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.

Cardiomyopathy


Related Terms

  • Congestive Cardiomyopathy
  • Constrictive Cardiomyopathy
  • Familial Cardiomyopathy
  • Heart Failure
  • Hypertrophic Nonobstructive Cardiomyopathy
  • Hypertrophic Obstructive Cardiomyopathy
  • Idiopathic Cardiomyopathy
  • Myocardiopathy
  • Primary Cardiomyopathy
  • Restrictive Cardiomyopathy

Differential Diagnosis

  • Acute coronary syndrome
  • Aortic regurgitation
  • Aortic stenosis
  • Arteriosclerotic heart disease
  • Cardiac tamponade
  • Constrictive pericarditis
  • Endocarditis
  • Frank pulmonary disease
  • Hypertensive emergency
  • Myocardial infarction (MI)
  • Myocarditis
  • Pericardial disease
  • Psychogenic dyspnea
  • Toxicity (cocaine, amphetamine, heavy metals, thyroid hormone)
  • Valvular heart disease

Specialists

  • Cardiologist, Cardiovascular Physician
  • Thoracic Surgeon

Comorbid Conditions

  • Coronary artery disease
  • Diabetes
  • Hypertension
  • Infection
  • Obesity
  • Recreational drug use including alcohol
  • Tobacco abuse

Factors Influencing Duration

Factors that influence disability include the age of individual, age of patient at onset of disease, extent of disease at diagnosis, presence of comorbid chronic illness, and response to therapy.

Medical Codes

ICD-9-CM:
425.4 - Cardiomyopathy, Other Primary
425.5 - Alcoholic Cardiomyopathy
425.7 - Nutritional and Metabolic Cardiomyopathy
425.8 - Cardiomyopathy in Other Diseases Classified Elsewhere
425.9 - Cardiomyopathy, Secondary, Unspecified
674.50 - Other and Unspecified Complications of The Puerperium, Not Elsewhere Classified, Peripartum Cardiomyopathy; Postpartum Cardiomyopathy, Unspecified as to Episode of Care or Not Applicable
674.51 - Other and Unspecified Complications of The Puerperium, Not Elsewhere Classified, Peripartum Cardiomyopathy; Postpartum Cardiomyopathy, Delivered, with or without Mention of Antepartum Condition
674.52 - Other and Unspecified Complications of The Puerperium, Not Elsewhere Classified, Peripartum Cardiomyopathy; Postpartum Cardiomyopathy, Delivered, with Mention of Postpartum Complication
674.53 - Other and Unspecified Complications of The Puerperium, Not Elsewhere Classified, Peripartum Cardiomyopathy; Postpartum Cardiomyopathy, Antepartum Condition or Complication
674.54 - Other and Unspecified Complications of The Puerperium, Not Elsewhere Classified, Peripartum Cardiomyopathy; Postpartum Cardiomyopathy, Postpartum Condition or Complication

Overview

The term "cardiomyopathy" refers to a group of diseases characterized by primary involvement of the heart muscle (primary myocardial disease). Cardiomyopathy is distinct from other heart disease, including hypertensive, congenital, valvular, and arteriosclerotic heart disease, in which the heart muscle is secondarily involved. Cardiomyopathy of any type damages the heart muscle and may lead to eventual heart failure. Three types of cardiomyopathy have been recognized traditionally (i.e., dilated, hypertrophic, and restrictive), but the advent of molecular genetics is expanding the classification.

Dilated cardiomyopathy involves an enlarged (dilated) ventricle on the right more often than the left side of the heart, in which thinning of the heart muscle reduces the pumping ability (contractile dysfunction). It may have no known cause (idiopathic), or it may be due to injury from viral infection (e.g., coxsackie virus, adenovirus, HIV) or bacterial infection, toxins (most commonly alcohol and cocaine, as well as methamphetamine, heavy metals, and cobalt, among others), advanced untreated endocrine problems (e.g., diabetes, thyroid disease), long-term nutritional deficiencies (notably thiamine and zinc deficiencies), neuromuscular diseases (e.g., muscular dystrophy), or genetic/familial disease (Goswami) The enlarged heart chambers are less able to pump blood or to achieve normal cardiac pressures and output, robbing organ systems of the blood and oxygen they need. It may also occur as a complication of higher cardiac output in pregnancy or childbirth (peripartum cardiomyopathy) and other high-output conditions such as anemia or thyrotoxicosis. Dilated cardiomyopathy has been suggested by experts to be part of an autoimmune response in which heart muscle cells are mistaken for foreign cells and infection-fighting antibodies are produced that inappropriately destroy the heart muscle. Disease progression can result in ventricular and supraventricular arrhythmias, thromboembolism, and sudden death from heart failure.

