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.

Ventricular Tachycardia


Related Terms

  • Torsades De Pointes
  • V Tach
  • VT

Differential Diagnosis

Specialists

  • Cardiovascular Internist
  • Critical Care Internist

Comorbid Conditions

Factors Influencing Duration

The length of disability from ventricular tachycardia may be influenced by the underlying cause for the condition, the severity of symptoms, and the type of ventricular tachycardia (i.e., sustained vs. nonsustained), the individual's response to treatment, the type of treatment, any complications, and the requirements of the job.

Medical Codes

ICD-9-CM:
427.1 - Paroxysmal Ventricular Tachycardia

Overview

Ventricular tachycardia is a potentially life-threatening abnormal heart rhythm (arrhythmia) in which the heartbeat is faster than 100 to 120 beats per minute (bpm) and is initiated in the lower heart chambers (ventricles) rather than from the sinoatrial (SA) node in the right upper heart chamber (right atrium).

Ventricular tachycardia may last as little as 30 seconds or less (nonsustained) or as long as several days (sustained). Based on its electrocardiographic morphology, ventricular tachycardia can be monomorphic (myocardial infarction scar related, or originated in the right ventricular outflow tract [RVOT]) or polymorphic (long QT syndrome and torsades de pointes).

Incidence and Prevalence: The incidence of ventricular tachycardia is difficult to determine because of the lack of symptoms when it is nonsustained. Sustained ventricular tachycardia occurs in about 1% of individuals who have experienced a heart attack (myocardial infarction [MI]) (Timmer). It is estimated that ventricular tachycardia or ventricular arrhythmia accounts for most of the 250,000 to 300,000 sudden cardiac deaths (SCD) per year in the US (Roger; Chugh).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Coronary heart disease (ischemic heart disease [insufficient oxygen to the heart muscle]), other heart problems, or previous heart surgery increase the risk of heart arrhythmias including ventricular tachycardia. High blood pressure (hypertension), congenital heart disease, thyroid problems, certain drugs and supplements, diabetes, obstructive sleep apnea, electrolyte imbalance, too much alcohol, and caffeine and nicotine use are all risk factors for heart arrhythmias ("Heart arrhythmia").

Ventricular tachycardia occurs most often in individuals with pre-existing heart disease, such as diseases of the heart valves (e.g., valve prolapse), disease of the heart muscle (cardiomyopathy), or rheumatic heart disease. Nonsustained ventricular tachycardia may occur in individuals with no underlying cardiac disease. Ventricular tachycardia can also occur after a heart attack (myocardial infarction [MI]), or as a result of drug toxicity. A form of ventricular tachycardia either inherited or associated with drug toxicity (torsades de pointes) has an abrupt onset and a poor prognosis.

Source: Medical Disability Advisor



Diagnosis

History: The individual may report no symptoms at all (asymptomatic). However, most individuals complain of sensation of the heart beating rapidly or intensely (palpitations), light-headedness, weakness, chest discomfort or pain, shortness of breath (dyspnea), abrupt loss of consciousness (syncope), and/or seizures.

Physical exam: The exam may reveal a pulse that is weak, rapid, or cannot be felt (nonpalpable). There may be inconsistencies in the blood pressure or abnormal (muffled) heart sounds. The individual may appear anxious, agitated, or may lose consciousness. There may be signs of heart failure such as crackles (bruits) on listening to the lungs with a stethoscope (auscultation), dyspnea, and low blood oxygen levels (hypoxemia).

Tests: Diagnosis is confirmed by recording the electrical activity of the heart (electrocardiogram [ECG]). This record of the electrical activity will show broad and abnormal waves (QT interval prolongation), a heart rate greater than 100 (or 120) bpm, and presence of the atria and ventricles beating separately (AV dissociation). An intracardiac electrophysiology study (EPS) may be ordered to confirm the arrhythmia and define the area causing the arrhythmia.

Blood tests may be performed to determine other causes, including abnormal levels for drugs, thyroid hormones, and potassium (serum electrolytes)—as well as calcium or evidence of an underlying MI.

If valvular heart disease or cardiomyopathy is suspected, an ultrasound of the heart (echocardiography) or cardiac catheterization may be required.

Source: Medical Disability Advisor



Treatment

Individuals who have nonsustained ventricular tachycardia but have no structural damage to the heart muscle, valves, or other symptoms may not require drug treatment. Underlying metabolic abnormalities or other cardiac disorders that may cause the condition should be treated. Toxic drug intake should be discontinued if it is causing ventricular tachycardia.

Sustained ventricular tachycardia is a medical emergency requiring immediate intervention to preserve life. Sustained ventricular tachycardia is treated initially with anti-arrhythmic drugs. Administration of an electric shock to the heart (electric cardioversion) may be required if a normal heartbeat (rhythm) is not restored quickly with drugs. Striking the individual's chest (thump conversion) may be used if the onset is observed. The results of this maneuver are unpredictable, so it should only be used when there is no an electrical defibrillator immediately available. After normal heart rhythm is restored, an anti-arrhythmic drug is usually continued for several months. Treatment of individuals with chronic, recurrent ventricular tachycardia is controversial. A device that shocks the heart into its normal rhythm may be implanted surgically (implantable cardiac defibrillator [ICD]) followed by administration of anti-arrhythmic drugs if the arrhythmia continues despite the ICD. Individuals with continued recurrence notwithstanding these methods of treatment may require a procedure to burn the area causing the arrhythmia (radiofrequency catheter ablation, catheter ablation).

