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Heart Disease

Heart disease is the leading cause of death in the United States. There are a number of different but interrelated disorders that can affect the heart.

When the walls of your arteries are damaged or if there is an excess of lipids (fat and cholesterol) in your blood, these lipids may enter the arterial walls, causing further damage. The body dispatches macrophages (white blood cells) to repair the damage; the macrophages ingest the cholesterol but do not necessarily repair the damage, as a result of which a mixture of macrophages, fat and cholesterol accumulates inside the arterial wall, forming a deposit known as a “plaque.” This condition is known as atherosclerosis, and falls under the larger category of arteriosclerosis (hardening of the arteries due to any cause).

If arteriosclerosis continues to progress, for example if fat or “bad cholesterol” (low-density lipoprotein) levels in the blood are higher than normal, then a number of complications can occur:

  • The plaque can just keep getting larger and larger, resulting in a narrowing of the artery.
    • If the artery is in the heart, this can result in angina.
    • If a clot formed elsewhere in the body moves to the location of the plaque, a more serious blockage can form; if in the heart, this can result in a heart attack, and if in the brain, it can result in a stroke.
  • If the thin outer layer of the plaque ruptures, a blood clot may form at the site of the plaque.
    • if the plaque is in an artery of the heart and the clot remains in the heart, then a heart attack occurs.
    • if the plaque is in the brain and the clot remains in the brain, then a stroke occurs.
    • the clot may move to a different location and block a blood vessel somewhere else.

The plaque need not increase in size continually; sometimes, especially if you were to go on a diet, receive medical treatment, or start an exercise program under the supervision of your doctor, the plaques may stop growing, or even shrink. The greatest danger is if a plaque ruptures, because then a clot may form inside the artery, causing blockage and resulting disability. The same methods (diet, exercise and cholesterol-lowering medical treatments) that are used to reduce the size of plaques or to prevent them from growing larger are believed also to reduce the probability of rupture. The discovery of the role of plaque rupture in arterial disease is one of the major recent advances of medical science.

Angina pectoris

Angina pectoris is a condition manifested by discomfort, pain or a squeezing sensation in the chest. The nature of the feeling varies; WebMD has a list of heart-disease symptoms that require you to contact a doctor. If you feel chest pain or think you may have symptoms of heart disease, then please seek medical attention immediately. The most important thing is to get immediate medical treatment. Angina is caused by a narrowing of the coronary arteries that feed the heart. The artery may narrow either because of a spasm of the muscle in the arterial wall, or because of a fatty plaque. Narrowing by plaque is more common. If untreated, angina may lead to heart attack. Also, the pain of angina (in which the blood supply of the heart muscle is partially blocked) and of heart attack (in which heart muscle dies) is very similar, so all patients with chest discomfort are urged to seek medical diagnosis and treatment as soon as possible.

If angina persists in spite of compliance with medical treatment, and if certain diagnostic findings are present, then the disease can be considered to be disabling. These diagnostic findings are highly technical, so only a doctor can interpret the results. However, if your doctor says you cannot work, an attorney can assist you in asking your doctor the right questions so that your medical records will contain the documentation required to support a claim for disability benefits.

Heart attack

A heart attack occurs when an artery in the heart is blocked completely or to an extent that causes heart muscle to start to die. The majority of deaths that occur in the United States are caused by heart attacks. Heart attacks can cause symptoms very similar to angina; WebMD maintains a list of symptoms that may indicate a heart attack and therefore require you to call an ambulance.

A heart attack is a disabling condition, but in some cases there is recovery in less than a year and in other cases death results. Treatment will reduce the possibility of ventricular fibrillation, a deadly heart rhythm disturbance that may occur within a few hours or less after the onset of symptoms. In spite of treatment, a heart attack sometimes results in the inability to work for a year or longer. If certain diagnostic findings are present, the Social Security Administration may presume that you are too disabled to work. Because the diagnostic evaluation is complex, only a doctor can determine whether the Social Security Administration’s criteria are present or not. If a heart attack is expected to result in disability, then an attorney can advise you on what documentation your doctor needs to provide in order to prove that you are eligible for disability benefits. You may also consider printing out the listing and giving it to your doctor. Be aware that even if your condition doesn’t meet or equal the listing, it probably causes “exertional impairments” that may make it hard to work. Trying to prove “exertional impairment” is an uphill battle in which the assistance of an attorney may be very valuable.

Arrhythmias

Arrhythmias, or irregularities in heartbeat, range from the harmless to the deadly. In order to understand arrhythmias you must first have a basic knowledge of the heart’s electrical conduction system. And to understand the conduction system, it may be useful to know about the anatomy of the heart.

