Valvular heart disease can cause impairment which can be quantitated using the AMA criteria.
Selection: A patient should have evidence of valvular 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 heart failure or ventricular dysfunction
(4) valvular stenosis and/or regurgitation severity
|
Functional Class |
Therapy |
Heart Failure or Ventricular Dysfunction |
Valvular Disease |
Impair-ment of the Whole Person |
|
none with ordinary daily activities or moderately heavy physical exertion (functional class I) |
continuous therapy not required |
no signs of CHF; no signs of ventricular dysfunction or dilation |
mild |
0 - 9% |
|
functional class II (none with ordinary daily activities but present with moderate exertion) |
effective |
no signs of CHF with therapy; chamber dys-function or dilatation present |
moderate |
10 – 29% |
|
functional class III (slight to moderate discomfort with ordinary daily activities) |
partially effective |
some signs of CHF; chamber dysfunction or dilatation present |
moderate or severe |
30 – 49% |
|
functional class IV (symptomatic at rest or with less than ordinary daily activities) |
ineffective |
signs of CHF; chamber dysfunction or dilatation present |
moderate or severe |
50 – 100% |
where:
• For a permanent impairment surgical correction of the valvular disorder should not be feasible or advisable for some reason.
• A patient who has had a valve surgery performed is classified based upon residual symptoms. If permanent complications occurred from surgery, then these are combined with the impairment associated with the valvular disease.
• Patients may require intermittent antibiotic therapy as prophylaxis for prevention of endocarditis.
Specialty: Sports Medicine & Rehabilitation, Cardiology, Emergency Medicine
