Classification of heart failure

1. Clinical stages according to N.D. Strazhesko and V.H. Vasilenko

2. Variant of heart failure:

- with systolic dysfunction of left ventricle (ejection fraction <40%);

- with normal systolic function of left ventricle (ejection fraction >40%).

3. Functional class according to New York Heart Association.

Classification of heart failure according n.D. Strazhesko and V.H. Vasilenko

The three clinical stages of heart failure are distinguished.

I stage initial, latent there are symptoms during physical exercises: dyspnea, palpitation. These symptoms subside at rest.

Symptoms and signs of heart failure characterize II stage not only during physical exercises, but at rest. II stage of heart failure subdivided into two stages - II stage A and II stage B.

In stage A there are features of congestion or lesser or greater circulation.

The characteristic of II stage В heart failure are the features of congestion in lesser and greater circulation. Patients are fully disabled. At rest pronounced cyanosis, swollen jugular veins, edema, and ascites are revealed.

III stage heart failure is defined as final, dystrophic with marked congestion in the lesser and greater, circulation hemodynamic disorders, irreversible morphological changes of ail organs, functional and metabolic disorders.

The patient would has extreme asthenia, loss of weigh, cardiac cachexia. Skin is dry, dark, trophic skin ulcers, marked edema, hydrothorax, hidropericardium, ascites, anasarca, fibrosis of liver, lungs and kidney.

Classification of heart failure according to New York Heart Association New York Heart Association Functional Classification (nyha)

I class - patients with cardiac disease but without resulting limitations of physical activity; ordinary physical activity does not cause dyspnea (or fatigue, palpitation, or anginal pain).

II class - patients with cardiac disease resulting in slight limitation of physical activity; they are comfortable at rest; ordinary physical activity results in dyspnea (or fatigue, palpitation, or anginal pain).

III class - patients with cardiac disease resulting in marked limitation of physical activity; they are comfortable at rest; less then ordinary physical activity causes dyspnea (or fatigue, palpitation, or anginal pain).

IV class - patients with cardiac disease resulting inability to carry on any physical activity without discomfort; symptoms of dyspnea (or of angina) may be present even at rest.

Clinical features

Symptoms and signs of heart failure depend on the prevalence of affected heart chambers. Left ventricular failure corresponds with reduction of the ventricular output and increasing pressure in the left atrium, pulmonary veins and later pulmonary artery. There are clinical picture of congestion in lesser circulation; breathlessness, paroxysmal nocturnal dyspnea, cough, sometimes hemoptysis, orthopnea, cyanosis and crepitation over the lung.

In patients with right ventricular failure due to the reduction of the ventricular output appear the clinical pictures of congestion in greater circulation: pain in the right hypochondrium, swollen jugular veins, edema on lower extremities, enlarged liver. Massive accumulation of fluid may cause ascites, pleural and/or pericardial effusion.

Total heart failure: failure of the left and right heart may develop because the disease process affects both ventricles, or because there is primary affection left heart failure with dilation of left atrium, pulmonary hypertension and as a result subsequently development of right heart failure.

The patient's complaints are fatigue, dyspnea, malaise, edema of legs, the attacks of breathlessness, cough. The general patients condition as usual grave, deranged consciousness, forced posture - orthopnea, cyanosis, anasarca.

Chronic heart failure is sometimes associated with marked weight loss (cardiac cachexia) caused by a combination of anorexia and impaired absorption due to gastrointestinal congestion, poor tissue perfusion due to a low cardiac output and skeletal muscle atrophy due to immobility.

Poor renal perfusion may lead to oliguria and uremia.