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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 Pacemaker Insertion


Text Only Home | Graphic-Rich Site | Overview | Reason for Procedure | How Procedure is Performed | Prognosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Maximum Medical Improvement | Medical Codes | References

Medical Codes

ICD-9-CM:
37.80 - Insertion of Permanent Pacemaker, Initial or Replacement , Type of Device Not Specified
37.82 - Initial Insertion of a Single-chamber Device, Rate Responsive; Rate Responsive to Physiological Stimuli Other Than Atrial Rate
37.83 - Initial Insertion of Dual-chamber Device; Atrial Ventricular Sequential Device
37.86 - Pacemaker Insertion, Replacement of Any Type Pacemaker Device with Single-chamber Device, Rate Responsive; Rate Responsive to Physiological Stimuli Other Than Atrial Rate
37.87 - Pacemaker Insertion, Replacement of Any Type Pacemaker Device with Dual-chamber Device; Atrial Ventricular Sequential Device

Related Terms

  • Atrial Overdrive Pacing
  • Demand Pacemaker
  • Fixed Rate Pacemaker
  • Permanent Pacemaker
  • Temporary Pacemaker
  • Transvenous Pacemaker

Overview

Image Description:
Cardiac Pacemaker Insertion - A frontal view of the upper chest reveals the heart and major blood vessels in the center. A pulse generator is shown implanted to the left of the heart with a pacing lead from the generator inserted in a vein and terminating in the heart muscle.
Click to see Image

Cardiac pacemaker insertion is the surgical implantation of a cardiac pacemaker, a device that supplies electrical impulses to the heart to maintain the heartbeat at a regular rate. A pacemaker stimulates the heart muscle with precisely timed discharges of electricity, causing the heart to beat in a manner that mimics a naturally occurring heart rhythm.

Pacemakers consist of two main parts, the pulse generator and the pacing lead(s). The pulse generator controls the pacing system. It contains a small battery and electronic circuitry that produces the electrical impulses sent to the heart. It also interprets the signals it receives back from the beating heart. A typical pulse generator is often less than 2 inches wide and a quarter-inch thick, weighing about an ounce or less. The pacing leads are thin, specially insulated wires that carry electrical impulses to the heart and return signals from the heart to the pulse generator's "brain."

The two main types of pacemakers are fixed-rate and demand. A fixed-rate pacemaker discharges impulses at a fixed, steady rate, regardless of the heart's activity. A demand pacemaker discharges impulses only when the heart rate slows or a beat is missed; a normal heartbeat and heart rate suppress the pacemaker. An external programmer can adjust the rate. More advanced types allow the heart rate to increase during exercise.

Because modern microelectronic circuits require little power and lithium batteries have a long life, a pacemaker usually runs satisfactorily for several years. Battery replacement involves only a minor operation.

Individuals who need temporary or permanent pacemaker insertion include those with sick sinus syndrome, which is a cardiac conduction defect that causes the normal pacemaker of the heart (sinus node) to stop, slow down inappropriately, or pause for long durations. Other conditions that may require pacemaker insertion include incomplete heart block (second-degree heart block, type I and type II), complete heart block (third-degree heart block), abnormal tachycardias (tachydysrhythmias), and hypersensitive carotid sinus syndrome. Individuals who have had heart surgery may need a temporary or permanent pacemaker. Generally, these heart rhythm disturbances are caused by coronary artery disease, heart chamber enlargement (hypertrophy or cardiomyopathy), congenital heart conduction disturbances, or heart muscle injury from either a heart attack or cardiac surgery.

In many cases, an implantable cardioverter-defibrillator (ICD) is implanted rather than a pacemaker. The pacemaker component of the ICD helps the heart beat regularly, and the defibrillator shocks the heart back into rhythm if it does not beat within a certain period.

Source: Medical Disability Advisor



Reason for Procedure

A cardiac pacemaker is inserted to restore proper heart rhythm. Depending on the severity of the heart rhythm disturbance, the pacemaker insertion may be a nonurgent, elective procedure, or it may be a life-saving, emergency procedure.

The beating of the heart is normally controlled by electrical signals that originate in a nerve bundle located in the right atrium of the heart (sinoatrial node, or SA node). These signals pass on to the powerful ventricle muscles of the heart through another nerve bundle or node (atrioventricular, or AV node) and the nerve distribution system (left and right bundle branches). This coordination of the atria and ventricles results in normal heart rhythm.

Sometimes the SA node stops working properly, either speeding up or slowing the rate of electrical impulses to the right atrium. If the rate is too slow (bradycardia), the heart does not supply enough blood (and oxygen) to the body. Likewise, an extremely rapid heart rate (tachycardia) reduces the pumping action of the heart, causing a low blood pressure and inadequate tissue oxygenation (ischemia). Problems may also occur with the electrical pathway between the atria and the ventricles (AV node). Poor timing between the contractions of the atria and the ventricles (asynchrony) may occur, or the signal to the ventricles may be blocked completely (heart block). The symptoms associated with these heart rhythm disturbances can range from dizziness and fatigue to complete loss of consciousness or cardiac arrest. When these symptoms occur, a pacemaker implant may be required to establish a normal rhythm.