In hypertrophic cardiomyopathy, the heart, usually the left ventricle, is enlarged. The muscular walls become extremely thick, reducing the space inside the ventricular cavities. This condition often has a negative effect on the mitral valve (mitral insufficiency) and the wall between the ventricles (septum), resulting in obstruction of cardiac outflow just beneath the aortic valve.

Restrictive cardiomyopathy, the least common form of this disease, is most commonly due to 1 of 2 conditions: (1) a disorder characterized by accumulation of insoluble proteins in the blood (amyloidosis) or (2) an inflammatory response by white blood cells activated by the immune system (sarcoidosis). The heart muscle becomes rigid and less elastic, interfering with contraction. It can be difficult to distinguish restrictive cardiomyopathy from constrictive pericarditis, which is curable with surgery.

Arrhythmogenic right ventricular cardiomyopathy (ARVD) is a rare form of cardiomyopathy in the United States in which the myocardium of the right ventricular wall is replaced by fibrous and/or fatty tissue. ARVD is characterized by ventricular arrhythmias and right ventricular pathology.

Cardiomyopathies often lead to heart failure (HF). HF is a progression of cardiac insufficiency that develops over months or years as the heart becomes less and less able to pump out all the blood that enters its chambers. As a result, with left sided heart failure, fluids accumulate in the lungs. Right-sided HF leads to fluid retention in the legs. Another consequence is retention of water and salt by the kidneys in response to receiving less blood from the heart; this increases the buildup of fluid throughout the body.

Incidence and Prevalence: Dilated cardiomyopathy affects about 1% of the total US adult population; it affects about 10% of the population above age 80 (Ferri). It has been noted as the underlying cause of death in 1.6 – 2.0 persons per 100,000 population yearly between 1999 – 2007 totaling 46,690 deaths during this time period (ICD10data.com). About 25% of dilated cardiomyopathies are thought to be familial (Hershberger). Hypertropic cardiomyopathy occurs in about 0.2% (about 1 individual in 500) of the population (Fananapazir ). Restrictive cardiomyopathy is relatively uncommon accounting for only 5% of all cases of primary heart disease (Viccello).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Cardiomyopathy strikes individuals of all ages, although the incidence of dilated cardiomyopathy increases with advanced age. Age at death from dilated cardiomyopathy has a J-shaped curve. Infants under 1 year old were recorded dying at a rate of 0.4 per 100,000, 1 – 4 year olds 0.1 per 100,000 and no reported deaths between the ages of 5 and 14. Then from age 15 on the rate steadily increases from 0.1 for 15 – 19 year olds to 17.3 per 100,000 in those 85 and older (ICD10data.com). Alcoholism is a causative factor in approximately 3.8% of all cardiomyopathies and can account for somewhere between 23% to 40% of all cases of dilated cardiomyopathy in Western countries (Piano). It sometimes occurs in women during the last trimester of pregnancy and up to 6 months after delivery. Hypertrophic cardiomyopathy is inherited in about 50% of cases (Hare 1739) and is found in individuals of any age, from neonates to the elderly (Berul). Loeffler's endocarditis, a form of restrictive cardiomyopathy, is more common in temperate latitudes (Benezet-Mazuecos).

For more information, refer to "Disease and Injury Causation," page 243.

Source: Medical Disability Advisor



Diagnosis

History: Regardless of the causes associated with specific cardiomyopathies, symptoms may include shortness of breath (dyspnea) during ordinary activities, dyspnea on exertion such as walking or climbing stairs, or shortness of breath when lying down to sleep (orthopnea). Fatigue and weakness are other common symptoms.

Hypertrophic cardiomyopathy may have no symptoms or produce complex symptoms ranging from dyspnea and fainting to angina, orthopnea, heart failure, and sudden death, even as a first manifestation of the disease. The individual may report only palpitations. Sudden death is most often the result of ventricular fibrillation, which can follow atrial fibrillation or atrial flutter, making early diagnosis important.

Dyspnea on exertion and fatigue are the most prominent symptoms of restrictive cardiomyopathy. Other symptoms include increased abdominal girth, swelling of the feet and ankles, and upper abdominal discomfort due to swelling of the liver. In individuals with restrictive cardiomyopathy secondary to infiltrative diseases (e.g., amyloidosis, sarcoidosis), fainting (syncope) or near syncope and sudden death may occur.

