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CARDIOVASCULAR SYSTEM

CARDIOVASCULAR SYSTEM. C&P Service (213A) March 2008. Objectives. Understanding of: General reasons for revised evaluation criteria on January 12, 1998 Primary parts of cardiovascular system

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CARDIOVASCULAR SYSTEM

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  1. CARDIOVASCULAR SYSTEM C&P Service (213A) March 2008

  2. Objectives Understanding of: • General reasons for revised evaluation criteria on January 12, 1998 • Primary parts of cardiovascular system • Basic principles in evaluating cardiovascular related disabilities

  3. Revised Criteria 1-12-98 Update cardiovascular rating schedule to ensure: • Current medical terminology • Current and unambiguous evaluation criteria • Reflection of medical advances • Revision of convalescent ratings based on medical advances • More consistent ratings

  4. FUNCTION OF THECARDIOVASCULAR SYSTEM Components: • Heart • Arterial & venous systems • Blood

  5. FUNCTION OF THE CARDIOVASCULAR SYSTEM Anatomy of the heart: • A hollow muscular organ lying in the center of the chest • Divided into left and right sides, each have upper chamber (atrium) that collects blood and a lower chamber (ventricle) that ejects blood • Inlet and outlet valves in each ventricle ensure one-way blood flow

  6. Heart – Anterior View

  7. Heart – Posterior View

  8. FUNCTION OF THE CARDIOVASCULAR SYSTEM Primary functions of the heart include: • Oxygen mover for the body • Collects O2-enriched blood coming from lungs • Pumps it to entire body • Helps rid body of waste product (CO2) • Collects oxygen-depleted blood from the body • Pumps it to the lungs for re-oxygenation

  9. FUNCTION OF THE CARDIOVASCULAR SYSTEM During each heartbeat, each heart chamber: • Relaxes as it fills (diastole) • And then contracts as it pumps blood (systole)

  10. CARDIOVASCULAR SYSTEM -- PULMONARY CIRCULATION Blood flow: • CO2-laden blood from body flows through the largest veins (vena cavae) into right atrium • Right atrium fills • Heart muscle propels blood into right ventricle

  11. CARDIOVASCULAR SYSTEM – PULMONARY CIRCULATION • Right ventricle fills • Heart muscle pumps blood through pulmonary valve into pulmonary arteries to the lungs • Blood in lungs absorbs O2 and gives up CO2 • CO2is exhaled (Respiratory System) • O2-enriched blood returns to the heart through pulmonary veins into the left atrium

  12. FUNCTION OF THE CARDIOVASCULAR SYSTEM • Left atrium fills • Blood is pumped into left ventricle • When left ventricle fills, heart muscle pumps blood through aortic valve into aorta (largest artery in the body) • O2-enriched blood supplies all of body except lungs

  13. FUNCTION OF THE CARDIOVASCULAR SYSTEM The Circulatory System: • Arteries • Arterioles • Capillaries • Venules • Veins

  14. FUNCTION OF THE CARDIOVASCULAR SYSTEM • Arteries: • Strong and flexible • Carry blood awayfrom the heart • Bear the highest blood pressures • Help maintain blood pressure between beats • Smaller arteries and arterioles: • Have muscular walls • Adjust their diameter to increase or decrease blood flow to a particular area

  15. FUNCTION OF THE CARDIOVASCULAR SYSTEM • Capillaries: • Tiny, extremely thin-walled • Act as bridges between arteries and veins • Allow nutrients to pass from blood to tissues • Allow waste to pass from tissues into blood • Drain into venules, which drain into veins, which lead back to the heart

  16. FUNCTION OF THE CARDIOVASCULAR SYSTEM • Veins: • Thin-walled but generally larger in diameter than arteries, • Carry same volume of blood, but at a lower speed, and • Under much less pressure

  17. Elements of CardiovascularRating Criteria METs • What are METs? • How are METs used in evaluation of the cardiovascular system?

  18. Elements of CardiovascularRating Criteria METs • Even if the requirement for a 10% or 30% evaluation is met, METs testing is required in all cases, with what four exceptions? • 38 CFR 4.100(b)

  19. Elements of CardiovascularRating Criteria Alternative criteria to METS • Left ventricular ejection fraction • Congestive heart failure • Cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray • Continuous medication

  20. Elements of CardiovascularRating Criteria Left ventricular ejection fraction (LVEF) • Otero-Castro v. Principi: DCs 7005 and 7007 do not require a separate showing of left-ventricular dysfunction in addition to an ejection fraction of 30 through 50% for a 60% rating. • If LVEF testing is not of record, evaluation should be based on the other criteria unless the examiner states that the LVEF test is needed in a particular case.

  21. Elements of CardiovascularRating Criteria In all cases, the following must be ascertained: • Whether or not cardiac hypertrophy or dilatation (documented by electrocardiogram, echocardiogram or X-ray) is present, and • Whether or not there is a need for continuous medication.

  22. Elements of CardiovascularRating Criteria Conditions rated on other criteria • Hypothyroid heart disease (DC 7008) – on hyperthyroidism (DC 7900) or s.v. arrhythmias (DC 7010) • Arrhythmias (DC 7010 and 7011) • Implantable cardiac pacemaker – on arrhythmias or heart block (DC 7015)

  23. Elements of CardiovascularRating Criteria Total impairment criteria • When is a 100 percent evaluation is required?

  24. Elements of CardiovascularRating Criteria Convalescence Periods • 2 months • 3 months • Indefinite period with mandatory exam at 6 months • Indefinite period with mandatory exam at 1 year • Application of 38 CFR 105(e)?

