TN 3 (10-99)

DI 34224.003 Cardiovascular Listings from 01/06/86 to 02/09/94

104.00 CARDIOVASCULAR SYSTEM

1. 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.

2. B. 

   Evaluation of cardiovascular impairment in children requires two steps:

   1. 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. 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.

3. C. 

   Chest roentgenogram (6 ft. PA film) will be considered indicative of cardiomegaly if:

   1. 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. 2. 

      The cardiac size is increased over 15 percent from any prior chest roentgenograms; or

   3. 3. 

      Specific chamber or vessel enlargement is documented in accordance with established criteria.

4. 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.

5. 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:

1. A. 

   Tachycardia (see Table I).

2. B. 

   Tachypnea (see Table II).

3. C. 

   Cardiomegaly on chest roentgenogram (see 104.00C).

4. D. 

   Hepatomegaly (more than 2 cm. below the right costal margin in the midclavicular line).

5. E. 

   Evidence of pulmonary edema, such as rales or orthopnea.

6. F. 

   Dependent edema.

7. G. 

   Exercise intolerance manifested as labored respiration on mild exertion (e.g., in an infant, feeding).

TABLE I — TACHYCARDIA AT REST

 

104.03 Hypertensive cardiovascular disease. With persistently elevated blood pressure for age (see Table III) and one of the following signs:

1. A. 

   Impaired renal function as described under the criteria in 106.02; or

2. B. 

   Cerebrovascular damage as described under the criteria in 111.06; or

3. C. 

   Congestive heart failure as described under the criteria in 104.02.

    

TABLE III — ELEVATED BLOOD PRESSURE

104.04 Cyanotic congenital heart disease. With one of the following:

1. A. 

   Surgery is limited to palliative measures; or

2. B. 

   Characteristic squatting, hemoptysis, syncope, or hypercyanotic spells; or

3. 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:

1. A. 

   Cardiac syncope; or

2. B. 

   Congestive heart failure as described under the criteria in 104.02; or

3. 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:

1. 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

2. B. 

   Congestive heart failure as described under the criteria in 104.02.