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.

Pericarditis, Acute


Related Terms

  • Acute Pericarditis
  • Dressler's Syndrome
  • Neoplastic Pericarditis
  • Nonrheumatic Pericarditis
  • Pericardectomy Syndrome
  • Pericardial Inflammation
  • Radiation Pericarditis
  • Tuberculosis Pericarditis
  • Uremic Pericarditis
  • Viral Pericarditis

Specialists

  • Cardiovascular Internist
  • Critical Care Internist
  • Thoracic Surgeon

Comorbid Conditions

Factors Influencing Duration

Duration will be increased if pericardiocentesis or pericardiectomy is required. Bloody fluid accumulations secondary to the development of pericarditis following an MI may dissipate quickly and necessitate only a brief period of drainage (1 to 2 days). Persistent accumulations of excess fluid, which may occur in individuals with cancer or kidney failure, require prolonged drainage (a week or more) and longer disability. If pericardiectomy is performed, the length of disability might be 2 to 3 weeks longer.

Medical Codes

ICD-9-CM:
420.90 - Pericarditis, Acute, Unspecified
420.91 - Pericarditis, Acute, Idiopathic
420.99 - Pericarditis, Acute, Other

Overview

Pericarditis is an inflammation and irritation of the sac-like structure that surrounds and confines the heart (pericardium or pericardial sac). Acute inflammation of the pericardium may be due to an infection , systemic diseases, autoimmune syndromes, uremia, tumors, radiation therapy, drug toxicity, tuberculosis, nosocomial infections (infections acquired in the hospital), or bleeding into the pericardium (hemopericardium). No cause is found in about 80% of individuals (idiopathic pericarditis) (Imazio).

Acute pericarditis may also be a consequence of a heart attack (myocardial infarction [MI]). Rarely, those who have an MI will develop Dressler's syndrome (pericarditis, fever, pleural effusions, and chest and joint pain, probably due to the immune system response to damaged heart tissue) (Spodik). In rare occasions, acute pericarditis recurs chronically.

Incidence and Prevalence: Acute pericarditis accounts for 5% of hospital admissions for noncardiac chest pain (Gopaldas).

Source: Medical Disability Advisor



Causation and Known Risk Factors

About two-thirds of pericarditis cases are caused by a virus. Among the viruses known to cause pericarditis are echovirus, coxsackievirus, cytomegalovirus, adenovirus, parvovirus B19, and human herpes virus 6; influenza, Epstein-Barr, varicella, rubella, mumps, hepatitis B, and hepatitis C viruses; and human immunodeficiency virus (HIV). About 4-5% of all cases are bacterial, with the most common cause being Mycobacterium tuberculosis. In rare cases, fungal or parasitic infections cause pericarditis. About one-third of cases are noninfectious, with about 10% of those resulting from autoimmune reactions and 5-7% caused by tumors (neoplasms). More rare are cases from indirect injury and drug-related cases (Imazio).

Source: Medical Disability Advisor



Diagnosis

History: In most individuals, stabbing chest pain is usually present and can be severe. The individual may mistake it for a heart attack; the pain is sharp and worsens when inhaling or coughing. Others may have a steady, dull, achy or pressure-like pain, originating in the center of the chest and radiating to the arms. In almost all cases, pain is relieved markedly when the individual sits up and leans forward. Pain is usually absent in pericarditis that is caused by chronic kidney failure (uremic pericarditis) or cancer or that follows radiation therapy. Other possible symptoms are dry cough, fatigue, and anxiety.

Physical exam: Fever may be present when pericarditis is caused by an infection. The most important physical sign is scratching or squeaking heart sounds (pericardial friction rub) heard with a stethoscope (auscultation) that change with different positions. Individuals may also have a rapid heartbeat (tachycardia), rapid breathing (tachypnea), low blood pressure (hypotension), enlarged jugular neck veins (jugular venous distention), muffled or distant heart sounds, and diaphoresis (excessive sweating).

Tests: The usual tests include blood work such as a complete blood count (CBC), tests to assess for inflammation (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) and autoimmune disorders, and cardiac enzyme tests for MI. Blood cultures may be needed to assess for systemic infection. Additional tests include physical and chemical examination of urine (urinalysis), chest x-rays, electrocardiogram, echocardiogram, and computed tomography (CT) or magnetic resonance imaging (MRI). Endomyocardial biopsy may be done for pericarditis thought to be associated with cancer.

Source: Medical Disability Advisor



Treatment

Treatment focuses on relieving the acute symptoms and treating any underlying cause. The inflammation is often treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or indomethacin. Individuals with severe pain may receive narcotic pain relievers such as morphine for a short time. Corticosteroids may be used if pain and inflammation are unresponsive to the standard anti-inflammatory drugs. In carefully selected individuals, colchicine may be added to treatment in the presence of recurrences or to prevent recurrence.

If the inflammatory condition is secondary to bacterial infection or tuberculosis, antibiotics or antituberculosis drugs are added as appropriate. If the source of inflammation is drug-induced, then the offending drug should be discontinued.

Sometimes, excessive fluid accumulates around the heart, restricting its movement (acute pericardial effusion, which may evolve into cardiac tamponade). It may be necessary to use a needle to remove fluid around the pericardium and relieve excess pressure (pericardiocentesis). This procedure is usually reserved for individuals who have large accumulations of fluid and associated shock (severe cardiac dysfunction).

In persistent cases of fluid accumulation, typically with tumors or kidney disease, it may be necessary to surgically remove part of the pericardium (pericardiectomy) to allow continuous drainage.