  25. Cor Pulmonale • A combination of hypertrophy and dilatation of the right ventricle secondary to pulmonary hypertension, due to disease of the lung parenchyma or pulmonary vascular system. • Always secondary to a lung condition. • Evaluate cor pulmonale as part of the pulmonary condition that causes it (Note 1 under §4.104).

  26. Congenital Heart Defects • Common heart conditions due to prenatal influences, such as: • patent foramen ovale, • patent ductus arteriosus, • coarctation of the aorta, and • intraventricular septal defect.

  27. Coexisting Heart Diseases • No etiological relationship between rheumatic heart disease and either hypertensive or arteriosclerotic heart disease. • A medical opinion necessary to determine whether current signs and symptoms can be attributed to one of the coexisting conditions.

  28. CARDIOVASCULAR SYSTEM For rating purposes, the cardiovascular system is subdivided into: • Diseases of the heart • Diseases of the arteries & veins

  29. Presumptive Service Connection • 38 CFR § 3.309(a) – Chronic diseases • Arteriosclerosis • Cardiovascular-renal disease, including hypertension • Endocarditis (all forms of valvular heart disease) • Myocarditis

  30. Presumptive Service Connection • 38 CFR § 3.309(c) – Former POWs • Atherosclerotic heart disease or hypertensive vascular disease (including hypertensive heart disease) • And their complications (including myocardial infarction, congestive heart failure, arrhythmia). • Beriberi heart disease • Organic residuals of frostbite

  31. Diseases of the Heart DC 7000, Valvular heart disease (includes rheumatic heart disease) • No etiological relationship between rheumatic heart disease and either hypertensive or arteriosclerotic heart disease. • If SC for rheumatic heart disease & develops hypertensive or arteriosclerotic heart disease, request a medical opinion to determine which condition is causing the current signs and symptoms.     

  32. Diseases of the Heart DC 7000, Valvular heart disease (includes rheumatic heart disease) - continued • If unable to separate the effects, the effects must be rated together. • Do not extend service connection to systemic manifestations or arteriosclerosis in areas remote from the heart.

  33. Diseases of the Heart DC 7001, Endocarditis DC 7002, Pericarditis DC 7003, Pericardial Adhesions

  34. Diseases of the Heart DC 7004, Syphilitic heart disease DC 7005, Arteriosclerotic Heart Disease DC 7006, Myocardial Infarction

  35. Diseases of the Heart DC 7007, Hypertensive Heart Disease DC 7008, Hyperthyroid Heart Disease

  36. Diseases of the Heart • What are ventricular arrhythmias? • What is ventricular tachycardia? • What is ventricular fibrillation?

  37. Diseases of the Heart DC 7010, Supraventricular arrhythmias DC 7011, Ventricular Arrhythmias (Sustained) DC 7015, Atrioventricular Block

  38. Diseases of the Heart DC 7016, Heart valve replacement (prosthesis) DC 7017, Coronary Bypass Surgery DC 7018, Implantable Cardiac Pacemakers

  39. Diseases of the Heart DC 7019, Cardiac Transplantation DC 7020, Cardiomyopathy

  40. Diseases of the Arteries & Veins DC 7101, Hypertensive Vascular Disease (hypertension and isolated systolic hypertension) • Separate evaluations for hypertension and heart disease are allowed.

  41. Diseases of the Arteries & Veins • Through relationship to hypertension, grant secondary SC for: • Cerebral arteriosclerosis or thrombosis with hemiplegia • Nephrosclerosis of the kidneys with impairment of renal function • myocardial damage or coronary occlusion of the heart • Note: Existence of arteriosclerosis does not imply or indicate previous hypertension.

  42. Diseases of the Arteries & Veins What is an aneurysm? DC 7110, Aortic Aneurysm DC 7111, Aneurysm, any large artery DC 7112, Aneurysm, any small artery

  43. Diseases of the Arteries & Veins DC 7113, Arteriovenous Fistula, Traumatic

  44. Diseases of the Arteries & Veins DC 7114, Arteriosclerosis Obliterans The ankle/brachial index (ABI)

  45. Diseases of the Arteries & Veins DC 7115, Thromboangiitis obliterans (Buerger's Disease) DC 7117, Raynaud's syndrome DC 7118, Angioneurotic edema DC 7119, Erythromelalgia

  46. Diseases of the Arteries & Veins Chronic Venous Insufficiency DC 7120, Varicose veins DC 7121, Post-phlebitic syndrome of any etiology

  47. Diseases of the Arteries & Veins DC 7122, Cold injury residuals • Rating criteria revised 1-12-98 and 8-13-98 • Presumptive SC for former POWs under 38 CFR 3.309(c) • Chosin Reservoir Campaign - Korean War, October 1950 through December 1950

  48. Diseases of the Arteries & Veins DC 7123, Soft Tissue Sarcoma (of vascular origin)

  49. SECONDARY SERVICE CONNECTIONSUBSEQUENT T0 AMPUTATION Grant SC for ischemic heart disease or other cardiovascular disease developing in a veteran who has: • SC amputation of one lower extremity at or above the knee, or • SC amputations of both lower extremities at or above the ankles.

  50. Fast Letter 01-05 Relationship of PTSD or Stress to Cardiovascular Disorders

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