Heart block — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 23 of 2022

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting heart block or death from heart block with the circumstances of a person's relevant service:

1. (1)
   having ischaemic heart disease at the time of the clinical onset of heart block;
2. (2)
   having pulmonary thromboembolism within the 7 days before the clinical onset of heart block;
3. (3)
   having infiltration of the myocardium due to an infiltrative disease from the specified list of infiltrative diseases at the time of the clinical onset of heart block;

   Note: specified list of infiltrative diseases is defined in the Schedule 1 - Dictionary.

4. (4)
   having cardiomyopathy at the time of the clinical onset of heart block;
5. (5)
   having a benign or malignant neoplasm involving the heart before the clinical onset of heart block;

   Note: A neoplasm involving the heart can be primary or metastatic. An example of a primary neoplasm involving the heart is cardiac lymphoma.

6. (6)
   having a lesion which compresses the atrioventricular node, bundle of His or the bundle branches of the heart at the time of the clinical onset of heart block;

   Note: Examples of lesions which can compress the atrioventricular node, bundle of His or the bundle branches of the heart include a paraoeseophageal hiatus hernia, a thoracic aortic aneurysm and a haematoma.

7. (7)
   having non-infectious myocarditis at the time of the clinical onset of heart block;

   Note: Non-infectious myocarditis can be acute or chronic.

   Note: Non-infectious myocarditis can be of autoimmune, infiltrative or immunological origin. Examples of causes of non-infectious myocarditis include immune checkpoint inhibitor therapy and giant cell myocarditis.

8. (8)
   having viral myocarditis at the time of the clinical onset of heart block;

   Note: Viral myocarditis can be acute or chronic.

   Note: Examples of viral causes of myocarditis include severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human immunodeficiency virus, group B coxsackieviruses and dengue virus.

9. (9)
   having a non-viral infection of the myocardium at the time of the clinical onset of heart block; (a) Borrelia burgdorferi (Lyme disease); (b) Corynebacterium diphtheriae (diphtheria); (c) Cysticercus species (cysticercosis); (d) Echinococcus species (hydatid disease); (e) Treponema pallidum (tertiary syphilis); (f) Trypanosoma cruzi (Chagas disease); and (g) Toxoplasma gondii (toxoplasmosis);

   Note: A non-viral infection of the myocardium can be caused by bacteria, protozoa, fungi or parasites.

   Note: Examples of non-viral infections of the myocardium include:.

10. (10)
    having infective endocarditis at the time of the clinical onset of heart block;
11. (11)
    having a mineral or electrolyte abnormality from the specified list of mineral or electrolyte abnormalities at the time of the clinical onset of heart block;

    Note: specified list of mineral or electrolyte abnormalities is defined in the Schedule 1 - Dictionary.

12. (12)
    taking a drug from the specified list of drugs within the 3 weeks before the clinical onset of heart block;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

13. (13)
    taking chloroquine or hydroxychloroquine for at least 1 year before the clinical onset of heart block;
14. (14)
    having ingested a plant containing cardiac glycosides within the 7 days before the clinical onset of heart block;

    Note: Examples of plants containing cardiac glycosides include the pong-pong tree (Cerbera odollam) and foxglove (Digitalis purpurea).

15. (15)
    having acute pyrethroid poisoning after inhaling, ingesting or having cutaneous contact with a pyrethroid insecticide within the 3 days before the clinical onset of heart block;

    Note: Clinical features of acute pyrethroid poisoning may include dermal, neurological, gastrointestinal and respiratory symptoms. Cardiac involvement can lead to chest pain, tachycardia, hypertension, hypotension and arrhythmia.

16. (16)
    experiencing penetrating trauma to the heart within the 1 year before the clinical onset of heart block;
17. (17)
    having a thoracic surgical procedure or an invasive cardiac procedure within the 1 year before the clinical onset of heart block; (a) alcohol septal ablation; (b) catheter ablation of arrhythmias; (c) open heart surgery; and (d) transcatheter aortic valve implantation;

    Note: Examples of thoracic surgical procedures include vascular, mediastinal, pulmonary and chest wall surgery.

