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.

Prinzmetal's Angina


Related Terms

  • Variant Angina
  • Vasospastic Angina

Differential Diagnosis

Specialists

  • Cardiologist, Cardiovascular Physician

Comorbid Conditions

Factors Influencing Duration

Factors that may influence the length of disability include the presence of underlying diseases such as coronary artery disease, cigarette smoking, severe stress, a potential need for revascularization surgery, and development of complications. Duration depends primarily on individual's response to treatment.

Medical Codes

ICD-9-CM:
413.1 - Prinzmetals Angina; Variant Angina Pectoris

Overview

Prinzmetal's variant angina, variant angina, or coronary artery vasospasm is an unusual syndrome of cardiac pain (angina) that typically occurs at rest. It is not brought on by exertion (effort angina) and is associated with characteristic changes of the electrocardiogram (ECG) involving the ST-segments.

Variant angina is due to constriction (spasm) of a coronary artery. Spasm causes a temporary, dramatic reduction of the diameter of a coronary artery, resulting in oxygen deprivation of the heart muscle (myocardial ischemia). Spasm may lead to chest pain (angina), an irregular heartbeat (arrhythmias), a heart attack (acute myocardial infarction), or sudden death. The spasm may be demonstrated during an x-ray procedure in which dye is injected into the coronary arteries to check for obstruction (coronary arteriography) caused by cholesterol buildup (plaques), or it may occur during a surgical procedure. The spasm may occur close to a plaque or may be due to an increased sensitivity to substances that cause blood vessels to contract (vasoconstrictor substances).

Incidence and Prevalence: Variant angina is present in 2% to 3% of the US patients undergoing coronary arteriography (Orford).

Source: Medical Disability Advisor



Causation and Known Risk Factors

More men than women are at risk for this angina, as are cigarette smokers.

Source: Medical Disability Advisor



Diagnosis

History: Individuals typically report pain in the center of the chest that sometimes radiates to the arms, neck, or shoulders. The pain occurs while the individual rests; pain with exertion is unusual. Characteristically, pain occurs in clusters of up to 2 to 3 between midnight and 6 in the morning. It usually resolves spontaneously. Pain is very responsive to nitroglycerin.

Physical exam: The blood pressure and heart rate may be elevated during pain. A transient arrhythmia and / or a heart murmur may also be present but disappears when the pain resolves.

Tests: Laboratory testing may be considered to eliminate other causes for chest pain. Testing can include a complete blood count (CBC) for anemia, infection, or decreased platelets; serum electrolytes and blood urea nitrogen (BUN) for renal failure or diabetes; and cardiac enzymes to assess for a heart attack (myocardial infarction).

The hallmark of Prinzmetal's angina is ST-segment elevation on the ECG during pain. In addition, there may be a wide variety of transient arrhythmias. Ambulatory ECG monitoring (Holter monitoring) often shows episodes of ST-segment deviation even in the absence of pain. Treadmill testing is usually well tolerated and is not associated with the ST-segment depression typical of effort angina.

Additional tests include an imaging study to look for blood flow abnormalities in the heart muscle (thallium scintigraphy) and coronary arteriography using medications or rapid breathing (hyperventilation) to provoke spasm.

Source: Medical Disability Advisor



Treatment

Nitroglycerin (NTG) under the tongue (sublingual) or swallowed (orally) usually promptly abolishes attacks of variant angina. Larger doses of NTG taken orally or applied to the skin as an ointment or patch (topically) often prevent attacks in ambulatory individuals. Intravenous NTG is used in hospitalized individuals who have frequent attacks.

Calcium channel blockers are another class of medications often given instead of or in addition to NTG preparations to dilate arteries. Beta-blockers are used widely for the treatment of effort angina and are not helpful in variant angina and may aggravate it.

Revascularization (coronary bypass or angioplasty) is not recommended for Prinzmetal's angina since symptoms due to coronary spasm usually persist or recur after these procedures. However, in those individuals with significant coronary artery disease, revascularization may help relieve symptoms.

Source: Medical Disability Advisor



Prognosis

Variant angina has a cyclical course. The first 3 to 6 months are characterized by frequent episodes of nocturnal pain. After that, it often enters a quiescent phase. The quiescent phase may last indefinitely or be punctuated by one or more recurrences of activity. Over time, the illness tends to "burn out."

