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Impairment Classification for Coronary Heart Disease
Class 1—Impairment of the Whole Person, 0—14%Because of the serious implications of reduced coronary blood flow, it is not reasonable to classify the degree of impairment as 0% to 10% in any patient who has symptoms of coronary heart disease corroborated by physical examination or laboratory tests. This class of impairment should be reserved for the patient with an equivocal history of angina pectoris in whom coronary angiography is performed, or for a patient on whom coronary angiography is performed for other reasons and in whom is found less than 50% reduction in the cross-sectional area of a coronary artery.
Class 2-Impairment of the Whole Person, 15—29% The patient has history of a myocardial infarction or angina pectoris that is documented by appropriate laboratory studies, but at the time of evaluation the patient has no symptoms while performing ordinary daily activities or even moderately heavy physical exertion (functional class 1); and The patient may require moderate dietary adjustment and/or medication to prevent angina or to remain free of signs and symptoms of congestive heart failure; and The patient is able to walk on the treadmill or bicycle ergometer and obtain a heart rate of 90% of his or her predicted maximum heart rate without developing significant ST segment shift, ventricular tachycardia, or hypotension; if the patient is uncooperative or unable to exercise because of disease affecting another organ system, this requirement may be omitted. or The patient has recovered from coronary artery surgery or angioplasty, remains asymptomatic during ordinary daily activities, and is able to exercise as outlined above. If the patient is taking a beta adrenergic blocking agent, he or she should be able to walk on the treadmill to a level estimated to cause an energy expenditure of at least 10 METs as a substitute for the heart rate target.
Class 3—Impairment of the Whole Person, 30—54% The patient has a history of myocardial infarction that is documented by appropriate laboratory studies, and/or angina pectoris that is documented by changes on a resting or exercise ECG or radioisotope study that is suggestive of ischemia;orThe patient has either a fixed or dynamic focal obstruction of at least 50% of a coronary artery, demonstrated by angiography; and The patient requires moderate dietary adjUstment or drugs to prevent frequent angina or to remain free of symptoms and signs of congestive heart failure, but may develop angina pectoris or symptoms of congestive heart failure after moderately heavy physical exertion (functional class 2);
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