Source: Medical Disability Advisor



Prognosis

Pericarditis may be life-threatening if left untreated. However, most cases of acute pericarditis that are treated heal promptly. There may be recurrences in the first few weeks or months. The prognosis also depends on the cause. Viral or idiopathic causes usually resolve quickly. Infectious, tuberculous, and cancer-related pericarditis have worse outcomes.

Pericardiectomy has a mortality rate of 7.5% (Gopaldas).

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation for acute pericarditis includes treatment to relieve symptoms of pain as well as exercises to improve strength and endurance. The greatest benefit to the heart occurs as the muscles improve efficiency in oxygen use, reducing the need for the heart to pump as much blood. Although such exercise may not improve the condition of the heart itself, the increased fitness level reduces the total workload of the heart.

Initially and when appropriate, physical therapists may choose to use passive modalities until acute symptoms have subsided. Once acute symptoms have resolved, a prescribed exercise program will begin. A physical therapist knowledgeable in cardiac rehabilitation will design a safe, individualized exercise program. The therapist keeps a daily log of the individual's blood pressure, heart rate, and cardiac rhythm. Individuals are encouraged to resume normal activities gradually. As their endurance improves, they can add aerobic routines such as brisk walking, cycling, swimming, or running to increase the strength and efficiency of the heart muscle. The goal is for individuals to resume their daily routine and eventually return to work.

The physical therapist will also watch closely for any shortness of breath, rapid heartbeat, coughing up of blood, or unexplained, excessive weight loss. Because of the varying degrees and effects of acute pericarditis, modifications may be needed for those individuals who are taking various medications or are experiencing other conditions resulting from the pericarditis.

Source: Medical Disability Advisor



Complications

As mentioned, acute pericarditis may be accompanied by fluid buildup (effusion) in the pericardial sac. When the fluid accumulates, it can constrict the heart, obstructing blood flow into the chambers of the heart and reducing blood flow out of the heart (cardiac tamponade). Tamponade may occur within minutes after cardiac trauma or rupture, causing shock and occasionally death, but it usually develops over time. Complications associated with pericardiocentesis include accidental puncture of cardiac vessels, the lung, and the liver while using a needle to remove fluid surrounding the heart.

When acute pericarditis recurs chronically, it may lead to stiffening of the pericardial sac that can impair heart movement and result in heart failure (chronic constrictive pericarditis).

If pericardiectomy is required, complications from surgery can include medication reaction, infection, and slow wound healing.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals with strenuous jobs may need to perform sedentary or lighter work until strength and endurance return.

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

Risk: No job should place an individual at increased risk of pericarditis. Relapse can occur over the course of a few years independent of any occupation. For evaluative purposes, is best to think of pericarditis as a cardiomyopathy.

Source: Medical Disability Advisor



Maximum Medical Improvement

90 to 180 days (wide range reflecting level of severity).

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 had a respiratory infection or any other infections?
  • Does individual have an autoimmune disorder?
  • Does individual have a history of tumors?
  • Has individual recently undergone radiation therapy?
  • Has individual recently had an MI?
  • Does individual complain of severe chest pain? Is the pain worsened by breathing in or coughing and relieved markedly by sitting up and leaning forward?
  • Is fever present?
  • Does the physician hear scratching or squeaking heart sounds (pericardial friction rub) with a stethoscope (auscultation)?
  • Were a complete blood count (CBC), blood chemistries, and blood work to assess for causes done? Were chest x-rays, electrocardiogram (ECG), echocardiogram, CT or MRI performed? If cancer was suspected, was endomyocardial biopsy done?
  • Was the diagnosis of pericarditis confirmed?

Regarding treatment:

  • Were nonsteroidal anti-inflammatory drugs (NSAIDs) administered? Narcotic pain relievers? If pain and inflammation did not respond to the anti-inflammatory drugs, were corticosteroids administered?
  • If the condition is secondary to bacterial infection or tuberculosis, were antibiotic or antituberculosis drugs added?
  • Has individual been compliant with all medication regimens?
  • Did fluid accumulate around the heart (pericardial effusion) restricting its movement (cardiac tamponade)? Was it necessary to remove the fluid using a needle (pericardiocentesis)? If fluid accumulates persistently, is surgical removal of part of the pericardium (pericardiectomy) required to allow for continuous drainage?

Regarding prognosis:

  • Was pericarditis treated promptly? If not, is individual in a life-threatening situation?
  • Is this an initial diagnosis or a recurrence?
  • Does individual have any underlying heart or other conditions that could prolong recovery?
  • Did complications from pericardiectomy or pericardiocentesis occur, such as accidental puncture of cardiac vessels, the lung, or liver? If so, what is the treatment plan for these complications and expected outcome after treatment?

Source: Medical Disability Advisor



References

Cited

Gopaldas, R. R., et al. "Predictors of In-Hospital Complications After Pericardiectomy: A Nationwide Outcomes Study." Journal of Thoracic and Cardiovascular Surgery 145 5 (2013): 1227-1233.

Imazio, M., et al. "Controversial Issues in the Management of Pericardial Diseases." Circulation 121 7 (2010): 916-928.

Jouriles, N. "Pericardial Disease (Pericarditis)." Rosen's Emergency Medicine: Concepts and Clinical Practice. Eds. J. A. Marx, et al. 8th ed. Philadelphia: Elsevier, Inc., 2013. 1130-1138.

Spangler, Sean. "Acute Pericarditis." eMedicine. Eds. Richard A. Lange, et al. 6 Oct. 2014. Medscape. 30 Oct. 2014 <http://emedicine.medscape.com/article/156951-overview>.

Spodik, David H. The Pericardium: A Comprehensive Textbook. Marcel Dekker, 1997.

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.

Source: Medical Disability Advisor






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