An acute myocardial infarction (AMI) occurs in about 3.5% to 6.5% of individuals. The 5-year survival rate is good at about 89% to 97% (Gersh).

Source: Medical Disability Advisor



Rehabilitation

The goal of rehabilitation for Prinzmetal's angina is to design a physical conditioning program for the individual that increases the amount of activity yet limits the onset of symptoms of this form of angina. Individuals must first be able to identify and communicate the symptoms as true angina pain. The physical therapist and / or other healthcare personnel knowledgeable in treating various forms of angina may use a scale to rank anginal symptoms to determine the amount and intensity of exercise prescribed and for the individual to communicate the level of symptoms. The individual ranks the pain on a scale of 1 to 10, with 1 being none and 10 requiring emergency room care.

Exercise sessions are tailored to each individual and their symptoms. Exercise sessions begin with a warm-up period followed by low-intensity exercises. Individuals gradually progress with time and intensity from walking with continuous monitoring to use of the stationary bicycle and finally to activities simulating work. The goal is to increase the strength and efficiency of the heart, decrease symptoms, and increase endurance so the individual will be more active and eventually return to work. Exercise programs are modified as needed for individuals on certain medications or with other comorbid conditions. Re-evaluation of the individual may be necessary if symptoms return during exercise.

Source: Medical Disability Advisor



Complications

During pain, life-threatening arrhythmias may occur. These arrhythmias include ventricular tachycardia, ventricular fibrillation, and heart block. These arrhythmias can be fatal. Complications to treatment of the arrhythmias include medication reactions or intolerance. A fatal, or more often nonfatal, acute myocardial infarction (AMI) may also occur. For those individuals requiring revascularization surgery, complications include medication reactions, infection, and recurrence of the plaques.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals with variant angina usually require no work restrictions or accommodations. However, those individuals engaged in occupations that require driving or working at heights or around moving machinery, or that expose them or others to a significant chance of serious injury (e.g., bus drivers), are often reassigned to other duties during the active phase of the illness when life-threatening arrhythmias may occur. There may also be a need to apply work restrictions to decrease stress upon the individual. Those individuals with significant coronary artery disease who have coronary bypass or angioplasty may require less strenuous work for a limited time after the procedure.

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:

  • Did individual present with a clinical history and physical findings consistent with the diagnosis of Prinzmetal's angina?
  • Were cardiac isoenzymes and a 12-lead ECG done? Were characteristic ECG changes noted during pain?
  • If the diagnosis was uncertain, were other conditions with similar findings ruled out?
  • Would individual benefit from consultation with a cardiologist?
  • Was cardiac arteriography with or without provocative medications performed? Was thallium scintigraphy performed?

Regarding treatment:

  • Was chest pain relieved with treatment?
  • Would individual benefit from nutritional counseling in order to comply with a low-fat, low-cholesterol diet?
  • Would individual benefit from enrollment in a community weight management program?
  • If individual is unable to quit smoking, has he or she been referred to a smoking cessation program?
  • Is individual participating in a regular exercise program?

Regarding prognosis:

  • Do symptoms persist despite treatment?
  • Has individual been compliant with treatment and lifestyle recommendations? If not, what can be done to enhance compliance?
  • Was the Prinzmetal's angina complicated by a myocardial infarction, arrhythmias, or cardiac arrest?
  • Does individual have coexisting medical conditions that may complicate treatment or impact recovery?

Source: Medical Disability Advisor



References

Cited

Gersh, B. J., E. Braunwald, and R. O. Bonow. "Chronic Coronary Artery Disease." Heart Disease: A Textbook of Cardiovascular Medicine. Eds. E. Braunwald, et al. 6th ed. Philadelphia: W.B. Saunders, 2001. 1272-1337. MD Consult. Elsevier, Inc. 12 Nov. 2004 <http://home.mdconsult.com/das/book/38346451-2/view/924?sid=277141262>.

Orford, James L., and Andrew P. Selwyn. "Coronary Artery Vasospasm." eMedicine. Eds. Gregory J. Dehmer, et al. 15 Sep. 2004. Medscape. 12 Nov. 2004 <http://emedicine.com/med/topic447.htm>.

Source: Medical Disability Advisor






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