Right heart failure classification
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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
Functional 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
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.
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.
- ↑ 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.