NYHA

Symptoms
Class

Cardiac disease, but no symptoms and no limitation in ordinary physical activity,

I
e.g. no shortness of breath when walking, climbing stairs etc.

Mild symptoms (mild shortness of breath and/or angina) and slight limitation during
II
ordinary activity.

Marked limitation in activity due to symptoms, even during less-than-ordinary

III activity, e.g. walking short distances (20–100 m).
Comfortable only at rest.

Severe limitations. Experiences symptoms even while at rest. Mostly bedbound

IV
patients.

Class Patient Symptoms

No limitation of physical activity. Ordinary physical activity does not cause undue
I
fatigue, palpitation, dyspnea (shortness of breath).

Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity

II
results in fatigue, palpitation, dyspnea (shortness of breath).

Marked limitation of physical activity. Comfortable at rest. Less than ordinary

III
activity causes fatigue, palpitation, or dyspnea.

Unable to carry on any physical activity without discomfort. Symptoms of heart

IV
failure at rest. If any physical activity is undertaken, discomfort increases.

ACC/AHA Heart Failure Classification

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The ACC/AHA classification of heart failure has four stages.

 Stage A: Those at risk for heart failure, but who have not yet developed
structural heart changes (diabetics, those with coronary disease without prior
infarct).
 Stage B: Individuals with structural heart disease (i.e. reduced ejection
fraction, left ventricular hypertrophy, chamber enlargement), however no
symptoms of heart failure have ever developed.
 Stage C: Patients who have developed clinical heart failure.
 Stage D: Patients with refractory heart failure requiring advanced
intervention (biventricular pacemakers, left ventricular assist device, or
transplantation).

ACCF/AHA Stages of HF NYHA Functional Classification

A At high risk for HF but None
without structural heart
disease or symptoms of HF.
B Structural heart disease but I
without signs or symptoms of
HF.
C Structural heart disease with I
prior or current symptoms of
HF.
II
III
IV
D Refractory HF requiring
specialized interventions.
No limitation of physical
activity. Ordinary physical
activity does not cause
symptoms of HF.
No limitation of physical
activity. Ordinary physical
activity does not cause
symptoms of HF.
Slight limitation of physical
activity. Comfortable at rest,
but ordinary physical activity
results in symptoms of HF.
Marked limitation of physical
activity. Comfortable at rest,
but less than ordinary activity
causes symptoms of HF.
Unable to carry on any
physical activity without
symptoms of HF, or
symptoms of HF at rest.