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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.

Heart Failure, Congestive


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Diagnosis

History: Individuals with left ventricular heart failure may complain of shortness of breath (dyspnea), dry hacking cough, difficulty in breathing when lying down (orthopnea), and awakening at night acutely short of breath (paroxysmal nocturnal dyspnea). Fatigue and activity intolerance, weakness, dizziness, and brief fainting spells (syncope) may also be reported. Individuals with right ventricular failure may report swelling (edema) in the feet and legs, pain in the upper right part of the abdomen due to edema in the liver, nausea, loss of appetite (anorexia), and excessive urination at night (nocturia). Individuals with both right and left ventricular failure (bi-ventricular failure) may report all the symptoms listed above. Individuals with CHF may report a history of diabetes or chronic alcohol abuse. A family history of heart failure may be reported. A personal history of prior heart attack (myocardial infarction), high blood pressure, arrhythmia, kidney problems, lung disease, or anemia may also be reported. History also includes a review of current medications.

Physical exam: In individuals with left ventricular failure, the use of a stethoscope (auscultation) might reveal popping sounds in the chest during breathing (pulmonary "rales" or "crackles") indicating congestion and a degree of pulmonary edema. In individuals with right ventricular failure, the veins in the neck may be enlarged (jugular venous distention), and the arms, hands, ankles and lower back may show signs of fluid overload such as swelling (peripheral edema). The abdomen may be distended due to accumulation of free fluid (ascites); the liver may be enlarged and tender (hepatomegaly). The individual may present with only fluid overload and no signs of organ dysfunction or reduced perfusion. The individual may be comfortable at rest and develop dyspnea, weakness, and fatigue on exertion only. In advanced cases, the heart rate may be rapid even when the individual is sitting or lying down (resting tachycardia). The rapid heart rate may be secondary to sinus tachycardia, or to atrial or ventricular tachyarrhythmias. Blood pressure may be elevated. Auscultation may reveal abnormal heart sounds (displaced apex beat, third heart sound). Respiratory muscle strength may be diminished, resulting in difficulty breathing and decreased endurance. Nausea, vomiting, and intestinal upset can be present. The individual may exhibit confusion; memory impairment, anxiety, and sometimes psychosis and disorientation are observed in elderly patients with advanced cerebrovascular atherosclerosis. In severe heart failure with acute decline in cardiac output, the systolic arterial pressure may be markedly reduced, pulse may be weak and rapid, and the skin may appear bluish (cyanosis).

Tests: Laboratory tests that may be performed include measurement of electrolytes (sodium, potassium, chloride), serum bilirubin, blood urea nitrogen (BUN), albumin and total protein levels, blood glucose, kidney function tests, and liver enzymes (liver function tests). A complete blood count (CBC) is done to assess for anemia or an elevated white cell count. Coagulation tests (prothrombin time, or PT; partial thromboplastin time, or PTT) may be done if the individual is taking anticoagulants to prevent blood clot formation. The amount of oxygen and carbon dioxide in the bloodstream is measured by oxygen saturation measurement, or by full arterial blood gas (ABG) analysis. Tumor necrosis factor-alpha (TNF-alpha) and endothelin-1 (ET-1) may be measured because they contribute to regulation of heart muscle function; both are usually elevated in CHF. B-type natriuretic peptide has become the most used blood test to confirm the presence of heart failure and to quantitate its severity. Urinalysis and 24-hour urine tests may be performed to evaluate albumin, creatinine, and sodium excretion and urinary output. A chest x-ray may show if the heart has increased in size (hypertrophied or dilated) and may differentiate between cardiogenic pulmonary edema and other lung disease. Echocardiography (cardiac ultrasound with duplex Doppler) may be used to evaluate function of the left ventricle and to obtain evidence of ventricular dilation and enlargement (hypertrophy). Transthoracic echocardiography also provides information about heart function and anatomy. Magnetic resonance imaging (MRI) may also be used to evaluate myocardial function and obtain detailed information about valvular disease. Electrocardiography (ECG) is used to identify changes associated with ventricular enlargement and to detect abnormal heart rhythms (arrhythmias), decreased blood flow and oxygen delivery to the heart (myocardial ischemia), or tissue death due to absence of blood flow to a certain region of the heart (myocardial infarction). For class I or II individuals who can withstand the activity, monitoring the heart with ECG while the individual exercises on a treadmill (cardiac stress test) may also be useful in identifying cardiac abnormalities associated with CHF. Six-minute walk tests also provide a good assessment of heart function and prognosis in CHF patients. Pulse oximetry may be done to assess hypoxemia and the severity of heart failure; oxygen saturation can also be monitored with pulse oximetry when supplemental oxygen is being administered.

Procedures that may be done to evaluate heart function include right-sided cardiac catheterization, left-sided cardiac catheterization, and coronary angiography. These invasive procedures are considered when the cause of heart failure is not revealed with noninvasive imaging methods, if heart attack (myocardial infarction) is a likely cause of heart failure, or to determine the severity of underlying valvular disease.

Source: Medical Disability Advisor