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.

Cardiac Catheterization


Medical Codes

ICD-9-CM:
37.21 - Right Heart Cardiac Catheterization, Cardiac Catheterization NOS
37.22 - Left Heart Cardiac Catheterization
37.23 - Combined Right and Left Heart Cardiac Catheterization

Related Terms

  • Angiocardiography
  • Left Heart Catheterization
  • Right Heart Catheterization

Overview

© Reed Group
Cardiac catheterization is an minimally invasive diagnostic procedure that provides information about the heart's chambers and valves, coronary arteries, the great vessels (aorta, pulmonary artery, pulmonary vein, and vena cava), and the blood flow within the heart (hemodynamics). Cardiac catheterization may also be performed as a therapeutic (interventional) procedure. Although it is invasive, it is not considered a surgical procedure.

During the procedure, various parameters can be measured within the heart (intracardiac pressure, oxygen saturation, cardiac output), opening and closing of the heart valves can be observed, pumping quality of the heart can be assessed, flow of blood into and through the heart chambers can be checked, and any narrowing or blockage of the coronary arteries can be measured. One or both sides of the heart may be catheterized. Right heart catheterization provides information about the right chambers of the heart (right atrium and ventricle), pulmonary artery, and right coronary arteries. Left heart catheterization provides information about the left chambers of the heart (left atrium and ventricle), aorta, and left coronary arteries. Coronary angiography is often used in conjunction with cardiac catheterization; it is the primary method for diagnosing coronary artery disease.

Cardiac catheterization is generally performed in a cardiac diagnostic lab on an outpatient or short-stay basis. It may also be performed as part of emergency care for individuals with acute cardiac symptoms, and for other inpatients whose cardiac condition is unclear or has deteriorated. In either setting, an operating room and surgical team are usually readily available in case emergency heart surgery becomes necessary.

Source: Medical Disability Advisor



Reason for Procedure

When noninvasive tests (e.g., electrocardiogram [ECG], echocardiography, cardiac stress test, and cardiac scanning) have failed to find a cause for an individual's cardiac symptoms or require additional verification of findings, cardiac catheterization may be indicated to confirm a diagnosis, as well as to determine the severity of the condition, plan treatment, and/or evaluate the response to treatment.

A number of heart disorders may be diagnosed and evaluated by cardiac catheterization, including heart attack (myocardial infarction), an enlarged area of the heart (ventricular hypertrophy), blockage in the pulmonary artery or one of its branches (pulmonary embolism), narrowed or blocked coronary arteries (with or without chest pain), narrowed or weakened heart valves (stenosis or regurgitation), congenital defects in the valves or chambers of the heart, inflammation of the heart (myocarditis), disease of the heart muscle (cardiomyopathy), and some heart rhythm disturbances (arrhythmias). The procedure may also be used to obtain blood samples from within the heart or tissue samples (biopsies) of the heart muscle, to measure the pumping ability of the heart muscle, and to evaluate the success of prior surgical procedures on the heart.

Several therapeutic procedures can be performed during a cardiac catheterization. These include dilation of a narrowed coronary artery with a balloon-tipped catheter (coronary balloon angioplasty) with or without placement of a stent to keep the vessel open, dilation of a narrowed (stenotic) heart valve with a balloon-tipped catheter (valvuloplasty), and radio-wave destruction of abnormal electrical pathways that are causing heart beat irregularities (radiofrequency ablation).

Source: Medical Disability Advisor



How Procedure is Performed

Several blood vessels are used for access to the arterial system, including the internal jugular and subclavian veins in the neck; brachial, axillary, or radial arteries in the arms; and the left and right femoral arteries in the groin. Access from the upper extremities (radial arteries) is preferred because of a low incidence of serious vascular complications and quicker recovery for the patient. Upper body access is essential if the femoral artery in the groin is compromised by atherosclerosis or obesity or the iliac or femoral vessels were used for a prior arterial graft.

The operative area (arm, neck, or groin) is shaved and washed with an antibacterial solution (prepped). The area is covered with a sterile drape, leaving the surgical field exposed. A mild sedative is first given to calm the individual, and then a local anesthetic is injected over the blood vessel used as the entry point for the catheter. Access to the vein or artery may be obtained either by direct surgical exposure of the blood vessel (vessel cut-down) followed by puncture of the vessel with a hollow-bore needle, or by a needle puncture directly through the skin and underlying tissue into the vessel (percutaneous access), which is most commonly used today for right- and left-heart catheterization. A guide wire is then inserted through the needle. The catheter is passed over the guide wire and into the artery after the needle has been removed.

