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 Murmur


Related Terms

  • Murmur

Differential Diagnosis

Specialists

  • Cardiologist, Cardiovascular Physician
  • Internal Medicine Physician

Comorbid Conditions

  • Cardiovascular disease
  • Endocrine disorders
  • Obesity
  • Respiratory disorders

Factors Influencing Duration

Length of disability may be influenced by underlying conditions, extent and nature of the murmur, and required treatment. The individual's age and severity of the symptoms may also be factors.

Medical Codes

ICD-9-CM:
785.2 - Undiagnosed Cardiac Murmurs; Heart Murmur NOS

Overview

A heart murmur is a sound produced by blood crossing a valve within the heart, a muscle that beats about 100,000 times daily. A valve functions like a thin door separating open areas (chambers) within the heart. When open, a valve allows blood to cross it in a forward fashion and, when closed, prevents blood from surging backward. When heart murmurs are audible at a certain volume with a stethoscope, they generally are considered abnormal in adults and may signal a mild to serious underlying condition.

Normal valves generally do not produce unusual murmurs except in children, who commonly have functional or innocent murmurs caused by fast blood flow or large volumes of blood moving through an otherwise healthy heart. Fast blood flow and accompanying murmurs can produce innocent murmurs in adults under certain circumstances, including presence of excess thyroid hormone (hyperthyroidism), anemia or fever. Pregnancy, associated with extra blood in the body, also can cause innocent murmurs.

Murmurs may occur in any of the four valves (tricuspid, pulmonic, mitral and aortic) associated with four chambers within the heart. Murmurs produced when blood flows across a valve in a forward fashion are called systolic. Murmurs produced by blood flowing in the opposite direction are called diastolic. Valves that are too narrow (stenotic) cause systolic murmurs and those that are too leaky (insufficient) cause diastolic murmurs.

Clues to the underlying cause of murmurs may be found in how murmurs are associated with the responsible valve, and whether the valve is stenotic or insufficient. A common murmur is mitral insufficiency (mitral regurgitation), often caused by heart attack (myocardial infarction) or conditions such as rheumatic fever.

Other causes of heart murmurs include high blood pressure (hypertension), degeneration and calcification of the valve due to hardening of the arteries (atherosclerosis), infection due to endocarditis, and trauma.

Incidence and Prevalence: Cardiovascular disease (CVD) is found in some form in about 64.4 million US residents ("Heart Facts"). Mitral regurgitation, a common source of heart murmur, may result when the heart's mitral valve fails to close properly (mitral valve prolapse or MVP), a condition found in about 4% of populations of developed nations (DiSandro).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals who smoke have a significantly increased risk of developing heart disease (about 350,000 deaths annually in the US being attributed to cigarette smoking) (Yakubov 756). Inactivity, diabetes mellitus, obesity and genetic factors also may be linked to heart disease.

Source: Medical Disability Advisor



Diagnosis

History: A history of a murmur since birth establishes it as congenital. The individual may report occurrences of frequent strep throats during childhood, which raises the possibility of overlooked rheumatic fever as a cause. A recently acquired murmur suggests atherosclerosis, hypertension, or endocarditis. The individual may report a history of heart attack, which can cause heart murmurs. The individual may have an underlying heart condition along with symptoms such as a bluish tinge to the skin, rapid breathing, chest pain, fatigue, or excessive sweating.

Physical exam: A stethoscope best identifies murmurs, which are rated by intensity. Grade 1 is barely audible and Grade 6 is audible even with the stethoscope off the chest. The location on the chest wall where the murmur is best heard and areas to which it radiates can help identify the heart (cardiac) structure from which the sound originates. For example, a murmur produced by a narrowed mitral valve (mitral insufficiency) is usually loudest at the apex of the heart (fifth intercostal space, mid clavicle line) and may radiate toward the breastbone (sternum). Where the murmur occurs in the cardiac cycle may offer important clues to the cause. The murmur may occur in the resting stage (diastole) or contracting stage (systole), early or late in the stage, or throughout the heartbeat.

Soft or hard to hear systolic murmurs can often be amplified by having the individual strain down as if attempting to lift a heavy object and exhale with nose and mouth blocked (Valsalva maneuver). The individual also may be asked to briefly inhale a substance called amyl nitrite that increases the flow of blood across a valve.

Tests: Because heart murmurs may develop from a variety of underlying causes, the diagnostic testing required will vary. Chest x-ray, analysis of heart rate and beats (electrocardiogram), measurement of pressure inside arteries or veins (cardiac catheterization), ultrasound imaging (echocardiography), treadmill exercise tests, and use of a dye for imaging blood flow (angiography) are typical diagnostic tests.

