Do you have a heart condition? Want to join the army? Not used the search function yet? Not been to see your GP or the Careers Office (or whatever they are called this year) then read on and ask your bone questions afterwards. Thank you. [align=center]CHAPTER 3: THE INFLUENCE OF PARTICULAR CONDITIONS ON PULHHEEMS ASSESSMENT FOR ENTRY[/align] Leaflet 4: CARDIOVASCULAR SYSTEM Heart disease 3.4.1. Candidates with established heart disease are graded P8, except in the following specific circumstances. 3.4.2. Congenital heart conditions. Candidates who have undergone successful correction of the following conditions may be graded P2, subject to the availability of relevant specialist correspondence: a. Patent Ductus Arteriosus (PDA) b. Atrial Septal Defect (ASD) c. Ventricular Septal Defect (VSD) In all cases, the single-Service Occupational Physician responsible for the selection of recruits should be consulted, with supporting documentation. 3.4.3. Cardiac murmurs. Although cardiac murmurs may be of no pathological significance, assessment of all murmurs is required by a consultant cardiologist or a service physician approved by the single Service. The following guidance applies after confirmation of the cause of the murmur: a. Benign physiological murmurs. Grade P2. b. Mitral Valve Leaflet Prolapse. If uncomplicated, functionally acceptable and requiring no treatment, grade P2. c. Bicuspid aortic valve and other valvular conditions . Normally graded P8. 3.4.4. Disturbances of Rhythm. Candidates with any symptomatic dysrhythmia or those who require medication to suppress disturbance of rhythm should be graded P8. Candidates who have had dysrhythmic foci or accessory pathways ablated should be assessed on an individual basis with the benefit of a full report from that individualâs specialist physician. Advice may be sought from the single-Service Occupational Physician responsible for the selection of recruits. Many of these candidates may be graded P2 if a procedure is deemed to have been curative . 3.4.5. Cardiomyopathy. A family history, which must be specifically sought, of sudden death before the age of 40 raises the question of inherited cardiomyopathy. Where there is a familial history, assessment by a Consultant Cardiologist is required, with as much information about the family as possible. If a diagnosis of cardiomyopathy is made all such candidates should be graded P8. Hyperlipidaemia 3.4.6. Candidates with an untreated total cholesterol level of 8.0 mmol/l or less may be graded P2 provided they do not require drug therapy. Candidates who apply for entry over the age of 35, with a cholesterol level that gives them a greater than 10% risk of cardiovascular disease within 10 years, will be considered on an individual basis. Candidates taking a statin should normally be graded P8 due to the likelihood of them being unable to tolerate arduous exercise. Candidates with a cholesterol level greater than 8.0mmol/l should normally be graded P8 due to the increased morbidity associated with hypercholesterolaemia. Hypertension 3.4.7. Blood pressure should be measured in accordance with the British Hypertension Society (BHS) guidelines (BHS IV). Cases of suspected âwhite coatâ hypertension must be carefully evaluated. Where there is doubt, a 24-hour ambulatory record, should be obtained and interpreted. Candidates with untreated hypertension4 should be graded P8. Peripheral vascular diseases 3.4.8. Raynaudâs phenomenon or disease. Even candidates with primary Raynaudâs disease deemed manageable by lifestyle changes, and thus at the lower end of the severity spectrum, should not be accepted as service life is such that the ability to keep the periphery warm at all times cannot be guaranteed and the functional capacity of affected individuals is likely to be impaired. Candidates with primary or secondary Raynaudâs disease or phenomenon should therefore be graded P8. 3.4.9. Congenital arterio-venous malformations. Candidates with congenital arterio-venous malformations should be graded P8. 3.4.10. Congenital lymphoedema. All candidates with congenital lymphoedema should be graded P8. 3.4.11. Deep venous thrombosis (DVT). The opinion of the single-Service Occupational Physician responsible for the selection of recruits should be sought on candidates with a previous history of DVT. The referral should detail the clinical circumstances and investigations of the DVT episode. (See also Leaflet 13 - Miscellaneous). 3.4.12. Thrombophilia. All candidates with thrombophilia should be referred to the single-Service Occupational Physicians responsible for the selection of recruits for an opinion as to medical suitability for Service. 3.4.13. Varices. Candidates with symptomatic varices or those that affect function should normally be graded P8. Those with asymptomatic minor varicosities, or following surgery with satisfactory outcome, may be graded P2 provided biomechanical function is not compromised.