have rheumatic fever as a child? Does individual have rheumatic heart disease?
  • Has individual experienced recent trauma?
  • Does individual have hypertension?
  • Does individual have Marfan's syndrome?
  • Does individual complain of shortness of breath, weakness, fatigue, swollen ankles, palpitations, sweating during the night, or chest pain (angina)?
  • Is fever present?
  • Is there a significant difference between the systolic and diastolic numbers of the blood pressure? Is diastolic murmur present? Other murmurs?
  • Was a chest x-ray or ECG performed since the initial diagnosis or after surgery?
  • Do the physical exam results and clinical picture coincide or is aortography needed to confirm a diagnosis?

Regarding treatment:

  • Has individual been taking medications as prescribed, participating in cardiac rehabilitation (if required), limiting activity, working on lifestyle changes, and participating in any other treatments prescribed?
  • Would individual benefit from surgical repair or replacement of the valve?

Regarding prognosis:

  • Have symptoms of AI worsened? How much do they interfere with daily activities?
  • Is there worsening of an underlying disease or infection?
  • What type of surgery is recommended? Repair or replacement of the valve? Is individual in a high- or low-risk surgical group?
  • Has individual developed heart failure?
  • Has individual recently undergone dental or medical procedures? If so, did individual take prophylactic antibiotics prior to the procedure?
  • Does individual have endocarditis?

Source: Medical Disability Advisor



References

Cited

Keller, Seth. "Aortic insufficiency." drkoop.com. Vitacost Holdings, Inc. 20 Oct. 2004 <http://www.drkoop.com/ency/article/000179.htm.>.

Saidinejad, Mohsen, and Samuel Ritter. "Aortic Valve Insufficiency." eMedicine. Eds. Christopher Johnsrude, et al. 1 Dec. 2003. Medscape. 20 Oct. 2004 <http://emedicine.com/ped/topic2487.htm>.

Seib, Paul. "Aortic Stenosis, Valvar." eMedicine. Eds. Juan Carlos Alejos, et al. 17 Jun. 2003. Medscape. 20 Oct. 2004 <http://emedicine.com/ped/topic2491.htm>.

Source: Medical Disability Advisor






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