Listing 4.04
Ischemic heart disease
This listing covers ischemic heart disease — narrowed or blocked heart arteries causing chest pain (angina) or similar symptoms — while you are on prescribed treatment.
Read the full plain-language explanation
SSA looks for one of three paths: (A) an exercise test showing serious problems at a low workload, (B) three separate blockage episodes needing procedures like stents or bypass in one year, or (C) severe artery blockages shown by angiography plus very serious daily activity limits when exercise testing is too risky. You need only one of A, B, or C.
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What Listing 4.04 asks for
What SSA looks for — see the 3 items
We will check your records against each of these. Every item comes straight from SSA's own listing.
- Path A (you need only one of A, B, or C): a monitored exercise test shows a serious heart problem at a light workload (5 METs or less).
- This can be specific ECG changes (ST depression lasting into recovery, or ST elevation in certain leads), a 10-point-or-more drop in blood pressure as exercise got harder, or reduced blood flow shown on imaging like a nuclear scan or stress echocardiogram.
Read the original wording
Path A (you need only one of A, B, or C): a monitored exercise test shows a serious heart problem at a light workload (5 METs or less). This can be specific ECG changes (ST depression lasting into recovery, or ST elevation in certain leads), a 10-point-or-more drop in blood pressure as exercise got harder, or reduced blood flow shown on imaging like a nuclear scan or stress echocardiogram.
(Listing 4.04, criterion A)
- Path B: within one 12-month span, you had three separate episodes of blocked blood flow to the heart, and each one needed a procedure to reopen the artery (angioplasty, stent, or bypass) or could not be treated with such a procedure.
- A reblockage fixed during the same hospital stay counts as part of the same episode, not a new one.
Read the original wording
Path B: within one 12-month span, you had three separate episodes of blocked blood flow to the heart, and each one needed a procedure to reopen the artery (angioplasty, stent, or bypass) or could not be treated with such a procedure. A reblockage fixed during the same hospital stay counts as part of the same episode, not a new one.
(Listing 4.04, criterion B)
- Path C: this path is used when an exercise test would be too risky for you and there is no recent test.
- Your existing angiogram (done for your own medical care, not for SSA) must show serious artery narrowing — for example, 50% or more in the left main artery, or 70% or more in another unbypassed artery — AND the disease must very seriously limit your ability to do daily activities on your own.
- Both parts (1 and 2) are required for this path.
Read the original wording
Path C: this path is used when an exercise test would be too risky for you and there is no recent test. Your existing angiogram (done for your own medical care, not for SSA) must show serious artery narrowing — for example, 50% or more in the left main artery, or 70% or more in another unbypassed artery — AND the disease must very seriously limit your ability to do daily activities on your own. Both parts (1 and 2) are required for this path.
(Listing 4.04, criterion C)
How long it must last:
- The impairment must have lasted or be expected to last at least 12 continuous months.
- Episodes under Path B must fall within a consecutive 12-month period, and exercise test results are considered timely for 12 months.
- SSA may wait 3 months after a heart attack or revascularization procedure before evaluating.
Read the original wording
The impairment must have lasted or be expected to last at least 12 continuous months. Episodes under Path B must fall within a consecutive 12-month period, and exercise test results are considered timely for 12 months. SSA may wait 3 months after a heart attack or revascularization procedure before evaluating.