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.

Coronary Balloon Angioplasty


Related Terms

  • Percutaneous Coronary Intervention (PCI)
  • Percutaneous Transluminal Coronary Angioplasty (PTCA)

Specialists

  • Cardiologist, Cardiovascular Physician
  • Thoracic Surgeon

Comorbid Conditions

Factors Influencing Duration

Age, procedural complications, job requirements, comorbid chronic illness, and coexistence of vascular disease elsewhere may affect the duration of disability. Duration depends on the underlying condition and any complications that arise.

Medical Codes

ICD-9-CM:
00.66 - Percutaneous Transluminal Coronary Angioplasty [PTCA]

Overview

© Reed Group
Coronary balloon angioplasty is a procedure designed to widen segments of coronary arteries narrowed by atherosclerotic plaque (coronary artery disease) using a catheter with a small balloon on its tip. The procedure is an alternative to coronary artery bypass surgery for restoring arterial blood flow to oxygen-deprived portions of the heart (revascularization). Another method used to open blocked arteries is atherectomy, which consists of boring through the artery with a burr. The procedure is usually complemented by the use of stents to hold the arteries open. Percutaneous access is achieved through a peripheral artery, usually the femoral artery in the groin. This method of access is called percutaneous coronary intervention (PCI). PCI is widely used to treat multivessel disease, vessel occlusion, saphenous vein graft disease, unstable angina, and heart attack (acute myocardial infarction). In 2010, an estimated 492,000 patients underwent PCI procedures in the US alone (Go).

Source: Medical Disability Advisor



Reason for Procedure

Initially, this procedure was performed on individuals with predictable chronic pain in the chest during exertion (stable angina or effort angina). Now, however, it is used for various acute coronary syndromes (unstable angina) and heart attacks (acute myocardial infarctions), and on individuals who survive a cardiac arrest outside the hospital.

Balloon angioplasty may be done to relieve obstructions in one, two, or all three of the coronary arteries. It is usually performed for single-vessel disease and in some cases of two-vessel disease. Individuals with three-vessel disease often have bypass surgery rather than angioplasty because it is safer. Those with disease of the most important coronary artery (left main coronary artery) almost always have bypass surgery.

The ideal indication for angioplasty is a narrowing (stenosis) located in a straight segment of the first part of a coronary artery without angulations or branching. The narrowing is preferably short (less than 1 cm), not total (incomplete or partial occlusion), and symmetrical, without calcium or a fresh blood clot (thrombus). The extent and severity of the coronary narrowing are determined beforehand by a coronary angiogram. Recent technological advances, such as "steerable" guide wires and balloons that can be inflated even when narrowing is less than ideal, have increased the safety and efficacy of the procedure. Using PCI has made coronary angioplasty simpler and encouraged widespread use. The advantages include use of only local anesthesia, outpatient or a one-day hospital stay, and a short recovery time.

If angioplasty is attempted on older vein grafts, heart damage may occur, because occlusion of these older grafts is often a result of buildup of atherosclerotic plaque (i.e., accumulation of lipids, cholesterol, calcium, and cellular debris) that can become dislodged into the distal portion of the coronary artery.

Angioplasty is not performed on mild obstructions that narrow the artery by less than 50%, because such lesions seldom cause symptoms. In addition, angioplasty may actually accelerate progress of such lesions (Popma 1425).

The typical goal is to reduce the narrowing of the vessel by at least 50% (Levine). Patients are carefully selected to avoid increased risk associated with age (<75 years) or comorbid chronic illness. Contraindications to angioplasty include lesions that are more than 2 cm long, twisted (tortuous) vessels, certain branching configurations (where there is a risk of occluding one branch while dilating the other), smaller than normal vessels, lesion calcification, the presence of thrombus in the vessel, total occlusions older than 3 months, and old vein grafts (risk of embolization). The benefits of the procedure are always weighed against individual risk (Patel).

Source: Medical Disability Advisor



How Procedure is Performed

Angioplasty is done under local anesthesia in a cardiac catheterization laboratory. Aspirin and/or other antiplatelet agents are usually administered before the procedure to prevent platelet aggregation, the first step in blood clotting, and to reduce the risk of acute formation of a blood clot at the angioplasty site.

A hollow-bore needle is inserted through the skin (percutaneously) into a peripheral artery in the groin (femoral artery) or less commonly the arm (radial artery). A guide wire is threaded into the needle and advanced into the aorta; then the needle is removed. A special small-caliber guiding catheter is advanced under fluoroscopic guidance to the mouth (ostium) of the coronary artery to be dilated. Next, a flexible, "steerable" guide wire is directed through the guiding catheter until it reaches the stenotic lesion. Radiographic contrast injections into the vessel through the guide wire allow fluoroscopic visualization of the coronary artery opening (lumen). The guide wire also serves as a support over which the balloon-tipped catheter is passed to perform the therapeutic procedure. Two openings in the catheter permit passage over the guide wire and the transport of a mixture of saline and radiographic contrast material to inflate the balloon. The balloon-tipped catheter is then advanced into the vessel to the point of the narrowing, where it is centered over the lesion and inflated with a small amount of fluid ("Coronary Angioplasty").

Fluoroscopic views ascertain if the vessel has been adequately opened. Only about 25% of cases achieve a satisfactory widening of the artery (less than 20% stenosis) on the first balloon inflation (Popma 1425). In 30% to 35% of cases, the balloon will have to be reinflated several times due to residual atherosclerotic plaque until the vessel is sufficiently stretched to relieve the stenosis and restore blood flow. A tear may occur in the vessel during the widening process (therapeutic dissection), usually at the edges of the atherosclerotic plaque (atheroma); this is actually beneficial to the procedure.

