Heart Failure Classification Scales

Two scales are commonly used to monitor heart failure in children. The Ross Classification of Congestive Heart Failure is used to describe heart failure in infants and young children, while the New York Heart Association (NYHA) Classification of Functional Capacity is used to describe heart failure in older children and adolescents. There are four stages of heart failure with stage four as the most severe.

Ross Classification of Congestive Heart Failure
Class I No limitations or symptoms.
Class II Mild tachypnea (rapid breathing) and/or diaphoresis (severe sweating) with feeds in infants; dyspnea (labored breathing) on exercise in older children. No growth failure.
Class III Marked tachypnea (rapid breathing) and/or diaphoresis (severe sweating) with feeds or exertion. Prolonged feeding time with growth failure.
Class IV Symptomatic at rest with tachypnea (rapid breathing), retractions, grunting, or diaphoresis (severe sweating)
New York Heart Association Classification of Functional Capacity
Class I Patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitations, dyspnea (labored breathing), or anginal (chest) pain
Class II Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitations (irregular heartbeat), dyspnea (labored breathing), or anginal (chest) pain.
Class III Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitations (irregular heartbeat), dyspnea (labored breathing), or anginal (chest) pain.
Class IV Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort increases.

Source: Children's Hospital of New York-Presbyterian, Heart Failure & Transplantation Patient Binder

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