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Cardiovascular disorders 

Cardiovascular disorders
Cardiovascular disorders

Anne E. Price

and Michael C. Petch

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date: 19 March 2018

Cardiovascular disorders remain one of the commonest causes of ill health and death but their incidence in Western society has been declining and there have also been significant reductions in death rates due to major advances in treatment over the last 20 years. Cardiovascular disease (CVD) affects working-age people and occupational physicians will see it regularly in the clinic. It affects fitness to work in two ways. First, an individual may suffer from symptoms on effort that limit their working capacity. Such disability is quantifiable and can often be alleviated by effective treatment. The second less common but more difficult problem is the risk of sudden incapacity, especially in individuals who appear well. This may occur for a variety of reasons including the risk of sudden cardiac death following ventricular fibrillation and whilst the instantaneous risk of sudden incapacity is very small, the consequences can be unacceptable. Assessment of this risk and its impact is possible in populations but explaining this concept to a bus driver who has lost his job is not easy. Limitation of working capacity and the risk of sudden incapacity can be well judged in populations by specialist opinion. For the individual this must be backed up by objective data, usually derived from the results of non-invasive tests such as electrocardiography (ECG) and exercise testing. Whilst disease progression can be unpredictable the use of objective data can ensure the individual is not unfairly excluded from work they can safely do. Sometimes cardiovascular symptoms are out of all proportion to the objective evidence of disease. This may arise from psychological disturbance following the development of CVD which in itself is associated with a high rate of common mental health problems. A heart attack proves devastating and the patient never returns to work despite prompt treatment, a full cardiac recovery, and only modest residual disease. The occupational physician needs to recognize the mental health problems associated with CVD and ensure that all treatment options are considered to facilitate rehabilitation to the workplace.

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