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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.

Palpitations


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

Medical Codes

ICD-9-CM:
427.0 - Paroxysmal Supraventricular Tachycardia
785.0 - Unspecified Tachycardia
785.1 - Palpitations; Awareness of Heartbeat

Related Terms

  • Increased Heart Rate
  • Paroxysmal Atrial Tachycardia (PAT)

Overview

Palpitations refer to a patient's awareness of a forceful, irregular, rapid, pounding or otherwise unusual heart rate. The cause of palpitations ranges from excessive awareness of normal variations in heart rate to life-threatening heart conditions. Evaluation must determine which individuals only require reassurance and those who need extensive evaluation and treatment.

Palpitations may be caused by a variety of cardiac disorders associated with a sudden change of heart rhythm or rate. Palpitations are most often due to either "skipped beats" or a short-lived, rapid beating of the heart known as paroxysmal atrial tachycardia (PAT).

Palpitations may also occur in individuals with no heart disease or only a mild heart disorder. They may be associated with anxiety, excitement, nervousness, strong exertion, or certain substances or medications. At times, individuals with palpitations have no underlying organic cause but instead are overly sensitive to normal heart actions. In such cases, palpitations are commonly noticed just before going to sleep or when resting quietly.

Incidence and Prevalence: Approximately 89,000 cases of palpitations are reported annually in the US (Orejarena).

Source: Medical Disability Advisor



Causation and Known Risk Factors

There are no racial or sexual predilections for palpitations.

Source: Medical Disability Advisor



Diagnosis

History: A history of an abrupt onset and termination of an episode of fast heart rate suggests PAT. A history of irregular, rapid heartbeats suggests atrial fibrillation. Skipped beats or thumping imply premature atrial or ventricular contractions. Since a variety of excesses can cause palpitations, a history of heavy cigarette smoking, caffeine or alcohol consumption, lack of sleep, and cocaine or amphetamine use should be noted.

The individual may report a sensation of skipping, fluttering, pounding, or racing heartbeats. The individual may also complain of shortness of breath (dyspnea), tingling of the hands and around the mouth, and light-headedness, weakness, and chest pain. Chest pain, light-headedness, and weakness can be indicative of low blood pressure from poor heart function and may also signal other serious underlying heart disease.

Physical exam: The exam is aimed at differentiating between pathologic and physiologic palpitations. It involves a careful evaluation of heart rate, heart rhythm, and blood pressure. A rapid or irregular heart rate may indicate heart rhythm disturbances, aortic regurgitation, or hyperthyroid conditions. If the palpations are just a sensation, the heart rate and rhythm are likely to be normal. Listening to the heart and lungs (auscultation) is done to determine if there are abnormal heart sounds or evidence of lung congestion that may be associated with congestive heart failure.

If actual palpitations occur during examination, the pulse will be fast or irregular. If no palpitations occur during examination, a heart murmur may be present that implies an underlying cause.

Tests: An electrocardiogram (ECG) in the absence of palpitations may be normal or show a variety of changes due to enlargement of a heart chamber or an old heart attack (myocardial infarction). An unusual but important cause of some arrhythmias causing palpitations is Wolff-Parkinson-White syndrome. An ultrasound recording (echocardiogram) may be done to look for evidence of mitral valve prolapse. An ambulatory ECG recording (Holter monitoring) or transtelephonic transmission of the ECG is often done in an attempt to document the type of arrhythmia causing palpitations. Exercise stress testing and electrophysiologic studies (mapping the electrical activity during cardiac catheterization) may be done in complex cases.

Lab tests may include lipid panels, thyroid hormone levels, chemistry panels, and cardiac enzymes to rule out coronary artery disease, myocardial infarction, and thyroid disease. Lab tests to evaluate drug levels may be needed for those on digitalis or thyroid replacement therapy.

Source: Medical Disability Advisor



Treatment

Treatment depends on the cause of the palpitations. In many individuals, no apparent cause for the palpitations is evident even after repeated Holter recordings and transtelephonic ECG transmissions.

Calming, emotional reassurance can be quite helpful when the palpitations are secondary to a heightened sensation rather than a physical cause. Modification of lifestyle, including limiting caffeine and alcohol intake, may be effective in reducing palpitations.