    Note: Examples of invasive cardiac procedures include:.

18. (18)
    experiencing a blunt chest injury within the 60 days before the clinical onset of heart block;

    Note: blunt chest injury is defined in the Schedule 1 - Dictionary.

19. (19)
    having a heart transplant before the clinical onset of heart block;
20. (20)
    having a bone marrow transplant or stem cell transplant within the 24 hours before the clinical onset of heart block;
21. (21)
    having graft versus host disease after a bone marrow transplant or stem cell transplant at the time of the clinical onset of heart block;
22. (22)
    undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical onset of heart block;
23. (23)
    undertaking strenuous physical activity greater than 6 METs for an average of at least 10 hours per week for a continuous period of at least the 5 years before the clinical onset of heart block;

    Note: MET is defined in the Schedule 1 - Dictionary.

24. (24)
    being envenomated by a scorpion or snake within the 24 hours before the clinical onset of heart block;
25. (25)
    having diabetes mellitus at the time of the clinical onset of heart block;
26. (26)
    having hypertension before the clinical onset of heart block;
27. (27)
    having obstructive sleep apnoea at the time of the clinical onset of heart block;
28. (28)
    having smoked cannabis products within the 7 days before the clinical onset of heart block;
29. (29)
    binge drinking within the 2 days before the clinical onset of heart block;

    Note: binge drinking is defined in the Schedule 1 - Dictionary.

30. (30)
    having a thyroid condition from the specified list of thyroid conditions at the time of the clinical onset of heart block;

    Note: specified list of thyroid conditions is defined in the Schedule 1 - Dictionary.

31. (31)
    having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical onset of heart block;

    Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.

32. (32)
    having acute rheumatic fever at the time of the clinical onset of heart block;
33. (33)
    having rheumatic heart disease at the time of the clinical onset of heart block;
34. (34)
    having ischaemic heart disease at the time of the clinical worsening of heart block;
35. (35)
    having pulmonary thromboembolism within the 7 days before the clinical worsening of heart block;
36. (36)
    having infiltration of the myocardium due to an infiltrative disease from the specified list of infiltrative diseases at the time of the clinical worsening of heart block;

    Note: specified list of infiltrative diseases is defined in the Schedule 1 - Dictionary.

37. (37)
    having cardiomyopathy at the time of the clinical worsening of heart block;
38. (38)
    having a benign or malignant neoplasm involving the heart before the clinical worsening of heart block;

    Note: A neoplasm involving the heart can be primary or metastatic. An example of a primary neoplasm involving the heart is cardiac lymphoma.

39. (39)
    having a lesion which compresses the atrioventricular node, bundle of His or the bundle branches of the heart at the time of the clinical worsening of heart block;

    Note: Examples of lesions which can compress the atrioventricular node, bundle of His or the bundle branches of the heart include a paraoeseophageal hiatus hernia, a thoracic aortic aneurysm and a haematoma.

40. (40)
    having non-infectious myocarditis at the time of the clinical worsening of heart block;

    Note: Non-infectious myocarditis can be acute or chronic.

    Note: Non-infectious myocarditis can be of autoimmune, infiltrative or immunological origin. Examples of causes of non-infectious myocarditis include immune checkpoint inhibitor therapy and giant cell myocarditis.

41. (41)
    having viral myocarditis at the time of the clinical worsening of heart block;

    Note: Viral myocarditis can be acute or chronic.

    Note: Examples of viral causes of myocarditis include severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human immunodeficiency virus, group B coxsackieviruses and dengue virus.

42. (42)
    having a non-viral infection of the myocardium at the time of the clinical worsening of heart block; (a) Borrelia burgdorferi (Lyme disease); (b) Corynebacterium diphtheriae (diphtheria); (c) Cysticercus species (cysticercosis); (d) Echinococcus species (hydatid disease); (e) Treponema pallidum (tertiary syphilis); (f) Trypanosoma cruzi (Chagas disease); and (g) Toxoplasma gondii (toxoplasmosis);

    Note: A non-viral infection of the myocardium can be caused by bacteria, protozoa, fungi or parasites.