As you may know, your heart consists of four “chambers”: the right atrium (also known as the right auricle), the right ventricle, the left atrium (also known as the left auricle) and the left ventricle. The heart also contains valves that cause the blood to flow in only one direction when the chambers of the heart contract.

Blood enters the heart from the rest of the body through the right atrium, which pumps it into the right ventricle. The right ventricle then expels the blood into the pulmonary arteries, which distribute the blood to the lungs where the red cells of the blood then pick up oxygen. After returning from the lungs through the pulmonary vein, the blood re-enters the heart through the left atrium, which pumps it into the left ventricle. The left ventricle then pumps the blood out to the rest of the body.

In the right atrium, there exists a small patch of highly-specialized tissue known as the sinoatrial (SA) node. The cells in the sinoatrial node have the ability to produce rhythmic electrical pulses. [These pulses are not like electrical currents that flow through wires; rather, they are a complex phenomenon that involves ions (charged particles) and the polarization and depolarization of membranes. They also differ somewhat from nerve impulses, with which you may be more familiar.] The pulses from the sinoatrial node cause the contraction of the atria (plural of atrium), and also are transmitted to another bundle of specialized tissue known as the atrioventricular (AV) node. At the AV node the electrical impulses are delayed briefly and then are distributed to the ventricles of the heart. The atria and the ventricles contract at different times, in order to optimize the pumping effect that causes blood to flow through your body.

Arrhythmias can occur when any part of the electrical conduction system is blocked. They also can occur if a beat starts anywhere other than in the SA node. There are many different kinds of arrhythmia, only a few of which are described here.

The most common arrhythmias are premature atrial contractions and premature ventricular contractions. These are usually experienced as a “skipped” or “extra” beat. Only your doctor can tell whether these are serious or not. Premature contractions are not disabling, and in many cases are not serious at all, but they should be evaluated by your doctor in order to make sure they are not a sign of a more serious problem (such as arteriosclerosis) that may deteriorate into other, more dangerous, arrhythmias.

Bradycardia is a condition in which the heart beats too slowly. It can have a variety of different causes, and should be evaluated by a doctor. In some cases it is harmless.

Heart block is a condition where electrical impulses flow from the atria, through the AV node, to the ventricles either too slowly, or not at all. It prevents the proper synchronization of the different parts of the heart, resulting in inefficient pumping of blood. It causes “exertional impairment” (the inability to do physical exercise or labor), and must be evaluated and treated by a doctor because if left untreated it may eventually result in death.

Atrial (or supraventricular) tachycardia is a condition in which your heart beats too fast. It should be evaluated by a doctor. Atrial flutter is a condition in which the atria beat at an extremely fast rate, so fast that the atria do not function properly. It can be thought of as being “in between” atrial tachycardia and atrial fibrillation. Atrial fibrillation is a condition where the random electrical activity occurs in the atria, resulting in the inability of the atria to pump blood. It is a dangerous condition that may result in the formation of blood clots that may move to the brain, causing stroke. It may also deteriorate into other dangerous arrhythmias, but it does not result in immediate death, because the AV node can generate impulses that cause the ventricles to continue to pump blood.

Ventricular tachycardia is a condition in which electrical impulses start abnormally in the ventricles. These abnormal impulses override the signals from the SA and AV nodes and cause the ventricles to beat extremely fast, and not in proper synchronization with the atria. There are two kinds of ventricular tachycardia: with or without “h√¶modynamic instability.” This simply is an indicator of the severity of the condition: “h√¶modynamic instability” is another way of saying that the heart cannot pump blood. Either type of ventricular tachycardia is a life-threatening emergency requiring immediate ambulance transport. The most common symptom is lightheadedness or fainting.

Ventricular fibrillation is a condition in which random electrical impulses cause the ventricles of the heart to quiver instead of to pump blood. This causes immediate unconsciousness, followed by a deterioration in breathing, and death. It is often caused by a heart attack; indeed, the reason that a heart attack is so deadly is that it may cause either ventricular fibrillation or congestive heart failure. The treatments for ventricular fibrillation are CPR and defibrillation, followed by advanced hospital care to resolve the cause of the problem. (Although most ambulances in the United States carry defibrillators which can restart the heart at the scene of an emergency, it is absolutely necessary to be transported to the hospital because if the root cause of the problem is not resolved, then it is likely to recur within a very short time. The most common root cause of ventricular fibrillation is heart attack; all causes of ventricular fibrillation require in-hospital medical treatment.) The probability of survival after ventricular fibrillation deteriorates with every minute of time that elapses between onset and successful defibrillation. In recognition of this fact, most communities have purchased defibrillators for their fire engines, and some communities have purchased defibrillators for their police since police or fire equipment may arrive at the scene of a “911″ call sooner than an ambulance. The urgency of resuscitation in case of ventricular fibrillation is one reason why you should always yield to emergency vehicles when driving.

