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.

Mitral Valve Prolapse


Related Terms

  • Ballooning Mitral Cusp
  • Barlow Syndrome
  • Barlow's Syndrome
  • Billroth I Procedure
  • Click-murmur Syndrome
  • Floppy Valve
  • Myxomatous Mitral Valve

Differential Diagnosis

  • Infective endocarditis
  • Mitral valve insufficiency
  • Papillary muscle infarction or dysfunction
  • Rheumatic heart disease

Specialists

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

Comorbid Conditions

Factors Influencing Duration

Most individuals with this disorder will not require surgery or other aggressive treatment; therefore, disability time should be minimal or nonexistent, unless surgery is involved. However, alcohol, caffeine, or cigarette may aggravate symptoms and prolong disability. Most disability time is a function of complications (mitral regurgitation, endocarditis, or arrhythmias). Disability depends on severity of symptoms, presence of complications, and treatment method.

Medical Codes

ICD-9-CM:
424.0 - Mitral Valve Disorders

Overview

© Reed Group
Mitral valve prolapse (MVP) is a common and highly variable condition associated with a disorder of the heart's mitral valve. The function of the mitral valve is to keep blood flowing in a single direction through the left side of the heart, thereby preventing backflow. When the valve is not functioning properly, or is prolapsed, the valve does not close tightly and allows blood to flow backward through the valve (mitral regurgitation).

The most common cause of mitral valve prolapse is a collagen-like growth (myxomatous changes) on the leaflets. The myxomatous changes are often idiopathic, but may occur in conjunction with connective tissue disorders such as Marfan syndrome, Duchenne muscular dystrophy, or cardiomyopathy. MVP may lead to enlargement of the left atrium and ventricle. Most cases of mitral valve prolapse are asymptomatic and are found incidentally on physical exam.

Incidence and Prevalence: MVP is the most common cardiac valve disorder and occurs in 3% to 5% of pediatric patients (Venugopalan). It is also a common disorder in otherwise healthy teenagers and young adults.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Studies reveal that MVP is twice as frequent in females as males (Venugopalan).

Source: Medical Disability Advisor



Diagnosis

History: Most patients with MVP are asymptomatic, although some patients present with symptoms of chest pain, shortness of breath, lightheadedness, fainting, fatigue, and irregular heartbeat (palpitations). Palpitations are often correlated with heart rhythm disturbances. Emotional stress may aggravate symptoms.

Physical exam: Listening to the heart will reveal heart sounds and blood flow patterns that are typical of mitral valve prolapse. There may be one or more systolic clicks. The murmurs may occur during all of systole or only in late systole. The clicks and murmur are minimized and may disappear when the patient shifts from a sitting to a supine (lying face upward) position.

Tests: Tests may include an electrocardiogram and an echocardiogram. Rarely, cardiac catheterization is done to assess the degree of mitral regurgitation.

Source: Medical Disability Advisor



Treatment

Individuals who are found to have an irregular or fast heartbeat (arrhythmias or tachycardia) or chest pain are often treated with beta-blocker drugs. When typical symptoms are not present with the tachycardia, the doctor may suggest anti-arrhythmic therapy to help regulate the heart rhythm. Individuals who have a systolic murmur (mitral regurgitation) are at a higher risk for infections of the heart lining (endocarditis), and should be given antibiotics before dental, genitourinary, gastrointestinal, and upper respiratory procedures or surgeries to minimize their risks of infection.

Mitral valve prolapse rarely requires surgical treatment. However, mitral valve replacement may be warranted for refractory heart rhythm disturbances, severe mitral regurgitation or incapacitating pain. In older individuals, males require surgical intervention more often than females.

Source: Medical Disability Advisor



Prognosis

Mitral valve prolapse is a relatively benign disorder. The condition is not progressive in childhood and most individuals will go through life without any symptoms or complications. Rarely, someone may require valve replacement if mitral regurgitation becomes a serious problem. Sudden death is also a very rare occurrence.

Source: Medical Disability Advisor



Complications

Bacterial endocarditis may develop in individuals with mitral valve prolapse. There may be a connection between this disorder and stroke. When the valve is especially thickened, the individual is at a higher risk for these complications. On rare occasions, mitral valve prolapse may progress to mitral regurgitation, which can precipitate congestive heart failure. Cerebral emboli (associated with increased platelet coagulant activity) are rare as well.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If the individual is symptomatic, severe stressful activity should be reduced. Individuals with definite clicks and murmurs are sometimes advised to avoid competitive sports or activities that require maximum effort.

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:

  • Is individual a female?
  • Does individual have any chest wall deformities?
  • Does individual complain of chest pain, shortness of breath, lightheadedness, fainting, fatigue, and irregular heartbeat (palpitations), or was this an incidental finding during a physical exam? Is individual experiencing emotional stress?
  • Did the physician hear a distinct click or murmur of the heartbeats when listening with a stethoscope (auscultation) and did they change when individual shifted positions?
  • Were electrocardiogram (ECG) and echocardiogram done?
  • Has a diagnosis of mitral valve prolapse been confirmed?

Regarding treatment:

  • If individual has an irregular or fast heartbeat (arrhythmias or tachycardia) or chest pain, are beta-blocker drugs being used?
  • If individual has a systolic murmur (mitral regurgitation), are antibiotics given before dental, genitourinary, gastrointestinal, and upper respiratory procedures or surgeries?
  • If individual has heart rhythm disturbances that cannot be controlled, severe mitral regurgitation, or incapacitating pain, would individual benefit from mitral valve replacement surgery?

Regarding prognosis:

  • Is individual currently receiving beta-blocker or other anti-arrhythmic medications to control symptoms? If the medication is ineffective, what other medications can be considered?
  • If individual has undergone recent surgery or dental work, were prophylactic antibiotics prescribed and taken as ordered? If not, has individual developed bacterial endocarditis?
  • How will this infection be treated and what is the expected outcome with treatment?
  • Does individual require mitral valve replacement surgery?

Source: Medical Disability Advisor



References

Cited

Venugopalan, Poothirikovil. "Mitral Valve Prolapse." eMedicine. Eds. Charles I. Berul, et al. 5 Oct. 2004. Medscape. 20 Oct. 2004 <http://emedicine.com/ped/topic1465.htm#section~treatment>.

Source: Medical Disability Advisor






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