    Note: Examples of non-viral infections of the myocardium include:.

43. (43)
    having infective endocarditis at the time of the clinical worsening of heart block;
44. (44)
    having a mineral or electrolyte abnormality from the specified list of mineral or electrolyte abnormalities at the time of the clinical worsening of heart block;

    Note: specified list of mineral or electrolyte abnormalities is defined in the Schedule 1 - Dictionary.

45. (45)
    taking a drug from the specified list of drugs within the 3 weeks before the clinical worsening of heart block;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

46. (46)
    taking chloroquine or hydroxychloroquine for at least 1 year before the clinical worsening of heart block;
47. (47)
    having ingested a plant containing cardiac glycosides within the 7 days before the clinical worsening of heart block;

    Note: Examples of plants containing cardiac glycosides include the pong-pong tree (Cerbera odollam) and foxglove (Digitalis purpurea).

48. (48)
    having acute pyrethroid poisoning after inhaling, ingesting or having cutaneous contact with a pyrethroid insecticide within the 3 days before the clinical worsening of heart block;

    Note: Clinical features of acute pyrethroid poisoning may include dermal, neurological, gastrointestinal and respiratory symptoms. Cardiac involvement can lead to chest pain, tachycardia, hypertension, hypotension and arrhythmia.

49. (49)
    experiencing penetrating trauma to the heart within the 1 year before the clinical worsening of heart block;
50. (50)
    having a thoracic surgical procedure or an invasive cardiac procedure within the 1 year before the clinical worsening of heart block; (a) alcohol septal ablation; (b) catheter ablation of arrhythmias; (c) open heart surgery; and (d) transcatheter aortic valve implantation;

    Note: Examples of thoracic surgical procedures include vascular, mediastinal, pulmonary and chest wall surgery.

    Note: Examples of invasive cardiac procedures include:.

51. (51)
    experiencing a blunt chest injury within the 60 days before the clinical worsening of heart block;

    Note: blunt chest injury is defined in the Schedule 1 - Dictionary.

52. (52)
    having a heart transplant before the clinical worsening of heart block;
53. (53)
    having a bone marrow transplant or stem cell transplant within the 24 hours before the clinical worsening of heart block;
54. (54)
    having graft versus host disease after a bone marrow transplant or stem cell transplant at the time of the clinical worsening of heart block;
55. (55)
    undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical worsening of heart block;
56. (56)
    undertaking strenuous physical activity greater than 6 METs for an average of at least 10 hours per week for a continuous period of at least the 5 years before the clinical worsening of heart block;

    Note: MET is defined in the Schedule 1 - Dictionary.

57. (57)
    being envenomated by a scorpion or snake within the 24 hours before the clinical worsening of heart block;
58. (58)
    having diabetes mellitus at the time of the clinical worsening of heart block;
59. (59)
    having hypertension before the clinical worsening of heart block;
60. (60)
    having obstructive sleep apnoea at the time of the clinical worsening of heart block;
61. (61)
    having smoked cannabis products within the 7 days before the clinical worsening of heart block;
62. (62)
    binge drinking within the 2 days before the clinical worsening of heart block;

    Note: binge drinking is defined in the Schedule 1 - Dictionary.

63. (63)
    having a thyroid condition from the specified list of thyroid conditions at the time of the clinical worsening of heart block;

    Note: specified list of thyroid conditions is defined in the Schedule 1 - Dictionary.

64. (64)
    having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical worsening of heart block;

    Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.

65. (65)
    having acute rheumatic fever at the time of the clinical worsening of heart block;
66. (66)
    having rheumatic heart disease at the time of the clinical worsening of heart block;
67. (67)
    inability to obtain appropriate clinical management for heart block;

Aggravation-only factors: the factors in subsections 9(34) to 9(67) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.