Cardiac Disease: Includes, but are not limited to, CHF,

Cardiomyopathy, Ischemic Heart Disease.

• Patient has been optimally treated with diuretics
  and vasodilators (patients not on vasodilators
  have a medical contraindication or choose not to
  take them).
• Patient has significant symptoms of recurrent
  congestive heart failure affecting their ability to
  perform physical activity without discomfort or
  causes increased discomfort.
• Ejection fraction of < 20%, if already available;
  abnormal EKG

Supporting documentation includes:

• History of unexplained syncope, cardiac or
  otherwise
• Angina pectoris-at rest
• Elevated cardiac enzymes
• History of previous myocardial infarction

• Treatment-resistant ventricular arrhythmias or
  symptomatic supraventricular
• History of cardiac arrest or resuscitation
  Signs/Symptoms:

• Dyspnea (shortness of breath) at rest or with
  minimal exertion
• Orthopnea -requires head of bed elevated when
  lying down
• Recurrent hospitalizations for exacerbated conditions

• Evidence of fluid overload-edema, ascites and/or rales.

• Chest pain
• JVD (jugular venous distension)
• Weakness