New York Heart Association classification

Anemia baseline hematocrit value <39% for men and >36% for women congestive heart failure class III/1V by New York Heart Association classification and/or history of pulmonary edema Hypotension systolic blood pressure <80mmHg for at least 1 hr requiring inotropic support with medications or intra-aortic balloon pump (IABP) within ... 

Amiodarone and carvedilol have been used in combination in 109 patients with severe heart failure and left ventricular ejection fractions of 0.25 (16). They were given amiodarone 1000 mg/week plus carvedilol titrated to a target dose of 50 mg/day. A dual-chamber pacemaker was inserted and programmed in back-up mode at a basal rate of 40. Significantly more patients were in sinus rhythm after 1 year, and in 47 patients who were studied for at least 1 year the resting heart rate fell from 90 to 59. Ventricular extra beats were suppressed from 1 to 0.1/day and the number of bouts of tachycardia over 167 per minute was reduced from 1.2 to 0.3 episodes per patient per 3 months. The left ventricular ejection fraction increased from 0.26 to 0.39 and New York Heart Association Classification improved from 3.2 to 1.8. The probability of sudden death was significantly reduced by amiodarone plus carvedilol compared with 154 patients treated with amiodarone alone and even more so compared with 283 patients who received no treatment at all. However, the study was not randomized, and this vitiates the results. The main adverse effect was s)mptomatic bradycardia, which occurred in seven patients two of those developed atrioventricular block and four had sinoatrial block and/or sinus bradycardia one patient developed slow atrial fibrillation. 

AMI acute myocardial infarction CHF congestive heart failure NYHA New York Heart Association classification of heart failure. ... 

Identify signs and symptoms of heart failure and classify a given patient by the New York Heart Association Functional Classification and American College of Cardiology/American Heart Association Heart Failure Staging. 

There are two common systems for categorizing patients with HF. The New York Heart Association (NYHA) Functional Classification (FC) system is based on the patient s activity level and exercise tolerance. It divides patients into one of four classes, with functional class I patients exhibiting no symptoms or limitations of daily activities, and functional class IV patients who are symptomatic at rest (Table 3-5). The NYHA FC system reflects a subjective assessment by a health care provider and can change frequently over short periods of time. Functional class correlates poorly with EF however, EF is one of the strongest predictors of prognosis. In general, anticipated survival declines in conjunction with a decline in functional ability. 

The New York Heart Association Functional Classification System is intended primarily to classify symptomatic HF patients according to the physician s subjective evaluation. Functional class (FC)-I patients have no limitation of physical activity, FC-II patients have slight limitation, FC-III patients have marked limitation, and FC-IV patients are unable to carry on physical activity without discomfort. 

Her research into heart failure has given her some information about what types of variables she should collect. Patients with heart failure show symptoms of decreased exercise tolerance, shortness of breath, increased fatigue, and fluid buildup in the lungs and tissues. Patients with heart failure are also classified clinically by their level of disability so that they may be followed longitudinally and provide a reference point when compared with other patients. This classification system is the New York Heart Association (NYHA) Functional Classification system and ranges from functional class I (no limitation of physical activity) to functional class IV (unable to carry on physical activity without discomfort) (Criteria Committee, 1973). 

The New York Heart Association (NYHA) classification is a well-accepted classification of heart failure based on the severity of symptoms ... 

The degree of severity of myocardial failure is categorized according to the New York Heart Association (NYHA) Functional Classification System Stages I—IV reflect an increasing level of disability. 

Currently, staging of CHF patients is with the New York Heart Association (NYHA) functional classifications I to IV. Class I patients are generally considered asymptomatic, with no restrictions on physical activity class IV patients are often symptomatic at rest, with severe limitations on physical activity. The problem with this classification system is that much of it is based on subjective criteria. Thus patients with co-morbidities that reduce their activities are often not detected. In addition, there are many causes for dyspnea, which is the primary symptom in many of these individuals. Finally, many patients with ventricular dysfunction modify their activities to accomplish activities of daily living and thus lack overt symptoms until late in their disease. Thus patients with CHF often go undiagnosed and untreated early in their disease or are misdiagnosed because of diseases such as pulmonary disease. Initiating treatment in the more... 

New York Heart Association Class Figure 44-17 Correlation of BNP concentrations (Biosite Triage) according to NYHA classification of heart failure. (From Maisel AS, Krisbnaswamy R Nowak RM, McCord J, Hollander JE, Due R ef al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002 347 ... 

TABLE 14—4. New York Heart Association Functional Classification... 

Angina may be classified according to symptom severity, disability induced, or a specific activity scale (Tables 15-1 and 15-2). The specific activity scale developed by Goldman and coworkers may be preferable because it has been shown to be equal to or better than the New York Heart Association (NYHA) or Canadian Cardiovascular Society (CCS) functional classifications for reproducibility and provides better agreement with treadmill testing. 

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