The diagnosis should be made in accordance with the current revised Jones criteria
for guidance in the diagnosis of rheumatic fever.
104.01 Category of Impairments, Cardiovascular System
104.02 Chronic Heart Failure. Documented by clinical and laboratory findings as described in 104.00E, and with one
of the following:
A. Persistent tachycardia at rest (see Table I);
OR
B. Persistent tachypnea at rest (see Table II), or markedly decreased exercise tolerance
(see 104.00E);
OR
C. Recurrent arrhythmias, as described in 104.05;
OR
D. Growth disturbance, with:
1. An involuntary weight loss (or failure to gain weight at an appropriate rate for
age) resulting in a fall of 15 percentiles from established growth curve (on standard
growth charts) which persists for 2 months or longer; or
2. An involuntary weight loss (or failure to gain weight at an appropriate rate for
age) resulting in a fall to below the third percentile from established growth curve
(on standard growth charts) which persists for 2 months or longer; or
3. Growth impairment as described under the criteria in 100.00.
Age
|
Apical Heart (beats per minute)
|
Under 1 year
|
150
|
1 through 3 years
|
130
|
4 through 9 years
|
120
|
10 through 15 years
|
110
|
Over 15 years
|
100
|
Age
|
Respiratory Rate Over (per minute)
|
Under 1 year
|
40
|
1 through 5 years
|
35
|
6 through 9 years
|
30
|
Over 9 years
|
25
|
104.03 Hypertensive Cardiovascular Disease.
With persistently elevated blood pressure equal to or greater than the 95th percentile
for age (see Table III), and one of the following:
A. Impaired renal function, as described in 106.02;
OR
B. Cerebrovascular damage, as described in 111.06;
OR
C. Chronic heart failure as described in 104.02.
Age
|
Systolic over (mm.Hg)
|
OR
|
Diastolic over (mm.Hg)
|
Under 1 month
|
95
|
|
--
|
1 month through 2 years
|
112
|
|
74
|
3 through 5 years
|
116
|
|
76
|
6 through 9 years
|
122
|
|
78
|
10 through 12 years
|
126
|
|
82
|
13 through 15 years
|
136
|
|
86
|
16 to 18 years
|
142
|
|
92
|
104.05 Recurrent arrhythmias, such as persistent or recurrent heart block (A-V dissociation), repeated symptomatic
tachyarrhythmias or bradyarrhythmias or long QT syndrome arrhythmias, not related
to reversible causes such as electrolyte abnormalities or digitalis glycoside or antiarrhythmic
drug toxicity, resulting in uncontrolled repeated episodes of cardiac syncope or near
syncope and arrhythmia despite prescribed treatment, including electronic pacemaker
(see 104.00A if there is no prescribed treatment), and documented by resting or ambulatory
(Holter) electrocardiography coincident with the occurrence of syncope or near syncope.
104.06 Congenital heart disease. With one of the following:
A. Cyanotic heart disease, with persistent, chronic hypoxemia as manifested by:
1. Hematocrit of 55 percent or greater on two or more evaluations within a 3-month
period; or
2. Arterial O saturation of less than 90 percent in room air, or resting PO of 60
Torr or less; or
3. Hypercyanotic spells, syncope, characteristic squatting, or other incapacitating
symptoms directly related to documented cyanotic heart disease; or
4. Exercise intolerance with increased hypoxemia on exertion;
OR
B. Chronic heart failure with evidence of ventricular dysfunction, as described in
104.02;
OR
C. Recurrent arrhythmias as described in 104.05;
OR
D. Secondary pulmonary vascular obstructive disease with a mean pulmonary arterial
pressure elevated to at least 70 percent of the mean systemic arterial pressure;
OR
E. Congenital valvular or other stenotic defects, or valvular regurgitation, as described
in 104.00F and 104.07;
OR
F. Symptomatic acyanotic heart disease, with ventricular dysfunction resulting in
significant restriction of age-appropriate activities or inability to complete age-appropriate
tasks (see 104.00A);
OR
G. Growth failure, as described in 100.00;
OR
H. For infants under 12 months of age at the time of filing, with life-threatening
congenital heart impairment that will or has required surgical treatment in the first
year of life, consider the infant to be under a disability until the attainment of
age 1 or for 12 months after surgery, whichever is the later event; thereafter, evaluate
impairment severity with reference to 104.02 to 104.08.
104.07 Valvular heart disease or other stenotic defects, or valvular regurgitation,
documented by appropriate imaging techniques or cardiac catheterization.
A. Evaluate according to criteria in 104.02, 104.05, 111.06, or 11.04;
OR
B. Critical aortic stenosis in newborn.
104.08 Cardiomyopathies, documented by appropriate imaging techniques, including echocardiography or cardiac
catheterization, if catheterization results are available from a treating source.
Impairment must be associated with an ejection fraction of 50 percent or less and
significant left ventricular dilatation using standardized age-appropriate echocardiographic
ventricular cavity measurements. Evaluate under the criteria in 104.02, 104.05, or
111.06.
104.09 Cardiac transplantation. Consider under a disability for 1 year following surgery; thereafter, evaluate residual
impairment under 104.02 to 104.08.
104.13 Chronic rheumatic fever or rheumatic heart disease. Consider under a disability for 18 months from the established onset of impairment
with one of the following:
A. Persistence of rheumatic fever activity for 6 months or more which is manifested
by significant murmur(s), cardiac enlargement (see 104.00E) or ventricular dysfunction,
and other abnormal laboratory findings, as for example, an elevated sedimentation
rate or ECG findings;
OR
B. Evidence of chronic heart failure, as described under 104.02;
OR
C. Recurrent arrhythmias, as described under 104.05.
104.14 Hyperlipidemia. Documented Type II homozygous hyperlipidemia with repeated plasma cholesterol levels
of 500 mg/ml or greater, with one of the following:
A. Myocardial ischemia, as described in 4.04B or 4.04C;
OR
B. Significant aortic stenosis documented by Doppler echocardiographic techniques
or cardiac catheterization;
OR
C. Major disruption of normal life activities by repeated hospitalizations for plasmapheresis
or other prescribed therapies, including liver transplant;
OR
D. Recurrent pancreatitis complicating hyperlipidemia.
104.15 Kawasaki syndrome. With one of the following:
A. Major coronary artery aneurysm;
OR
B. Chronic heart failure, as described in 104.02.