The individual's history of illness, medications, and use of alcohol, tobacco, or cocaine may be important in diagnosing the type of cardiomyopathy. The family's history of heart disease may also be helpful.

Physical exam: The examining physician looks for signs of heart failure and fluid accumulation in tissues. The individual may present with physical abnormalities relating to the specific cause of a cardiomyopathy, such as signs and symptoms of diabetes, thyroid disease, nutritional deficiencies, and neuromuscular disease. Abnormalities not related to a cause but reflecting HF include prominence of the neck veins (jugular vein distension); sounds of fluid in the lungs audible with a stethoscope (crackles or rales); a heart murmur; tachypnea or tachycardia; an extra heart sound (gallop); low pulse pressure; and swelling of the lower legs, ankles, and/or abdomen.

The individual with dilated cardiomyopathy often appears breathless and pale and has difficulty breathing while lying down (recumbent). Fast heart rate (tachycardia) and abnormal beats (ectopic beats) are common. There may be wheezing and other chest findings consistent with pulmonary edema and heart failure. The liver may be enlarged (hepatomegaly).

The primary finding on physical exam in individuals with hypertrophic cardiomyopathy may be a systolic heart murmur that changes in character with different physical tests, such as squatting or forcible exhalation against a closed airway (Valsalva maneuver) and performing exercise after the heart has been stressed with drugs such as amyl nitrite or nitroglycerin (stress test).

Common physical findings with restrictive cardiomyopathy are swelling of the ankles and feet, fluid in the abdomen (ascites), and an enlarged, tender liver. The heart sounds are distant with extra sounds (gallop).

Tests: A complete blood count (CBC) is done because anemia is a high cardiac output state that can be causative, and a chemistry profile is done to evaluate organ system involvement. Laboratory tests are obtained to identify abnormalities related to specific causes. For example, thyroid function tests identify a possible thyroid disorder or thyroid hormone toxicity (thyrotoxicosis), and cultures of various fluids help identify active bacterial and fungal diseases. Viruses, if suspected, may be identified with specific virology tests not performed in the average hospital laboratory. Cardiac biomarkers can differentiate ischemic heart disease from cardiomyopathy. B-type natriuretic peptide can be monitored to determine the extent of fluid accumulation. A pregnancy test is usually done because pregnancy also involves high cardiac output. Urine toxicology screening may help identify a toxin responsible for injury to the heart muscle.

An electrocardiogram (ECG), chest x-rays, and echocardiogram are usually obtained to evaluate overall function of the heart and resulting pulmonary congestion. One or more of these tests are almost always abnormal in an individual with a cardiomyopathy. Cardiac catheterization (central venous line or pulmonary artery catheterization) can help indicate cardiac filling pressures and estimate cardiac output. Computed tomography (CT) scans may reveal heart muscle tissue abnormalities in more detail; biopsy of the heart muscle may be performed to investigate myocarditis, connective tissue disease, and amyloidosis.

Source: Medical Disability Advisor



Treatment

Individuals with all types of cardiomyopathy are usually urged to make lifestyle changes. Restriction of salt and abstention from alcohol are important dietary changes. Obesity must be addressed. Cessation of smoking reduces the workload on the heart.

Treatment varies widely because of the many possible causes. In general, treatment of HF common to most cardiomyopathies includes combinations of medications to remove excess fluid from the body (loop diuretics, potassium-sparing diuretics), to strengthen the heartbeat (cardiac glycosides, i.e., Digitalis preparations such as digoxin), and to reduce the heart’s workload (usually a combination of angiotensin-converting enzyme [ACE] inhibitors, nitrates [vasodilators], beta blockers, and angiotensin-II receptor-blockers [ARBs]).

Cardiomyopathies attributable to infections are treated with the appropriate antimicrobials. Treatment may include anticoagulants to reduce the risk of blood clots. Some individuals may not respond to drug therapy.

In some individuals, the mitral valve on the left side of the heart becomes leaky (incompetent; this condition is also called mitral insufficiency), allowing blood to travel in a reverse direction across it. This condition compounds HF and may require heart surgery, which consists of reconstructing the valve (valvuloplasty) or replacing it with an artificial valve.

A heart transplant is indicated in the most serious cases if all other criteria for transplantation surgery are met.

