TN 3 (10-99)
DI 34224.003 Cardiovascular Listings from 01/06/86 to 02/09/94
104.00 CARDIOVASCULAR SYSTEM
-
A.
General. Evaluation should be based upon history, physical findings, and appropriate laboratory
data. Reported abnormalities should be consistent with the pathological diagnosis.
The actual electrocardiographic tracing or an adequate marked photocopy, must be included.
Reports of other pertinent studies necessary to substantiate the diagnosis or describe
the severity of the impairment must also be included.
-
B.
Evaluation of cardiovascular impairment in children requires two steps:
-
1.
The delineation of a specific cardiovascular disturbance, either congenital or acquired.
This may include arterial or venous disease, rhythm disturbance, or disease involving
the valves, septa, myocardium or pericardium; and
-
2.
Documentation of the severity of the impairment, with medically determinable and consistent
cardiovascular signs, symptoms, and laboratory data. In cases where impairment characteristics
are questionably secondary to the cardiovascular disturbance, additional documentation
of the severity of the impairment (e.g., catheterization data, if performed) will
be necessary.
-
C.
Chest roentgenogram (6 ft. PA film) will be considered indicative of cardiomegaly
if:
-
1.
The cardiothoracic ratio is over 60 percent at age one year or less, or 55 percent
at more than one year of age; or
-
2.
The cardiac size is increased over 15 percent from any prior chest roentgenograms;
or
-
3.
Specific chamber or vessel enlargement is documented in accordance with established
criteria.
-
D.
Tables I, II and III below are designed for ease of adjudication and not for diagnostic purposes. The
adult criteria may be useful for older children and should be used when applicable.
-
E.
Rheumatic fever, as used in this section, assumes diagnosis made according to the revised Jones Criteria.
104.01 Category of Impairments, Cardiovascular System
104.02 Chronic congestive failure. With two or more of the following signs:
-
A.
Tachycardia (see Table I).
-
B.
Tachypnea (see Table II).
-
C.
Cardiomegaly on chest roentgenogram (see 104.00C).
-
D.
Hepatomegaly (more than 2 cm. below the right costal margin in the midclavicular line).
-
E.
Evidence of pulmonary edema, such as rales or orthopnea.
-
-
G.
Exercise intolerance manifested as labored respiration on mild exertion (e.g., in
an infant, feeding).
TABLE I — TACHYCARDIA AT REST
Age |
Apical heart (beats per minute) |
Under 1 yr.................... |
150 |
1 through 3 yrs............... |
130 |
4 through 9 yrs............... |
120 |
10 through 15 yrs............. |
110 |
Over 15 yrs................... |
100 |
TABLE II — TACHYPNEA AT REST
Age |
Respiratory rate over (per minute) |
Under 1 yr.................... |
40 |
1 through 5 yrs............... |
35 |
6 through 9 yrs............... |
30 |
Over 9 yrs.................... |
25 |
104.03 Hypertensive cardiovascular disease. With persistently elevated blood pressure for age (see Table III) and one of the
following signs:
-
A.
Impaired renal function as described under the criteria in 106.02; or
-
B.
Cerebrovascular damage as described under the criteria in 111.06; or
-
C.
Congestive heart failure as described under the criteria in 104.02.
TABLE III — ELEVATED BLOOD PRESSURE
Age |
Systolic over (mmHg) OR |
Diastolic over (mmHg) |
Under 6 months..... |
95 |
60 |
6 mo. to 1 yrs..... |
110 |
70 |
1 through 8 yrs.... |
115 |
80 |
9 through 11 yrs... |
120 |
80 |
12 through 15 yrs.. |
130 |
80 |
Over 15 yrs........ |
140 |
80 |
104.04 Cyanotic congenital heart disease. With one of the following:
-
A.
Surgery is limited to palliative measures; or
-
B.
Characteristic squatting, hemoptysis, syncope, or hypercyanotic spells; or
-
C.
Chronic hematocrit of 55 percent or greater or arterial O2 saturation of less than 90 percent at rest, or arterial oxygen tension less than
60 Torr at rest.
104.05 Cardiac arrhythmia, such as persistent or recurrent heart block or A-V dissociation
(with or without therapy). And one of the following:
-
-
B.
Congestive heart failure as described under the criteria in 104.02; or
-
C.
Exercise intolerance with labored respirations on mild exertion (e.g., in infants,
feeding).
104.07 Cardiac syncope with at least one documented syncopal episode characteristic of specific cardiac
disease (e.g., aortic stenosis).
104.08 Recurrent hemoptysis. Associated with either pulmonary hypertension or extensive bronchial collaterals
due to documented chronic cardiovascular disease.
104.09 Chronic rheumatic fever or rheumatic heart disease. With:
-
A.
Persistence of rheumatic fever activity for 6 months or more, with significant murmur(s),
cardiomegaly (see 104.00C), and other abnormal laboratory findings (such as elevated
sedimentation rate or electrocardiographic findings); or
-
B.
Congestive heart failure as described under the criteria in 104.02.