The cardinal manifestations of heart failure (HF) are dyspnea and fatigue, which may limit exercise tolerance, and fluid retention, which may lead to pulmonary congestion and peripheral edema. Both abnormalities can impair the functional capacity and quality of life of affected individuals, but they do not necessarily dominate the clinical picture at the same time. Some patients have exercise intolerance but little evidence of fluid retention, whereas others complain primarily of edema and report few symptoms of dyspnea or fatigue
The approach that is most commonly used to quantify the degree of functional limitation
imposed by HF is one first developed by the New York Hearth Association. This system assigns patients to 1 of 4 functional classes, depending on the degree of effort needed to elicit symptoms: patients may have symptoms of HF at rest (class IV), on less-than-ordinary exertion (class III), on ordinary exertion (class II), or only at levels of exertion that would limit normal individuals (class I).
The development of HF can be appropriately characterized by considering 4 stages
of the disease.
This staging system has established risk factors and structural prerequisites; that the development of HF has asymptomatic and symptomatic phases; and that specific treatments targeted at each stage can reduce the morbidity and mortality of HF.
American College of Cardiology–American Heart Association classification of chronic heart failure
Stage A: High risk for developing heart failure. Description: Hypertension, diabetes mellitus, coronary artery disease, family history of cardiomyopathy
Stage B: Asymptomatic heart failure . Description: Previous myocardial infarction, left ventricule dysfunction, valvular heart disease
Stage C: Symptomatic heart failure. Description: Structural heart disease, dyspnea and fatigue, impaired exercise tolerance
Stage D: Refractory end-stage heart failure. Description: Marked symptoms at rest despite maximal medical therapy
Hobbs R, Boyle A. Disease management project. Cleveland Clinic. Heart failure. Internet. Accessed on June 16, 2016.