Sign-in
(your email):
(case sensitive):



 
 

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.

Myocarditis, Acute


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Maximum Medical Improvement | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
391.2 - Myocarditis, Acute Rheumatic
422.0 - Acute Myocarditis in Diseases Classified Elsewhere
422.90 - Myocarditis, Acute
422.99 - Acute Myocarditis, Other and Unspecified; Other

Related Terms

  • Interstitial Myocarditis
  • Subacute Myocarditis

Overview

Acute myocarditis is an inflammation of the heart muscle (myocardium). There are many possible etiologies, but the condition is most often caused by a viral infection, with direct invasion of the myocardium by the infectious agent. Acute myocarditis may also be caused by toxins, drugs, or hypersensitivity immune reactions. When myocarditis follows an autoimmune reaction secondary to infection, the infectious organism triggers the release of proteins that are normally found only in the heart muscle; while trying to eliminate the virus, the body's immune system attacks these proteins, which causes significant injury to and inflammation of the heart muscle. Myocarditis is usually self-limited but may lead to acute heart failure.

Incidence and Prevalence: The true incidence of myocarditis is difficult to ascertain because many of the cases are not detected at the time of acute illness. Myocarditis is found in up to 33% of Mycoplasma pneumoniae infections, 5-15% of Chlamydia psittaci infections, and 1-8% of Borrelia burgdorferi infections (Calabrese).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals at risk for developing myocarditis have experienced an infection caused by a bacterium, virus, parasite, rickettsia, or fungus. Diseases caused by some of these organisms are rheumatic fever, trichomoniasis, influenza, and diphtheria. Rarely, myocarditis may be caused by an adverse reaction to prescription drugs or illicit drugs (such as cocaine), or to radiation therapy for treatment of cancer.

The major cause of acute and chronic dilated cardiomyopathy (a consequence of acute myocarditis) is viral infection. Viruses known to cause cardiomyopathy include parvovirus B19, Coxsackie B virus, adenovirus, HIV, and hepatitis C. Less frequently Epstein-Barr virus, cytomegalovirus, and human herpes virus 6 have been known to cause myocarditis. Nonviral infectious causes include Borrelia burgdorferi (the causative agent of Lyme disease) and the protozoan Trypanosoma cruzi (the causative agent of Chagas disease in areas of rural Central and South America). Myocarditis may also be associated with some medications, including some anticonvulsants, antibiotics, and antipsychotics (Cooper).

Source: Medical Disability Advisor



Diagnosis

History: Individuals most often have a history of an infection accompanied by a fever, although they may not recall or realize that it occurred. Flu-like symptoms often bring them to a physician with complaints of weakness, fatigue, and shortness of breath with activity, often indicating some degree of heart failure. The diagnosis of myocarditis is usually delayed, as it is frequently not detected at the time of the precipitating acute illness. The finding of a heart with thin, weak walls (dilated cardiomyopathy) may give the suggestion of a former acute myocarditis.

Physical exam: On exam, the heart rate is increased. Listening to the heart and lungs can reveal an irregular or "galloping" heart rhythm and fluid in the lungs (pulmonary edema).

Tests: Chest x-ray, electrocardiogram (ECG), and Doppler echocardiogram are indicated. In addition to diagnostic ultrasound, current reports suggest that magnetic resonance imaging (MRI) may be the preferred noninvasive method of achieving an accurate diagnosis. However, an endomyocardial biopsy is often necessary for definitive diagnosis.

Source: Medical Disability Advisor



Treatment

Usually, care focuses on treating any symptoms of heart damage that arise in conjunction with the myocarditis. If the causative organism of the infection is known (which is not often the case), specific medication can be prescribed to eradicate the infection.

Drugs to aid heart function, such as digitalis, beta- and calcium channel blockers, and antiarrhythmics, may be prescribed. Other drugs that may be used are diuretics, corticosteroids, and anticoagulants.

Rest, sleep, and avoidance of stress are necessary, but physical exercise that does not aggravate symptoms may be beneficial.

