Right heart failure classification: Difference between revisions
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==Classification== | ==Classification== | ||
Right heart failure can be functionally classified according to the New York Heart Classification - NYHA (I-IV) or structurally according to the American College of Cardiology/ American Heart Association – ACC/AHA (stage A, B, C and D). | *Right heart failure can be functionally classified according to the New York Heart Classification - NYHA (I-IV) or structurally according to the American College of Cardiology/ American Heart Association – ACC/AHA (stage A, B, C and D). | ||
*The ACC staging system is useful in that Stage A encompasses "pre-heart failure" — a stage where intervention with treatment can presumably prevent progression to overt symptoms. ACC Stage A does not have a corresponding NYHA class. ACC Stage B would correspond to NYHA Class I. ACC Stage C corresponds to NYHA Class II and III, while ACC Stage D overlaps with NYHA Class IV. | |||
===Functional NYHA Classification=== | ===Functional NYHA Classification=== | ||
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===Structural ACA/AHA Classification=== | ===Structural ACA/AHA Classification=== | ||
According to the [[American College of Cardiology]]/[[American Heart Association]] working group, the stages (A-D) are:<ref name="Hunt-2005">{{cite journal |author=Hunt SA, Abraham WT, Chin MH, ''et al.'' |title=ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult |journal=Circulation |volume=112 |issue=12 |pages=e154–235 |year=2005 |pmid=16160202 |doi=10.1161/CIRCULATIONAHA.105.167586 |url=http://circ.ahajournals.org/cgi/reprint/112/12/e154.pdf |format=PDF}}</ref> | According to the [[American College of Cardiology]]/[[American Heart Association]] working group, the stages (A-D) are:<ref name="Hunt-2005">{{cite journal |author=Hunt SA, Abraham WT, Chin MH, ''et al.'' |title=ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult |journal=Circulation |volume=112 |issue=12 |pages=e154–235 |year=2005 |pmid=16160202 |doi=10.1161/CIRCULATIONAHA.105.167586 |url=http://circ.ahajournals.org/cgi/reprint/112/12/e154.pdf |format=PDF}}</ref> | ||
{|class="wikitable" border="1" | |||
|- | |||
|'''Stage A''' | |||
|Patients at high risk for developing HF in the future but no functional or structural heart disorder | |||
|- | |||
|'''Stage B''' | |||
|A structural heart disorder but no symptoms at any stage | |||
|- | |||
|'''Stage C''' | |||
|Previous or current symptoms of heart failure in the context of an underlying structural heart problem, but managed with medical treatment | |||
|- | |||
|'''Stage D''' | |||
|Advanced disease requiring hospital-based support, a heart transplant or [[palliative care]] | |||
|} | |||
==References== | ==References== | ||
Revision as of 22:22, 18 November 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
There are many different ways to categorize Right heart failure, including:
- Whether the abnormality is due to insufficient contraction (systolic dysfunction), or due to insufficient relaxation of the heart (diastolic dysfunction), or to both.
- Whether the problem is primarily increased venous back pressure (preload), or failure to supply adequate arterial perfusion (afterload).
- Whether the abnormality is due to low cardiac output with high systemic vascular resistance or high cardiac output with low vascular resistance (low-output heart failure vs. high-output heart failure).
- The degree of functional impairment conferred by the abnormality (as reflected in the New York Heart Association Functional Classification[1])
- The degree of coexisting illness: i.e. heart failure/systemic hypertension, heart failure/pulmonary hypertension, heart failure/diabetes, heart failure/renal failure, etc.
Classification
- Right heart failure can be functionally classified according to the New York Heart Classification - NYHA (I-IV) or structurally according to the American College of Cardiology/ American Heart Association – ACC/AHA (stage A, B, C and D).
- The ACC staging system is useful in that Stage A encompasses "pre-heart failure" — a stage where intervention with treatment can presumably prevent progression to overt symptoms. ACC Stage A does not have a corresponding NYHA class. ACC Stage B would correspond to NYHA Class I. ACC Stage C corresponds to NYHA Class II and III, while ACC Stage D overlaps with NYHA Class IV.
Functional NYHA Classification
According to the New York Heart Association functional classification, the classes (I-IV) are:
| Class I | No limitation is experienced in any activities; there are no symptoms from ordinary activities |
| Class II | Slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion |
| Class III | Marked limitation of any activity; the patient is comfortable only at rest |
| Class IV | Any physical activity brings on discomfort and symptoms occur at rest |
Structural ACA/AHA Classification
According to the American College of Cardiology/American Heart Association working group, the stages (A-D) are:[2]
| Stage A | Patients at high risk for developing HF in the future but no functional or structural heart disorder |
| Stage B | A structural heart disorder but no symptoms at any stage |
| Stage C | Previous or current symptoms of heart failure in the context of an underlying structural heart problem, but managed with medical treatment |
| Stage D | Advanced disease requiring hospital-based support, a heart transplant or palliative care |
References
- ↑ Criteria Committee, New York Heart Association. Diseases of the heart and blood vessels. Nomenclature and criteria for diagnosis, 6th ed. Boston: Little, Brown and Co., 1964;114.
- ↑ Hunt SA, Abraham WT, Chin MH; et al. (2005). "ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult" (PDF). Circulation. 112 (12): e154–235. doi:10.1161/CIRCULATIONAHA.105.167586. PMID 16160202.