Pulseless electrical activity is a condition in which the heart stops beating but an electrocardiogram shows a heart rhythm that may even be normal. Because the heart isn’t beating, however, death may be imminent unless the root cause of the condition is resolved quickly. The proper diagnosis of the root cause is a very complex process that requires an extremely high degree of medical judgment.

Asystole is a condition in which the heart stops completely. It is denoted by a “flatline” on an electrocardiogram. Survival after asystole is rather uncommon, but may be possible if the root cause of the asystole is resolved immediately.

What does arrhythmia have to do with Social Security?

Arrhythmias, as described above, may be disabling. In some cases your doctor may advise you not to perform certain types of work, because stress from work may precipitate a worsening of the arrhythmia. The Social Security Administration’s medical listing for arrhythmia is simple. If it causes you to faint or lose consciousness repeatedly, and is documented by Holter monitoring or other diagnostic techniques, and does not respond to prescribed medical treatment, then you are disabled. (Unfortunately, arrhythmias severe enough to cause loss of consciousness may also cause death.) If you don’t meet or equal this listing, arrhythmias may still cause exertional (or even non-exertional) impairments that may make it hard or impossible for you to work. Your lawyer can provide a “residual functional capacity” form for your doctor to fill out that will explain how your impairments relate to the Social Security Administration’s regulations pertaining to inability to work.

Heart failure

Heart failure is a chronic condition in which the heart is unable to pump blood effectively. Heart failure comes in two kinds: systolic and diastolic.

In systolic heart failure, the heart is too weak to expel the proper amount of blood when it contracts. Systolic heart failure is measured by a number called “ejection fraction,” which is simply the percentage of the blood in a ventricle that is expelled when it contracts. An ejection fraction of 30% or less, when accompanied by certain other signs or symptoms, is presumptive evidence of disability. An ejection fraction of 30%-40% may also be associated with systolic heart failure. A normal heart will produce an ejection fraction of 50% or more; however, an ejection fraction of 50% or more does not necessarily mean the heart is normal. For example, a heart with diastolic failure may have a normal or even an elevated ejection fraction.

Diastolic heart failure occurs when the muscle of the heart becomes harder than normal. The heart does not fill correctly when the muscle is not contracting; as a result, even though the percentage of the volume of the heart ventricle that is ejected may be normal, the total volume may be too small.

Both systolic and diastolic heart failure have very similar symptoms, but the treatments are very different. In both cases it is common to use drugs, but most drugs to treat systolic failure will make diastolic failure worse, and most drugs used to treat diastolic failure will make systolic failure worse.

A heart attack can cause ventricular fibrillation (which leads to death) directly, or it can cause heart failure. Heart failure can also cause ventricular fibrillation, or it may cause death directly.

There are two ways in which heart failure may qualify you for Social Security disability benefits (assuming you also meet the “technical,” or non-medical, requirements): you can either have a disease that is severe enough to meet or equal the listing, or you may have exertional impairment. All patients with heart failure have exertional impairment, but not all patients with exertional impairment are disabled; rather, exertional impairments are evaluated by the Social Security Administration according to a set of “grids” which dictate a certain result based on your age, your education and your work experience (the better your education, the less likely you are to get benefits; the greater your age, the more likely you are to get benefits). A disease generally has to be very severe in order for somebody to “meet or equal” a listing, and if you don’t meet or equal a listing then the “grids” are designed to make it very hard to get benefits unless you’re either of advanced age or uneducated.

The secret of the grid

One of the secrets of the “grids” is that somebody who is non-disabled at the age of 54 or lower may be found to be disabled at the age of 55 or higher; some claimants have even been found to be non-disabled by the disability determination service in their state and then, after appealing, are found to be disabled by an administrative law judge merely by virtue of the fact that the claimant turned 55 while waiting for their hearing.

If you’re not willing to wait until you’re 55 years of age, you probably will need a lawyer to prove your case. If you feel chest pain or think you may have symptoms of heart disease, then please seek medical attention immediately. The most important thing is to get better; you can worry about benefits later. But once you are out of the hospital, call Social Security to start a claim, then after that, feel free to call the law offices of Bill Gordon at 1-866-646-0626 to discuss your options further.

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