Source: Medical Disability Advisor



Treatment

Appropriate therapeutic intervention is based on the underlying medical condition responsible for the heart murmur. Functional murmurs are not caused by valvular defect or a hole in the wall dividing upper heart chambers (septal defect) and pose no danger to the individual. Murmurs of a significant nature require medical treatment such as antibiotics prescribed to treat and / or prevent infection. High blood pressure medications (antihypertensives) decrease pressure and stress on the heart. In serious cases of heart murmur, open or closed surgical repair of valves may be performed. Surgical procedures may include valve replacement with synthetic or natural grafts.

Source: Medical Disability Advisor



Prognosis

An individual may have a benign functional murmur without any problems or impact on longevity. A murmur associated with valvular stenosis or insufficiency can result in significant complications that must be managed. Generally, medical management of heart murmurs is very good. Surgical valve replacement has good success rates, although the procedure at times is associated with complications or death depending on the degree of impairment.

Source: Medical Disability Advisor



Rehabilitation

Individuals with heart murmurs due to serious underlying medical conditions should attend outpatient physical and occupational therapy at a clinic specializing in cardiac rehabilitation, 3 times a week for 8 to 12 weeks. Cardiac rehabilitation centers offer electrocardiogram (ECG) monitoring of all participants during the exercise sessions. Individuals learn to self-monitor their pulse and rate the amount of energy they expend by utilizing a rating of perceived exertion scale. This is a numbered scale that rates exercises from "very, very light" to "very, very hard." Individuals use this scale and their pulse to stay within safe exercise parameters predetermined by their physicians.

Individuals also perform aerobic exercise such as treadmill walking or stationary bicycling. Occupational therapy addresses any fatigue or shortness of breath that may occur during activities of daily living. Individuals learn to utilize equipment such as a shower chair to decrease the energy expended during bathing or a long-handled sponge to decrease the amount of arm activity necessary for bathing. (Excessive arm activity is more taxing on the heart and can lead to fatigue). Occupational therapists may teach energy conservation techniques where activities of daily living such as meal preparation are broken up into smaller components to make tasks more manageable.

Source: Medical Disability Advisor



Complications

Abnormal murmurs may indicate susceptibility to an infection of the heart (endocarditis). Endocarditis is most often acquired from dental work with gum bleeding that allows bacteria in the mouth to enter the bloodstream. Bacteria then settle on the abnormal valve and cause a potentially serious infection. This infection can be easily prevented with penicillin or a related antibiotic before the dental work is performed. Individuals with a murmur should inform their dentist of this condition before any work (including teeth cleaning) is done.

Incompetent or stenotic valves can, over time, lead to heart failure, irregular heartbeats, or heart attack.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

No work restrictions or special accommodations usually are required for an individual with a heart murmur. However, if the associated valvular stenosis or insufficiency results in a significant complication, the condition may dictate work restrictions or accommodations. Job stress and physical activity should correspond to worker fitness. Individuals may be advised to resume work on a part-time basis following surgery.

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:

  • Does individual complain of dizziness, chest pain, or fluttering heart?
  • Has individual had an ECG to rule out heart rhythm disturbances? Has individual had an echocardiogram? Has individual had a chest x-ray to rule out congestive heart failure?
  • Does individual have visible symptoms of underlying heart condition such as bluish skin or rapid breathing?

Regarding treatment:

  • What treatments or medications have been tried?
  • Is individual a candidate for surgery or undergone past surgery?
  • Is individual a candidate for antibiotic therapy to address possible underlying heart infection (endocarditis)?

Regarding prognosis:

  • Does individual demonstrate symptoms of congestive heart failure such as shortness of breath, low blood pressure, weight gain, or swelling of legs and feet?
  • Does individual have a murmur associated with valvular stenosis or insufficiency? Did complications occur and are they being managed?
  • Has individual undergone rehabilitation appropriate to any underlying condition?

Source: Medical Disability Advisor



References

Cited

"Heart Facts 2004: All Americans/African Americans." American Heart Association. American Heart Association, Inc. 14 Oct. 2004 <http://www.americanheart.org/presenter.jhtml?identifier=3000992>.

DiSandro, Daniel. "Mitral Regurgitation." eMedicine. Eds. Robert M. McNamara, et al. 6 Oct. 2004. Medscape. 14 Oct. 2004 <http://emedicine.com/emerg/topic314.htm>.

Yakubov, Steven J., and Edward T. Bope. "Examination of the Heart." Rakel: Textbook of Family Practice. Ed. Robert E. Rakel. 6th ed. Philadelphia: W.B. Saunders, 2002. 753-756. MD Consult. Elsevier, Inc. 14 Oct. 2004 <http://home.mdconsult.com/das/book/41608297-2/view/1009?sid=280127813>.

Source: Medical Disability Advisor






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