Congenital heart disease can cause impairment which can be quantitated using the AMA criteria.
Selection: A patient should have evidence of congenital heart disease based on physical examination, laboratory studies or other findings.
Parameters:
(1) functional class (using the 1964 NYHA criteria)
(2) therapy (diet, medication, surgery) and its effectiveness
(3) evidence of cardiac chamber dysfunction and dilatation
(4) valvular stenosis and/or regurgitation severity
(5) pulmonary vascular resistance
(6) right to left shunt
(7) left to right shunt
Functional Class |
Therapy |
Cardiac Chamber Dysfunction and Dilation |
Valvular Stenosis and/or Regurg-itation |
Impair-ment of the Whole Person |
no symptoms with moderately heavy physical exertion (class I) |
continuous therapy not required; may be intermittent |
no signs (? mild) |
mild |
0 - 9% |
symptoms with moderately heavy physical exertion (class II) |
moderate adjustments in diet and drugs to remain free of signs and symptoms |
moderate signs |
moderate |
10 – 29% |
symptoms during ordinary activities (class III) |
despite dietary and medical therapy |
moderate to severe |
moderate or severe |
30 – 49% |
CHF with less than ordinary daily activities (class IV) |
poorly responsive to therapy |
moderate to severe |
severe |
50 – 100% |
Pulmonary Vascular Resistance |
Right to Left Shunt |
Left to Right Shunt |
Impair-ment of the Whole Person |
none or mild elevation |
none |
small; pulmonary flow less than 1.5 times systemic flow |
0 - 9% |
moderate elevation; less than 0.5 times systemic vascular resistance |
none |
moderate; pulmonary flow >= 1.5 and < 2.0 times systemic flow |
10 – 29% |
>= 0.5 times systemic vascular resistance |
present |
pulmonary flow >= 2.0 times systemic flow |
30 – 49% |
>= 0.5 times systemic vascular resistance |
present |
pulmonary flow >= 2.0 times systemic flow |
50 – 100% |
where:
• Pulmonary to systemic blood flow in the shunt is referred to as Qp / Qs.
• Class 3 and 4 congenital heart disease overlap in most of the measures except functional class and responsiveness to therapy.
Specialty: Sports Medicine & Rehabilitation, Cardiology, Emergency Medicine