Some individuals may have such serious damage to the heart that a heart transplant must be considered.

Source: Medical Disability Advisor



Prognosis

In some individuals, the microorganism is successfully treated, and damage to the heart is minimal. Because heart damage has often been done by the time symptoms are noted, progression to heart failure can occur. Untreated, the disease can cure spontaneously or lead to sudden congestive heart failure and death. Even with treatment, many individuals do not survive severe myocarditis.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Cardiovascular Internist
  • Emergency Medicine Physician
  • Infectious Disease Internist

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications of myocarditis can include progression to dilated cardiomyopathy, acute heart failure, cardiogenic shock, and death.

Source: Medical Disability Advisor



Factors Influencing Duration

Most individuals with myocarditis are advised to avoid exercise and strenuous activity until their ECG readings return to normal. Some individuals may require extensive hospitalization until their condition stabilizes. When bed rest is called for, recovery depends on the severity of the inflammation. The age of the individual and the response to treatment may also determine length of disability. Duration is often influenced by a delay in diagnosis, which is common in this disorder.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions and accommodations are not necessary with complete recovery. An individual who is still recovering may slowly return to regular duties. Follow-up doctor visits are frequently needed. For individuals with severe heart damage, a permanent leave may be required.

For more information, refer to "Work Ability and Return to Work," pages 271 and 274.

Risk: No job should put someone at increased risk for myocarditis. This condition is best thought of as a type of cardiomyopathy and handled similarly.

Source: Medical Disability Advisor



Maximum Medical Improvement

360 days.

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:

  • Has individual recently been infected by a bacterium, virus, parasite, rickettsia, or fungus, causing diseases such as rheumatic fever, trichomoniasis, influenza, or diphtheria?
  • Has individual recently been in South or Central America, and been bitten by an insect causing transmission of the parasite Trypanosoma cruzi (Chagas disease)?
  • Does individual recall a recent infection accompanied by fever?
  • Did flu-like symptoms, such as weakness, fatigue, or shortness of breath with activity, cause the individual to seek medical attention?
  • Were chest x-ray, electrocardiogram (ECG), and echocardiogram done?
  • Was an endomyocardial biopsy required?
  • Was the diagnosis of acute myocarditis confirmed?

Regarding treatment:

  • Was individual treated with antibiotics?
  • If so, was individual absolutely compliant with the antibiotic regimen?
  • Were drugs to aid heart function, such as digitalis, beta- and calcium channel blockers, and antiarrhythmics, prescribed?
  • Were other drugs, such as diuretics, corticosteroids, and anticoagulants, also used?
  • Was individual instructed on getting enough rest and sleep and avoiding stress?
  • Was physical exercise, based on limitations of symptoms, prescribed?
  • Is individual compliant with all medication and treatment regimens?
  • If serious damage to the heart was done, is a heart transplant being considered?
  • If so, has individual been placed on a heart transplant list?

Regarding prognosis:

  • Did the condition respond favorably to treatment?
  • Was the diagnosis made in time to prevent heart damage?
  • If not, how extensive is the damage to the heart?
  • Are there underlying disorders that are compromising heart function?
  • Have complications occurred, such as progression to dilated cardiomyopathy or heart failure?
  • If these complications have occurred, what is the individual's chance for survival?
  • Is this individual a candidate for heart transplant?

Source: Medical Disability Advisor



References

Cited

Calabrese, F., and G. B. Thiene. "Myocarditis and Inflammatory Cardiomyopathy: Microbiological and Molecular Biological Aspects." Cardiovascular Research 60 1 (2003): 11-25.

Cooper, L. T. "Myocarditis." New England Journal of Medicine 360 15 (2009): 1526-1538.

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.

Tang, Wai Hong W. "Myocarditis." eMedicine. Eds. Henry H. Ooi, et al. 5 Sep. 2014. Medscape. 27 Sep. 2014 <http://emedicine.medscape.com/article/156330-overview>.

Source: Medical Disability Advisor