Source: Medical Disability Advisor



How Procedure is Performed

Cardiac pacemaker implantation is a common procedure done most often in an operating room or in a cardiac catheterization laboratory. The procedure lasts 1 to 2 hours and usually requires only local anesthetic. In transvenous endocardial implantation, leads inserted through a vein are guided down into the heart. The tips of the leads are secured in position in either the right atrium or the right ventricle or both, depending on the part of the heart muscle to be stimulated and the condition being treated. Once the leads are in place, they are connected to the pulse generator, and the pacemaker is adjusted to the appropriate stimulating and sensing thresholds. The pulse generator is fitted into a pocket created under the skin of the upper chest near the collarbone.

Sometimes, depending on the heart condition, the pacing lead is placed on the outside of the heart muscle (epicardial approach). This procedure is done under general anesthesia, usually at the time of other heart surgery. The lead is attached to the outer surface of the part of the heart muscle to be stimulated. The pulse generator is fitted into a pocket constructed under the skin of the abdomen.

Occasionally, a temporary transvenous pacemaker is inserted. The temporary pacemaker may be used in individuals who need the assistance of a pacemaker only temporarily (i.e., those whose heart rhythm is likely to return to normal). Occasionally, in emergency situations (i.e., complete heart block), a temporary pacemaker is inserted in the emergency department or in the intensive care ward. The procedure for the temporary pacemaker insertion is similar to the transvenous endocardial implantation described above, except the pulse generator is strapped to the individual's arm rather than surgically implanted. Because the end of the pacemaker leads and the pulse generator lie outside the body and can be damaged and / or the entry site of the leads can be infected, temporary pacemakers are generally used only for a short time (2 to 3 days).

Source: Medical Disability Advisor



Prognosis

The outcome is generally good for both permanent and temporary pacemaker insertion. Temporary pacemakers placed in emergency settings have a higher risk of complications, particularly infection or blood clot formation (thrombophlebitis).

Source: Medical Disability Advisor



Specialists

  • Cardiologist, Cardiovascular Physician
  • Emergency Medicine Physician
  • Thoracic Surgeon

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications of pacemaker insertion include infection, air embolism, collapse of the lung (pneumothorax), perforation of the heart wall (myocardial perforation), malposition of the pacemaker leads, vascular or nerve damage, thrombophlebitis, bleeding, and abnormal atrial or ventricular heartbeats (premature atrial contractions, atrial tachycardia, premature ventricular contractions, ventricular tachycardia). These complications are uncommon when a permanent pacemaker is inserted in the operating room or cardiac catheterization laboratory. The complications are more common with temporary pacemaker insertions, particularly when the pacemaker is inserted under emergency circumstances.

These complications generally respond well to medical intervention (antibiotics or anti-inflammatory drugs) after the temporary pacemaker is removed or replaced.

Source: Medical Disability Advisor



Factors Influencing Duration

The individual's age, type of surgical procedure, and any complications may influence the length of disability. In some cases, pacemaker implantation is done on an outpatient basis and requires only a few days of recovery. If the pacemaker was inserted to treat heart rhythm disturbances secondary to a heart attack or open heart surgery, the length of recovery is longer.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Strenuous activity, including lifting, carrying, pulling, and pushing objects over 10 pounds, reaching or stretching above the head, and sudden, jerky arm movements, is restricted. Other restrictions apply to workplace use of powerful electromagnetic pulses that might interfere with the operation of the pacemaker. Sources include strong magnetic fields, electrical cables carrying more than 10,000 amperes of current, alternating welding currents, powerful radio transmitters, TV and radar transmitters, power tools and assembly line robots, induction furnaces, and electric generating plants or substations. Digital cellular telephones and antitheft devices also have the potential to interfere with pacemakers. Until further tests have been conducted, individuals with pacemakers should turn off mobile phones when they are in a breast pocket, hold the phone at least 10 to 12 inches from the pacemaker when using it, use the phone on the ear opposite to the implant, and try to stay away from electronic surveillance equipment. When in doubt, employers should consult with the individual's doctor regarding appropriate work restrictions and accommodations.

For more information on risk, capacity, and tolerance, refer to "Work Ability and Return to Work," pages 274-277.

Risk: Once stabilized from pacemaker insertion, no job would place an individual at risk except for the presence of strong magnetic fields.

Source: Medical Disability Advisor



Maximum Medical Improvement

14 days.

Source: Medical Disability Advisor



References

Cited

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

General

Bonow, Robert O. , et al., eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia: W.B. Saunders, 2012.

Source: Medical Disability Advisor