The drug regimen for hypertrophic cardiomyopathy often includes beta-blockers and calcium channel blockers to help the heart function properly. If the treatment is unsuccessful, the individual may benefit from implantation of a defibrillator device. Some individuals may require surgery to remove excess myocardial tissue in the interventricular septum (septal myomectomy). Septal ablation is a newer, less invasive, alternative technique in which an alcohol solution is injected into an artery supplying the portion of the heart where the muscle is thickened and causing obstruction. This causes a localized, controlled "heart attack" to that thickened part of the muscle, which helps to decrease the amount of obstruction. In rare cases, a heart transplant is recommended.

In individuals with restrictive cardiomyopathy, drug therapy is usually attempted but is often unsuccessful.

Source: Medical Disability Advisor



Prognosis

Morbidity and mortality vary widely and are related to the cause and severity of a given cardiomyopathy and the age and general health status of the individual. Regardless of its cause, the natural history of cardiomyopathy may be short, with death occurring within several months to 2 years. The clinical course may also be relatively stable and surprisingly long in some individuals who respond to therapy. Long-term studies show that survival is proportional to disease severity at diagnosis.

The annual mortality rate of individuals with dilated cardiomyopathy is 20% in those with moderate heart failure and can be as high as 50% in those with severe heart failure (Ferri; Okutucu). The risk of death varies greatly with the presence or absence of comorbidity. Accounting for one’s comorbidities and risk profile can enhance the accurate prediction of survival (Pocock; Okutucu)

Young individuals with a recent onset of dilated cardiomyopathy generally have a good outcome, because of either successful drug therapy or spontaneous reversal of the cardiomyopathy. It is possible, however, that some individuals, particularly those who are older, will not respond to the medication and may require a heart transplant.

Individuals with hypertrophic obstructive cardiomyopathy often have a poor prognosis because drug treatment is generally unsuccessful unless surgery is performed to remove excess myocardial tissue in the interventricular septum (septal myomectomy). The annual mortality rate of all individuals with hypertrophic cardiomyopathy is 1% to 2% (Ferri). The mortality rate among non-infant pediatric patients is about 1% per year. The 1-year survival rate for in infants younger than 1 year old is 85.8% (Colan). It is the most common cause of sudden death among young adults (Maron). In all who suffer from hypertrophic cardiomyopathy, sudden death is a possible outcome, usually from ventricular fibrillation occurring without warning (Maron).

Restrictive cardiomyopathy does not often respond to treatment, and the outcome generally is poor (Ammash).

Source: Medical Disability Advisor



Rehabilitation

Cardiac rehabilitation programs include individuals with cardiomyopathy and provide a supervised exercise program to maintain strength and efficiency of the heart muscle. Individually designed exercise programs for cardiomyopathy progress on an as-tolerated basis that is considered safe for each individual.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistCardiomyopathy
Cardiac Rehabilitation SpecialistUp to 2-5 visits per week within 3-12 weeks

Source: Medical Disability Advisor



Complications

Complications include heart failure, fluid overload, pulmonary edema, hypoxia, cardiogenic shock, and sudden death. Irregular, rapid heart rate (atrial fibrillation) may occur and can progress to ventricular fibrillation in hypertrophic cardiomyopathy. A small blood clot (thrombus) may form within the heart, and an even smaller piece can be dislodged (embolus) and carried by the bloodstream to any organ of the body, with serious consequences. For example, an embolus to the brain can cause a stroke, while an embolus to the eye can cause blindness. A pulmonary embolism can result in sudden death.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions are related to the severity of the HF secondary to the cardiomyopathy. Few individuals are able to perform strenuous work, although some can perform moderately strenuous activities, and many can perform jobs that require primarily cognitive functioning. Accommodations may be needed for frequent medical appointments. Individuals taking diuretics to control fluid overload may need bathroom breaks more frequently during the workday. Cardiopulmonary exercise tests are helpful in determining functional capacity, although extreme exertion or heavy work should be avoided secondary to the increased risk of sudden cardiac death. For further information on risk, capacity, and tolerance, please refer to "Work Ability and Return to Work," pages 271-274.

Risk: As job duties require increasing cardiac demands, the minimum time to return to work will increase.

Capacity: Capacity as determined by stress ECHO testing will guide both therapy and give indications on safer work recommendations. Restrictions are often needed in more advanced disease despite maximum medical therapy.

Tolerance: Some work accommodations may allow a patient to work despite concerns over their symptoms.

Source: Medical Disability Advisor



Maximum Medical Improvement

Non-viral cardiomyopathy can be at MMI at 90 days.

