Congestive heart failure classification
| Heart failure | |
| ICD-10 | I50.0 |
|---|---|
| ICD-9 | 428.0 |
| DiseasesDB | 16209 |
| MedlinePlus | 000158 |
| eMedicine | med/3552 |
| MeSH | D006333 |
| Cardiology Network |
 Discuss Congestive heart failure classification further in the WikiDoc Cardiology Network |
| Adult Congenital |
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Classification Schemes of Congestive Heart Failure
Framingham Criteria
Major Criteria
- Paroxysmal nocturnal dyspnea
- Jugular vein distention
- Rales
- Radiographic cardiomegaly
- Acute pulmonary edema
- S3
- Central venous pressure > 16 cmH2O
- Circulation time ≥ 25 sec
- Hepatojugular reflux
- Pulmonary edema
- Visceral congestion
- Cardiomegaly at autopsy
- Weight loss ≥ 4.5 kg in 5 days in response to treatment of heart failure
Minor Criteria
- Bilateral ankle edema
- Nocturnal cough
- Dyspnea on ordinary exertion
- Hepatomegaly
- Pleural effusion
- 30% decrease in baseline vital capacity
- Tachycardia
Boston Criteria of Congestive Heart Failure
- Category I: History
- Rest dyspnea 4 points
- Orthopnea 4 points
- Paroxysmal nocturnal dyspnea 3 points
- Dyspnea on walking on level ground 2 points
- Dyspnea on climbing 1 point
- Category II: Physical Examination
- Heart rate abnormality (1 point if 91 to 110 bpm; if >110 bpm, 2 points)
- Jugular venous pressure elevation (2 points if >6 cm H2O; 3 points if >6 cm H2O and hepatomegaly or edema))
- Lung crackles (1 point if basilar; 2 points if more than basilar)
- Wheezing 3 points
- Third heart sound 3 points
- Category III: Chest Radiography
- Alveolar pulmonary edema 4 points
- Interstitial pulmonary edema 3 points
- Bilateral pleural effusion 3 points
- Cardiothoracic ratio >0.50 (posteroanterior projection) 3 points
- Upper zone flow redistribution 2 points
No more than 4 points are allowed from each of three categories; hence the composite score (the sum of the subtotal from each category) has a possible maximum of 12 points.
The diagnosis of heart failure is classified as "definite" at a score of 8 to 12 points, "possible" at a score of 5 to 7 points, and "unlikely" at a score of 4 points or less.
New York Heart Association Criteria (NYHA)
- NYHA I: No symptoms with ordinary activity.
- NYHA II: Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, dyspnea, or angina.
- NYHA III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.
- NYHA IV: Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency present at rest.
ACC/AHA Classification of Chronic Heart Failure
Classification System based on structural and symptomatic stages of the syndrome.
Stage 1: patients at risk of developing heart failure but who have no structural heart disease at present. Stage 2: patients with structural heart disease but no symptoms. Stage 3: patients with structural heart disease and symptomatic heart failure. Stage 4: patients with severe refractory heart failure.
Stage A
Patients “at Risk”
- Hypertension
- Diabetes mellitus
- Coronary artery disease
- Exposure history to cardiac toxins:
- History of cardiotoxic drug therapy.
- History of alcohol abuse.
- Familial history of cardiomyopathy
Stage 2
Patients with structural heart disease, but no history of signs or symptoms of heart failure.
- Left ventricular hypertrophy (LVH)
- Myocardial fibrosis
- Left ventricular dilatation or dysfunction
- Asymptomatic valvular heart disease
- Previous myocardial infarction
Stage 3
Underlying structural heart disease and symptoms of heart failure.
- Dyspnea or fatigue due to left ventricular systolic dysfunction.
- Asymptomatic patients receiving treatment for prior symptoms of heart failure.
Stage 4
Despite of maximal medical therapy, symptoms of heart failure at rest and advanced structural heart disease.
- Awaiting for heart transplantation
- Requiring continuous inotropic or mechanical support
- Hospital management of heart failure