Guided by x-ray images of deep tissue structures (fluoroscopy) in a darkened room, the physician advances the guide wire and catheter into various parts of the heart. After specific pressure readings are taken, an iodinated dye or radiographic contrast medium is injected through the catheter into the heart chambers and coronary arteries (coronary angiography). The working heart can then be viewed on a monitor. When diagnostic evaluation and therapeutic procedures (e.g., balloon angioplasty, stent placement, or valvuloplasty) are completed, the catheter is removed. If an incision has been made in the skin over the blood vessel, it is closed with sutures.

Following cardiac catheterization with a groin entry, individuals are generally restricted to bed rest for several hours to promote blood clot formation and decrease the risk of bleeding from the insertion site.

Source: Medical Disability Advisor



Prognosis

The immediate outcome for uncomplicated cardiac catheterization used for diagnostic purposes is excellent, although outcomes after therapeutic procedures vary, depending on the underlying cardiac condition requiring the procedure, as well as the type of procedure performed. The risk of major complications during the procedure is 1% to 2%, and the death rate from the procedure is about 0.11% (Garcia-Borbolla). The poorest prognosis and highest procedure-related mortality are found in individuals older than age 60 or younger than one year (Garcia-Borbolla). A high risk of death is also found in those with preexisting valvular heart disease, kidney dysfunction (renal insufficiency), diabetes mellitus requiring insulin therapy, peripheral artery disease, and pulmonary insufficiency.

Within the first year after coronary balloon angioplasty and stent placement, about 10% to 40% of the treated coronary arteries develop restenosis (Teirstein; Park). Use of newer, drug-eluting stents that resist restenosis can reduce this figure to 5% or less (Teirstein).

The prognosis following balloon valvuloplasty is excellent for individuals with mitral valve stenosis without regurgitation. Symptoms of congestive heart failure, including pulmonary edema, shortness of breath, limitation of activity, and recurrent blood clots (in spite of treatment with anticoagulant drugs), are usually relieved. The immediate outcome for those who have a balloon valvuloplasty because of pulmonary valve stenosis is also excellent. Symptoms, including shortness of breath with exertion, fainting, chest pain, and right heart failure, are usually relieved. The rate of restenosis within the first 5 years is generally low for valvuloplasty procedures performed with cardiac catheterization; morbidity and mortality are influenced by the individual's diagnosis, age, and overall health status.

Outcomes for treatment of less severe congenital aortic stenosis in young adults are good with balloon valvuloplasty. The individual usually gains long-term relief of symptoms with few complications. Outcomes for balloon valvuloplasty in older adults with severe aortic stenosis as a result of calcification are poor. Symptoms of heart failure may be relieved temporarily, but the valve may quickly narrow again, requiring surgery for valve replacement.

The prognosis for cardiac catheterization and associated therapeutic procedures is negatively influenced by the presence of chronic diseases such as diabetes, coronary artery disease, and peripheral vascular disease, which may complicate procedural results and recovery.

Source: Medical Disability Advisor



Specialists

  • Cardiologist, Cardiovascular Physician
  • Thoracic Surgeon

Source: Medical Disability Advisor



Rehabilitation

For the procedure itself, no rehabilitation is required. The individual will be able to resume most usual activities after a period of several days. Any limitations will depend on the insertion site and are most significant if the groin was used.

If cardiac catheterization leads to a diagnosis of cardiovascular disease, cardiac rehabilitation may be recommended. Sessions are focused on improving the individual's capacity for activity and endurance and generally begin in an outpatient facility. The rehabilitation program begins 2 weeks after the procedure (or when the physician determines the incision site is healed) and continues for about 6 to 12 weeks (1 hour per day, 3 to 4 days a week). The rehabilitation program for cardiovascular disease is planned in four phases.

Phase 1 begins with low-demand aerobic activities using large muscle groups, such as the lower extremities. In a hospital or cardiac rehabilitation setting, the individual is monitored for heart rate and rhythm and blood pressure. Initial exercises include self-care activities, such as sitting up in bed and moving from the bed to a chair. Exercises of varying intensity, such as marching in place and raising both arms overhead, are performed. Walking (with continuous monitoring) 2 to 5 minutes and progressing to 15 to 20 minutes is also part of this phase. At 10 days to 2 weeks, the individual may progress to supervised exercise with a stationary bicycle.

Phase 2 consists of similar exercises with varying progression of time and intensity, depending on the individual.

Phase 3 occurs at 3 to 12 months following an acute cardiac episode or cardiac surgery and is supervised in a rehabilitation center. A physical therapist experienced in cardiac rehabilitation keeps a daily log of the individual's blood pressure, heart rate, and cardiac rhythm. Individuals are typically attached to an ECG, a device used to record the continuous electrical activity of the heart muscle. Higher levels of exercise, such as swimming and hiking, comprise this phase. Light jogging is appropriate as tolerated.

