ABSTRACT
Hypertrophic cardiomyopathy outlines a pathological condition of considerable interest not only in the field of cardiology but also for medical-legal aspects. Along with a great variability in symptoms, the evaluation of injury from a medical-legal point of view is not always of easy interpretation. The purpose of this review is to provide a targeted medical-legal evaluation on the basis of well known clinical and prognostic indications, also with reference to the quality of life.
Subject(s)
Cardiomyopathy, Hypertrophic/diagnosis , Death, Sudden, Cardiac/prevention & control , Legislation, Medical , Cardiomyopathy, Hypertrophic/physiopathology , Cardiomyopathy, Hypertrophic/therapy , Early Diagnosis , Humans , Italy , Prognosis , Quality of Life , Risk Assessment , Risk Factors , Severity of Illness IndexABSTRACT
Brugada syndrome is a congenital arrhythmogenic disease, characterized by alterations in sodium channels in the absence of structural myocardial changes. It leads to ventricular electrical instability, causing arrhythmias with high risk of sudden cardiac death. Patients affected by Brugada syndrome show electrocardiographic alterations either at baseline or after stimulation. Symptomatology and electrocardiographic alterations are the most important prognostic elements. The only effective treatment is the implantation of an automatic implantable cardioverter-defibrillator, which dramatically reduces arrhythmic mortality. This device is used only in symptomatic patients for abortive sudden cardiac death or syncope with electrocardiographic alterations, whereas in most patients just a careful follow-up is required. In this article we evaluate the medical-legal aspects of patients with Brugada syndrome, in forensic pathology, social insurance, private insurance, medical professional liability and ability to work. First of all, we analyze the question of medical professional liability, mostly in case of a wrong identification of prognostic factors. Then we consider the medical-legal evaluation of Brugada syndrome in the field of social insurance, in relation to the clinical picture and particularly to the frequency of arrhythmic events. As far as private insurance is concerned, we dwell upon patients' insurability in the various types of policies, refundable medical expenses and evaluation of pathology in health insurance. Finally, we discuss the question of ability to work, with special regard to armed forces and police, whose committees do not provide a specific evaluation for Brugada syndrome by making identical use of automatic implantable cardioverter-defibrillators and pacemakers, thus ignoring the great clinical differences between these two devices.
Subject(s)
Brugada Syndrome , Liability, Legal , Brugada Syndrome/diagnosis , Brugada Syndrome/therapy , Humans , Insurance, Health , PrognosisABSTRACT
After a short examination of the pathophysiological and clinical-prognostic aspects of dilated cardiomyopathy, the authors focus their attention on the explicit normative evaluation references (concerning various protection areas) and the most updated medical-legal indications for this disease. They suggest for these patients some criteria of medical-legal evaluation of biological damage, of the inability to work, work unsuitability, based on the analysis of the following parameters: left ventricular ejection fraction, NYHA class/functional capacity, hemodynamics, left ventricular diameters and volumes, degree of left ventricular diastolic dysfunction, and cardiopulmonary exercise testing.
Subject(s)
Cardiomyopathy, Dilated/diagnosis , Disability Evaluation , Cardiomyopathy, Dilated/physiopathology , Cardiomyopathy, Dilated/therapy , Early Diagnosis , Guidelines as Topic , Humans , Legislation, Medical/standards , Legislation, Medical/trends , Prognosis , Severity of Illness Index , Stroke Volume , Work Capacity EvaluationABSTRACT
The prevalence of chronic obstructive vascular disease of the inferior limbs has been increasing in the western countries. As a consequence, the number of patients affected by this pathology, who undergo public health or forensic medicine examination to obtain the law-established benefits, is constantly rising. This paper illustrates the pathophysiology, epidemiology, clinical and prognostic factors used to attribute the Fontaine and Rutherford class, and the instrumental evaluation parameters necessary for a medical-legal assessment. The authors describe also the variety of welfare and social actions that the social security system provides to this type of patients in Italy, with an overview of damage assessment parameters within the forensic medicine. Finally, the authors suggest medical-legal criteria for the staging of permanent damage in these patients, based on stenosis degree, on systolic pressure measured at the ankle at rest and after exercise, on ankle brachial index, on Doppler morphology and spectral analysis of the velocity peak, and on the walking distance ability.
Subject(s)
Peripheral Vascular Diseases/diagnosis , Chronic Disease , Humans , Italy , Social Security/legislation & jurisprudenceABSTRACT
Heart transplantation is a curative surgical-medical procedure capable of radically modifying the prognosis of patients in the terminal phase who are non-responsive to other treatments and whose life expectancy is < 1 year, thus greatly increasing survival and distinctly improving their quality of life. The authors illustrate the numerous welfare and social security services, guaranteed by our Social Security System for such patient categories, with an overview of damage parameters within the medical-legal field, encompassing areas of civil responsibility. They therefore illustrate the changes, determined by the graft, on the patient's quality of life, while considering both the psycho-physical aspect and the family, social and working relationships before finally elaborating medical-legal guidelines for the assessment of such patients, for both biological damage and in their capacity for work, based on the pathophysiology of the transplanted heart.
