Introduction

JAN’s Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee’s individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar.

Information about Heart Conditions

How prevalent are heart conditions?

Over 70 million Americans have heart conditions, amounting to one in four men and women. Looking at specific age groups, cardiovascular disease from a heart condition is the number one disease affecting individuals ages 65 and older, second for ages 25 through 64, third for ages zero through 14, and fifth for ages 15 through 24. One in five males and females are affected: one in three men and one in 10 women (American Heart Association, 2005).

What are heart conditions?

The majority of heart conditions are diagnosed as high blood pressure. Coronary heart disease, congenital heart failure, and stroke are also prominent. Heart valve abnormalities, congestive heart failure, enlarged heart, murmurs, hypertension, marfan syndrome, and rheumatic fever may also contribute to a heart condition. Congenital cardiovascular defects, present in about one percent of live births, may be other causes (American Heart Association, 2005).

What are the symptoms of a heart condition?

Each type of heart condition has its own set of indicators and most symptoms could be caused by other conditions. Also, some heart conditions may have no noticeable effects and may develop differently in women than in men. Women's symptoms may progress over a much longer period of time and also be subtler than men's symptoms. Symptoms may include:

• angina (chest pain sometimes radiating down the left arm or into the jaw);
• sensations of fluttering, thumping, pounding, or racing of the heart (palpitations);
• edema (swelling and fluid retention in the legs, ankles, abdomen, lungs, or heart);
• lightheadedness, weakness, dizziness, or fainting spells;
• breathlessness;
• chronic fatigue; and
• gastric upset (or nausea) (American Heart Association, 2005).

What causes heart conditions?

Men over 45 years old and women over 55 years old, or women who have passed menopause or had their ovaries removed, have a greater chance of being diagnosed with heart conditions. Other increased risk factors for heart conditions include:

• high blood cholesterol/blood pressure,
• physical inactivity,
• excess body weight,
• diabetes,
• coronary artery disease,
• abnormal heartbeat,
• carotid artery damaged by atherosclerosis,
• family history of having a close blood relative who had a heart attack or stroke before age 55 (if father or brother) or before age 65 (if mother or sister),
• smoking, excessive drinking, drug abuse, and poor diet (American Heart Association, 2005).

How are heart conditions treated?

Depending upon what type of heart condition an individual has, surgery, drugs, exercise, diet modification, or a transplant may be options (American Heart Association, 2005).

Heart Conditions and the Americans with Disabilities Act

Is a heart condition a disability under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with heart conditions will have a disability under the ADA and some will not.

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

Accommodating Employees with Heart Conditions

Note: People with heart conditions may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with heart conditions will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.

Questions to Consider:

1. What limitations is the employee with the heart condition experiencing?

 

2. How do these limitations affect the employee and the employee’s job performance?

 

3. What specific job tasks are problematic as a result of these limitations?

 

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?

 

5.Has the employee with the heart condition been consulted regarding possible accommodations?

 

6. Once accommodations are in place, would it be useful to meet with the employee with the heart condition to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

 

7. Do supervisory personnel and employees need training regarding heart conditions?

Accommodation Ideas:

Fatigue/Weakness:

• Reduce or eliminate physical exertion
• Schedule periodic rest breaks away from the workstation
• Allow a flexible work schedule and flexible use of leave time
• Allow work from home
• Implement ergonomic workstation design
• Provide a scooter or other mobility aid if walking cannot be reduced
• Provide parking close to the work-site
• Install automatic door openers
• Move workstation close to other work areas, office equipment, and break rooms
• Provide mechanical assists and lifting aids

Respiratory Difficulties:

• Provide adjustable ventilation
• Keep work environment free from dust, smoke, odor, and fumes
• Implement a "fragrance-free" workplace policy and a “smoke free” building policy
• Avoid temperature extremes
• Use fan/air-conditioner or heater at the workstation
• Redirect air conditioning and heating vents
• Provide adequate exhaust systems to remove fumes from office machines
• Allow individual to wear a respirator mask
• Allow work from home

Seizure Activity and Blackouts:

• Eliminate the need to use sharp objects
• Eliminate blinking and flickering lights
• Replace fluorescent lighting with full spectrum or natural lighting
• Use computer monitor glare guards, adjust monitor intensity and color, and decrease the cursor speed of the mouse
• Provide protective clothing/equipment
• Modify job tasks requiring fine finger dexterity
• Allow flexible work hours
• Allow periodic rest breaks
• Allow work from home

Stress:

• Develop strategies to deal with work problems before they arise
• Provide sensitivity training to coworkers
• Allow telephone calls during work hours to doctors and others for support
• Provide information on counseling and employee assistance programs
• Reduce workplace stress

Temperature Sensitivity:

• Modify work-site temperature
• Modify dress code
• Use fan/air-conditioner or heater at the workstation
• Allow flexible scheduling and flexible use of leave time
• Allow work from home during extremely hot or cold weather
• Maintain the ventilation system
• Redirect air conditioning and heating vents
• Provide an office with separate temperature control

Situations and Solutions:

A locomotive operator with myocardial infarction experienced reduction in stamina exacerbated by working midnight shifts.  The employer required that he work only day and afternoon shifts to accommodate his restrictions.

A supervisor with heart disease was limited in the level of physical activity he could exert.  The individual was relieved of marginal functions involving manual labor. 

A maintenance technician, restricted from working in extreme temperatures, was accommodated with a modified schedule not requiring her to work outside in these conditions.

An assembly line worker with congestive heart failure and chronic obstructive pulmonary disease was restricted to sedentary work and no lifting in excess of 15 pounds. The assembly line job, which could not be modified, required both standing and lifting over 15 pounds.  The individual was accommodated with a transfer to a sedentary job.

A receiving clerk with a congenital heart defect was limited in her ability to perform strenuous activity.  She was accommodated by having merchandise placed in smaller boxes and being provided a height adjustable material lift to help retrieve elevated boxes. The employer also gave her a reserved parking space closer to the building and allowed another employee to fill out her time card, minimizing walking and stair climbing.

An individual, who delivered mail in a high-rise office building had high blood pressure and was limited to no lifting and pushing over 25 pounds. The employer provided the individual with a power cart and compact lifting devices to assist with moving materials.

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Resources

References

American Heart Association. (2005). Heart disease and stroke statistics — 2005 update.  Retrieved September 3, 2008, from http://www.americanheart.org/downloadable/heart/1105390918119HDSStats2005Update.pdf

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act.  Retrieved September 3, 2008, from http://www.jan.wvu.edu/links/ADAtam1.html

Updated 09/05/08