Phase 4 of cardiac rehabilitation for cardiovascular disease occurs 12 months after discharge from the hospital. Long-term maintenance of performance levels reached during phases 2 and 3 are concerns at this time. Aerobic exercises that increase cardiovascular fitness, such as walking briskly, running, jogging, swimming, climbing stairs, or bicycling, are encouraged. The American Heart Association recommends 30 to 60 minutes of aerobic activity 3 or 4 times a week to help control high blood pressure. Throughout all phases, it is important to allow the heart rate to gradually return to normal by cooling down slowly after exercise.

Family members are encouraged to participate in the rehabilitation program because it educates them about lifestyle changes and reduces fear and anxiety about increasing activity and exercise. Education includes a review of medications, lifestyle changes, goal setting, nutrition counseling (a low-fat, no-salt-added diet), stress management, and instruction about the safe performance of activities, such as sexual activity, work, and recreational activities.

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications of cardiac catheterization include bleeding or infection at the catheter insertion site; inflammation and clot formation (thrombophlebitis) within the blood vessel; allergic reaction to the dye or contrast medium used to view the heart fluoroscopically; the dislodging of a blood clot within a heart valve, within a coronary artery, or from the catheter tip (embolism) that travels to the heart, brain, or lungs, causing a heart attack, stroke, or pulmonary embolism; minor heart beat irregularity (arrhythmia) during the procedure as a result of the catheter's movement through sensitive parts of the heart; ventricular tachycardia or fibrillation intraoperatively requiring immediate defibrillation; trauma to a coronary artery resulting in rupture or dissection (usually during angioplasty); systemic infection; decreased blood pressure (hypotension) or congestive heart failure during the procedure; hemorrhage; and puncture of the heart wall that results in blood collecting in the sac around the heart and restricting its ability to beat (cardiac tamponade). The risk of major complications (e.g., heart attack, stroke, acute renal failure) is generally less than 1% to 2% (Garcia-Borbolla).

Source: Medical Disability Advisor



Factors Influencing Duration

Factors influencing the length of disability following cardiac catheterization include the underlying reason for the catheterization, number and severity of procedure complications, amount of blood lost if complications arise, number of blood transfusions required to compensate for blood loss, success of any therapeutic procedures performed, individual's nutritional status and mental and emotional stability, individual's access to rehabilitation facilities, and strength of the individual's support system.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Activity following cardiac catheterization is restricted for several days to prevent bleeding from the insertion site, and the specific restriction is related to the location of the insertion site (groin, neck, or arm). Depending on the location, these restrictions may include no driving, no heavy lifting, limited walking, and no climbing stairs or ladders. Individuals who have had cardiac catheterization without experiencing serious complications or disabilities may be able to return to work in 1 to 2 weeks.

Factors affecting return to work may also include the results of a cardiac stress test and how well the ventricle is able to pump (cardiac ejection fraction). Individuals with residual chronic heart disease or chest pain may require work restrictions and accommodations that conserve their energy and reduce strain on the heart. Work hours may initially need to be limited and gradually increased over several weeks until the individual is working a full shift. Other medical problems or permanent disabilities because of underlying medical conditions (i.e., diabetes, chronic obstructive lung disease, and chronic renal failure requiring dialysis) or postoperative complications (i.e., partial paralysis or speech impairment due to stroke) may also require work restrictions and accommodations.

Risk: Risk of the procedure is low. The greater risk consideration is the underlying reason for the procedure, usually for coronary artery disease, which is reviewed under other headings such as angina.

Capacity: The procedure may greatly improve capacity if it is associated with an intervention of stenting.

Tolerance: There would be no expected effect on tolerance.

Source: Medical Disability Advisor



References

Cited

Garcia-Borbolla, Mariano, Rafael Garcia-Borbolla, and Begona Balboa. "Complications of Cardiac Catheterization." Advances in the Diagnosis of Coronary Atherosclerosis. Ed. Suna Kirac. InTech, 2011. In Tech Open. 9 Nov. 2011. InTech. 7 May 2014 <http://www.intechopen.com/books/advances-in-the-diagnosis-ofcoronary-atherosclerosis/complications-of-cardiac-catetherization>.

Kern, Morton. "Catheterization and Angiography." Goldman's Cecil Medicine. Eds. Lee Goldman and Andrew I. Schafer. 24 ed. Saunders, Elsevier, 2011.

Olade, Roger B. "Cardiac Catheterization (Left Heart)." eMedicine. Eds. Karlheinz Peter, et al. 8 Apr. 2014. Medscape. 7 May 2014 <http://emedicine.medscape.com/article/160601-overview>.

Park, C. , and H. Park. "Identification of Independent Risk Factors for Restenosis Following Bare Metal Stent Implantation: Role of Bare Metal Stents in the Era of Drug Eluting Stents." Experimental and Therapeutic Medicine 6 3 (2013): 840-846.

Teirstein, P. S. , and M. J. Price. "Left Main Percutaneous Coronary Intervention." Journal of the American College of Cardiology 60 17 (2012): 1605-1613.

Source: Medical Disability Advisor