TN 3 (10-99)

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

104.00 CARDIOVASCULAR SYSTEM

  1. 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. 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.

  3. 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.

  4. 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. 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. Tachycardia (see Table I).

  2. Tachypnea (see Table II).

  3. Cardiomegaly on chest roentgenogram (see 104.00C).

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

  5. Evidence of pulmonary edema, such as rales or orthopnea.

  6. Dependent edema.

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

TABLE I — TACHYCARDIA AT REST

AgeApical 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
AgeRespiratory 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:

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

  2. Cerebrovascular damage as described under the criteria in 111.06; or

  3. Congestive heart failure as described under the criteria in 104.02.