Anti-arrhythmic medications and, on occasion, sending an electrical current through the heart to safely correct an irregular heart rhythm (cardioversion) may be used to slow excessively fast heart rates. Antihypertensive medications may be necessary if the individual has high blood pressure.

In some individuals with premature contractions, exercise reduces or abolishes them.

Source: Medical Disability Advisor



Prognosis

The outcome varies considerably with the underlying cause of the palpitations. Anxiety disorders are often brief and respond well to behavior modification and medications. Those with heart rhythm disturbances or thyroid disorders generally respond well to medications. Palpitations due to PAT or premature ventricular contractions (PVCs) usually diminish with time. Even if they do not, palpitations do not usually affect survival. An exception may be those individuals with frequent, multifocal PVCs that lead to ventricular tachycardia.

Source: Medical Disability Advisor



Differential Diagnosis

  • Anxiety
  • Heart murmur
  • Malingering
  • Thyroid disease

Source: Medical Disability Advisor



Specialists

  • Cardiovascular Internist
  • Clinical Psychologist
  • Emergency Medicine Physician
  • Endocrinologist
  • Internal Medicine Physician

Source: Medical Disability Advisor



Rehabilitation

Individuals with heart palpitations due to serious underlying medical conditions should attend outpatient physical and occupational therapy at a clinic specializing in cardiac rehabilitation.

Cardiac rehabilitation centers offer ECG monitoring of all participants during exercise sessions. Individuals learn to monitor their pulse and determine the amount of energy they expend by utilizing a rating of perceived exertion scale. Using this scale, individuals monitor their pulse rate to stay within safe exercise parameters predetermined by their physicians.

Individuals attend physical therapy to learn basic conditioning and stretching exercises. They 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. Occupational therapists may teach energy conservation techniques in which activities of daily living are broken into smaller components that make tasks more manageable.

Source: Medical Disability Advisor



Comorbid Conditions

  • Mitral valve prolapse
  • Wolff-Parkinson-White syndrome

Source: Medical Disability Advisor



Complications

If palpitations are caused by an arrhythmia with some duration, dizziness or a loss of consciousness (syncope) may result. The specific type of arrhythmia may have its own complications. In general, however, palpitations are not associated with significant complications.

Source: Medical Disability Advisor



Factors Influencing Duration

Disability varies with the underlying cause, course of treatment, and individual's response to treatment.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

No work restrictions or accommodations are necessary for most individuals with palpitations. If dizziness or loss of consciousness (syncope) is associated with palpitations in individuals responsible for the well-being of others (i.e., bus drivers), reassignment may be warranted.

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 the underlying cause of palpitations been identified (i.e., caffeine, certain medications, fatigue, anxiety, underlying heart disturbance)?
  • Does individual display symptoms of anxiety such as nervousness, sleep disturbances, or fatigue?
  • Does individual have a rapid heart rate (over 100 beats/minute) while at rest? Does individual complain of chest pain?
  • Has individual had a chemistry panel, cardiac isoenzymes, thyroid panel, and electrocardiogram (ECG)?
  • Does individual display signs of congestive heart failure such as low blood pressure, swelling of feet and legs, or shortness of breath?

Regarding treatment:

  • Have modifications in lifestyle, including limiting caffeine and alcohol intake, been effective in reducing palpitations?
  • Has treatment of underlying conditions (arrhythmias, congestive heart failure, thyroid disorders) effectively controlled rapid heart rate?
  • Has treatment been appropriate according to underlying condition? Were anti-arrhythmic medications indicated? Was cardioversion indicated?
  • If not effective, what alternative therapy is available?
  • Is surgery indicated to correct an underlying disorder (i.e., valvular heart disease)?

Regarding prognosis:

  • Have palpitations resolved with appropriate treatment? If not, what else could be going on? Should diagnosis be revisited?
  • Would individual benefit from additional counseling or change in medication or medication dosage?

Source: Medical Disability Advisor



References

Cited

Orejarena, L. A., et al. "Paroxysmal Supraventricular Tachycardia in the General Population." Journal of the American College of Cardiology 31 1 (1998): 150-157.

Source: Medical Disability Advisor