The widening of the coronary artery is usually followed by placement (using also a catheter) of a small metal mesh tube called a stent that serves as a permanent scaffold in the treated segment of the artery. Some stents are coated with antiproliferative drugs that are gradually released into the artery; these stents are called drug-eluting stents. The end result of the procedure is evaluated by angiography.

Source: Medical Disability Advisor



Prognosis

Percutaneous coronary interventions (PCI) using advanced techniques in selected patients have an excellent success rate (Levine). Coronary symptoms are relieved in about 80% of cases of balloon angioplasty (Popma 1425). A recurrence of narrowing (restenosis) of the artery 6 to 9 months after the procedure may lead to myocardial infarction, progression of atherosclerosis, or death in about 1% to 2% of cases each year (Popma 1425). Restenosis after PCI occurs in about 30% of patients who have had balloon angioplasty without stent placement ("Coronary Angioplasty"). Stenting and the use of drug-eluting stents may reduce the restenosis rate and improve outcomes significantly (Brodie; Stefanini; Patel; Levine). The risk of restenosis is higher for individuals with longer lesions, smaller vessels, diabetes, and multivessel atherosclerosis (Brodie).

Coronary symptoms that develop longer than 9 months after balloon angioplasty likely result from new atherosclerotic disease in a different vessel rather than from restenosis. However, survival is very good following balloon angioplasty, with a 10-year survival rate of 95% for those with single-vessel disease and 81% for those with multivessel disease (Popma 1425). In individuals with a totally obstructed vessel, passage of a guide wire through the blockage can be very challenging depending on the characteristics of the patient, the lesion, and the procedure used (Morino). However, evolving techniques and drug-eluding stents are improving the prognosis for PCI in totally occluded vessels (Morino; Stefanini).

Source: Medical Disability Advisor



Complications

Abrupt vessel closure may occur in 5% to 8% of cases (Popma 1425). Myocardial infarction occurs in about 15% of cases or more (Levine). Stroke occurs in 0.5% of balloon angioplasties (Popma 1425). Emergent coronary artery bypass graft (CABG) surgery is needed in less than 3% of cases ("Coronary Angioplasty"). The intraprocedural or in-hospital mortality rate is less than 2% (Levine).

Other complications may include arrhythmias, kidney insufficiency, and perforation of a coronary artery. Complications at the artery access site may include hematoma, pseudoaneurysm, arteriovenous fistula and arterial dissection and/or occlusion, occurring in 2 to 6% of cases (Levine).

Complications are more likely to occur in higher risk groups such as those over the age of 65, as well as with people who have chronic kidney disease, who are in shock, or who have extensive heart disease ("Coronary Angioplasty").

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Within the first week after angioplasty, individuals should, as much as possible, avoid lifting more than 10 to 15 pounds, as well as bending, to reduce the chances of late bleeding from the entry site in the groin. If an acute myocardial infarction occurs or urgent bypass surgery is necessary, other work restrictions may be needed.

For more information on risk, capacity, and tolerance as they apply to myocardial infarction, refer to "Work Ability and Return to Work," pages 264-267.

Risk: With simple brief exertional angina, no lost work time may be needed other than usual doctor appointments. If an individual does not address underlying risk factors, then job factors will not be the only ongoing risk. Risk will increase with high stress positions or jobs with very heavy physical exertion. Jobs that have a physical component, when performed under safe conditions, may be beneficial and protective for an individual.

Examining causal risk factors also aids in understanding future concerns. For more information, refer to "Disease and Injury Causation," pages 238-243.

Capacity: Capacity is determined by stress ECHO testing or similar provocative testing. Attention should focus on METS achieved and whether testing reproduced any symptoms.

Tolerance: Individuals will often complain about chest symptoms and knowing whether this represents angina is critical in reassuring return to work discussions. Emphasis should be on results of objective testing and ensuring optimal medical management.

Source: Medical Disability Advisor



Maximum Medical Improvement

In the absence of myocardial infarction, MMI can be determined at 30 days.

Source: Medical Disability Advisor



References

Cited

"Coronary Angioplasty." National Institutes of Health. 1 Feb. 2012. U.S. Department of Health and Human Services. 30 May 2013 <http://www.nhlbi.nih.gov/health/health-topics/topics/angioplasty/>.

Brodie, B. R. , et al. "Outcomes with Drug-Eluting Stents Versus Bare Metal Stents in Acute St-Elevation Myocardial Infarction: Results from the Strategic Transcatheter Evaluation of New Therapies (Stent) Group." Catheterization and Cardiovascular Interventions 72 (2008): 893-900.

Go, A. S. , et al. "Heart Disease and Stroke Statistics--2013 Update: A Report from the American Heart Association." Circulation 127 (2013): e6-e245.

Levine, G. N. , et al. "2011 Guideline for Percutaneous Coronary Intervention: Executive Summary: A Report by ACCF/AHA/SCAI." Circulation 124 (2011): 2574-2609.

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

Morino, Y. , et al. "Predicting Successful Guidewire Crossing through Chronic Total Occlusion of Native Coronary Lesions within 30 Minutes." Journal of the American College of Cardiology 4 (2011): 213-221.

Patel, M. R. , et al. "2009 Appropriateness Criteria for Coronary Revascularization: A Report by Accf/Scai/Sts/Aats/Aha/Asnc ." Journal of the American College of Cardiology 53 (2009): 530-553.

Popma, J. J., Donald S. Baim, and Frederic S. Resnic. "Percutaneous Coronary and Valvular Intervention." Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Eds. Peter Libby, et al. 8th ed. W.B. Saunders, 2007. 1419-1449.

Stefanini, G. G. , and D. R. Holmes. "Drug-Eluting Coronary-Artery Stents." New England Journal of Medicine 368 (2013): 254-265.

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.

Source: Medical Disability Advisor






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