Viral cardiomyopathy may require much longer duration to stabilize—up to 360 days as improvement can often be seen over time.

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:

  • Were appropriate diagnostic laboratory tests performed?
  • Was echocardiogram done to confirm diagnosis and rule out other possible heart conditions? ECG? Chest x-ray?
  • Was myocardial biopsy done?
  • Did individual require cardiac catheterization to further investigate cardiomyopathy?
  • Does a Holter or event recorder study indicate that intermittent arrhythmias are occurring?
  • Was diagnosis of cardiomyopathy confirmed? What type?

Regarding treatment:

  • Were clinical symptoms addressed and treated appropriately?
  • Is individual taking medications as prescribed?
  • Did symptoms improve, persist, or worsen?
  • Were corresponding adjustments made in specific drug therapy (additions or increased or decreased dosage)?
  • Was surgery required?
  • Did the individual participate fully in a cardiac rehabilitation program, including making lifestyle changes? If not, are there barriers that prevent compliance with rehabilitation and treatment recommendations, such as insurance limitations, lack of motivation, excess fatigue, or psychosocial stress?

Regarding prognosis:

  • What was the extent of disease at the time of diagnosis? Is the individual compliant with the treatment being prescribed? Are symptoms progressing? Do serial echocardiograms show heart function is stable, or worsening over time?
  • Does individual have concurrent illnesses or chronic conditions that may influence ability to recover?
  • Has individual developed complications that may affect recovery?
  • Would individual benefit from consultation with a cardiac surgeon? Was heart surgery considered?
  • Has a stress echocardiogram been done to estimate safe exercise levels?

Source: Medical Disability Advisor



References

Cited

Ammash, N. M. , et al. "Clinical Profile and Outcome of Idiopathic Restrictive Cardiomyopathy." Circulation 101 (2000): 2490-2496.

Benezet-Mazuecos, J. "Loeffler Endocarditis: What Have We Learned?" American journal of hematology 82 (2007): 861-862.

Berul, Charles I., and Christina Y. Miyake. "Cardiomyopathy, Hypertrophic." eMedicine. Eds. Christopher Johnsrude, et al. 25 Aug. 2009. Medscape. 6 Sep. 2009 <http://emedicine.medscape.com/article/890068-overview>.

Colan, S. D. , et al. "Epidemiology and Cause-Specific Outcome of Hypertrophic Cardiomyopathy in Children." Circulation 115 (2007): 773-781.

Fananapazir, L. , and ND Epstein. "Prevalence of Hypertrophic Cardiomyopathy and Limitations of Screening Methods." Circulation 92 (1995): 700-704.

Ferri, Fred. "Cardiomyopathy." Ferri's Clinical Advisor: Instant Diagnosis and Treatment. Mosby, Inc., 2010. 177-180.

Goswami, Vivek J. , and Frank E. Wilklow. "Dilated Cardiomyopathy ." eMedicine. Eds. Henry H. Ooi, et al. 3 Feb. 2012. Medscape. 23 Jan. 2013 <http://emedicine.medscape.com/article/152696-overview>.

Hare, Joshua M. "The Dilated, Restrictive, and Infiltrative Cardiomyopathies (Chapter 64)." Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Eds. Peter Libby, et al. 8th ed. W.B. Saunders, 2007. 1739-1760.

Hershberger, R. E. , and J. D. Siegfried. "Update 2011: Clinical and Genetic Issues in Familial Dilated Cardiomyopathy." Journal of the American College of Cardiology 57 (2011): 1641-1649.

Melhorn, J. Mark, and William Ackerman, eds. Disease and Injury Causation, Guides to the Evaluation of. AMA Press, 2008.

Okutucu, S. , and A. Oto. "Risk Stratification in Nonischemic Dilated Cardiomyopathy: Current Perspectives." Cardiology journal 17 (2010): 219-229.

Piano, M. R. "Alcoholic Cardiomyopathy: Incidence, Clinical Characteristics, and Pathophysiology." Chest 121 (2002): 1638-1650.

Pocock, S. J. "Predicting Survival in Heart Failure: A Risk Score Based on 39 372 Patients from 30 Studies." European Heart Journal (2012): 1404-1413.

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.

Viccellio, Asa, and Vivek J. Goswami. "Restrictive Cardiomyopathy." eMedicine. Ed. Henry H. Ooi. 29 Jun. 2011. Medscape. 23 Jan. 2013 <http://emedicine.medscape.com/article/153062-overview>.

Source: Medical Disability Advisor






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