NYHA classification

Cynthia has decided to collect information on each patient s level of edema, blood pressure, weight, NYHA classification, and shortness of breath. She also will record laboratory values where appropriate. When... 

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

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 ... 

Recent studies demonstrate that cardiac resynchronization therapy (CRT) offers a promising approach to selected patients with chronic heart failure. Delayed electrical activation of the left ventricle, characterized on the ECG by a QRS duration that exceeds 120 ms, occurs in approximately one-third of patients with moderate to severe systolic heart failure. Since the left and right ventricles normally activate simultaneously, this delay results in asynchronous contraction of the left and right ventricles, which contributes to the hemodynamic abnormalities of this disorder. Implantation of a speciahzed biventricular pacemaker to restore synchronous activation of the ventricles can improve ventricular contraction and hemodynamics. Recent trials show improvements in exercise capacity, NYHA classification, quality of life, hemodynamic function, and hospitalizations. A device that combined CRT with an implantable cardioverter-defibrillator (ICD) improved survival in addition to functional status. CRT is currently indicated only in NYHA class ni-IV patients receiving optimal medical therapy (ACE inhibitors, diuretics, -blockers, and digoxin) and... 

Symptomatic status, as measured by the NYHA classification, is improved in many patients. Restenosis is noted in 32% to 40% of patients after balloon angioplasty at 6 months, and half these patients will have symptoms associated with restenosis. A few late restenotic events occur, but most restenosis occurs within the first... 

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. 

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 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... 

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. 

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

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