Sustained ventricular tachycardia can deteriorate into loss of contractile ability by the heart (ventricular fibrillation). This is a medical emergency in which death is a possibility.

Source: Medical Disability Advisor



Prognosis

The predicted outcome for individuals who experience nonsustained ventricular tachycardia depends upon the underlying cause for the condition. The outcome is good for individuals who experience ventricular tachycardia as a one-time experience. Complete recovery without lasting adverse reactions may be expected if there is no serious underlying heart disease.

Torsades de pointes can lead to sudden death. Torsades de pointes will lead to sudden cardiac death in up to 31% of cases (Go).

After a MI, the risk of death is 5% to 10%; for those with a prior MI and nonsustained ventricular tachycardia, the 2-year mortality rate is 30%; and for those with ventricular tachycardia that can be caused by EPS study (inducible), the 2-year mortality is 50% (Braunwald).

There is approximately a 30% overall reduction in mortality in individuals with sustained ventricular tachycardia who have an ICD. However, annually, 1% to 2% of individuals who have a cardiac defibrillator implanted surgically will experience SCD (Go).

Source: Medical Disability Advisor



Complications

Possible complications of ventricular tachycardia include progression to a complete lack of organized ventricular contractions (ventricular fibrillation), low blood pressure (hypotension), general organ and cardiovascular system failure (shock), an abnormal condition of the heart characterized by circulatory congestion (congestive heart failure [CHF]), and death.

Additional complications include reaction to medications used to treat the arrhythmia. Surgical complications if an ICD is implanted include infection and malfunction of the device.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

A leave of absence for treatment may be required. Individuals who continue to experience sudden syncope or dizziness may need limitations on access to unrestricted heights, dangerous machinery, driving, or hazardous work.

For more information on risk, capacity, and tolerance, refer to "Work Ability and Return to Work," page 274-277.

Risk: Once stabilized from ICD insertion, no job would place an individual at risk except for the presence of strong magnetic fields.

Capacity: Ventricular tachycardia can be limiting particularly in the presence of underlying structural heart disease. Capacity for the underlying structural disease must be assessed.

Source: Medical Disability Advisor



Maximum Medical Improvement

60 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:

  • Does individual complain of palpitations, light-headedness, weakness, chest discomfort, dyspnea, syncope, and/or seizures?
  • Does individual have a history of heart disease or a recent MI?
  • Are there other underlying conditions present that would contribute to ventricular tachycardia?
  • Does physician note a pulse that is weak, rapid, or nonpalpable?
  • Are there inconsistencies in the blood pressure or abnormal (muffled) heart sounds?
  • Does individual appear anxious or agitated?
  • Was ECG obtained?
  • Was an intracardiac EPS done?
  • Has the diagnosis been confirmed?
  • Is ventricular tachycardia nonsustained or sustained?

Regarding treatment:

  • Has ventricular tachycardia become more frequent?
  • Does individual require drug treatment?
  • Have underlying medical conditions been treated?
  • Are the appropriate anti-arrhythmic drugs being prescribed?
  • Is individual taking these drugs exactly as prescribed?
  • Would implantation of an ICD be of benefit?

Regarding prognosis:

  • Did individual experience nonsustained ventricular tachycardia?
  • Did individual recover completely with or without treatment?
  • Has individual developed torsades de pointes? What can be done for this condition?
  • Are anti-arrhythmic drugs treating tachycardia successfully?
  • Is individual compliant with the medication regimen?
  • Has the condition recurred?
  • Does individual have an ICD implanted? If so, is it functioning properly?
  • Has individual developed any complications? If so, what are they?
  • Is individual expected to survive these complications?

Source: Medical Disability Advisor



References

Cited

"Heart arrhythmia." Mayo Clinic. 31 Jul. 2014. Mayo Foundation for Medical Education and Research. 30 Jul. 2015 <http://www.mayoclinic.com/health/heart-arrhythmias/DS00290/DSECTION=risk-factors>.

Braunwald, E., et al., eds. "Specific Arrhythmias: Diagnosis and Treatment." Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia: W.B. Saunders, 2001. 857-863. ClinicalKey. Elsevier, Inc. 30 Jul. 2015 <http://www.clinicalkey.com/#!/browse/book/3-s2.0-C2012001143X>.

Chugh, S. S. , et al. "Epidemiology of sudden cardiac death: clinical and research implications." Progress in Cardiovascular Diseases 51 3 (2008): 213-228.

Go, A. S. , et al. "Heart Disease and Stroke Statistics—2013 Update." Circulation. American Heart Association. 30 Jul. 2015 <http://circ.ahajournals.org/content/127/1/e6.full?sid=f3a7fc24-5402-4493-9f46-75e4b0b6c0a2>.

Roger, Véronique L. , et al. "Heart Disease and Stroke Statistics—2012 Update." Circulation. American Heart Association. 30 Jul. 2015 <http://circ.ahajournals.org/content/125/1/e2.full?sid=0637b1e8-849f-43d3-8e02-80a2fac5f526>.

Timmer, J. R. , et al. "Predictors of ventricular tachyarrhythmia in high-risk myocardial infarction patients treated with primary coronary intervention." Netherlands Heart Journal 18 3 (2010): 122-128. NIH. National Center for Biotechnology Information. 30 Jul. 2015 <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848354/>.

Source: Medical Disability Advisor






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