chapter  9
Impairment of cardiovascular functions
ByRamar Sabapathi Vinayagam
Pages 10

The primary function of the heart is to pump and to move the blood continuously with essential pressure to the whole body and deliver oxygen and nutrients to all organs and tissues. Further, it transports carbon dioxide and waste products through the venous circulation to the appropriate organs for excretion. Ejection fraction indicates the amount of blood pumped by the ventricle during each heartbeat. Normal ejection fraction is 55%–70%. Abnormal ejection fraction refers to the subnormal volume of blood ejected by the ventricle namely mild: ≥45% to <55%, moderate: ≥30 to <45%, and severe: <30%. “Integrated Evaluation of Disability,” defines impairment class in hypertensive heart disease, ischemic heart disease and cardiomyopathy based on the severity of cardiovascular symptoms, METs aerobic functional capacity by exercise test with treadmill, and systolic and diastolic dysfunction assessed by echocardiography. Structural abnormalities such as congenital heart disease, valvular heart disease, hypertensive heart disease, ischemic heart disease and cardiomyopathy may produce dysrhythmia. Examination of the pulse, auscultation of the heart, ECG and/or Holter monitoring and echocardiography evaluates dysrhythmia. “Integrated Evaluation of Disability” assigns impairment for dysrhythmia based on its severity, the burden of treatment, failure of pacemaker/AICD devices, replacement of devices and coexisting left ventricular dysfunction. “Integrated Evaluation of Disability” assigns impairment for persons with valvular heart disease based on symptomatic/asymptomatic valvular disease, left ventricular systolic and diastolic function, pulmonary artery pressure and right ventricular function. Echocardiogram evaluates valvular lesions, its impact on the size of the atrium and ventricle, and its functions.