Behind the Diagnosis: Understanding Heart Failure Classification

There’s more to heart failure than meets the eye — it’s a condition that involves many types and classifications. Heart failure classification can help your cardiologist determine the severity of the disease based on how it affects your daily functioning. If you have heart failure, knowing the particular type you have and how your cardiologist classifies it can help both of you manage the condition.

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What’s Your Type?

“In many cases, heart failure affects the left ventricle, which is the organ’s largest chamber and pumping powerhouse,” says Tara Kay, PA-C, of Beaufort Memorial Heart Specialists. “This is known as left-sided heart failure. With this type of heart failure, either your left ventricle has weakened such that the heart can’t pump forcefully enough to send sufficient blood into the body or the ventricle has tightened and has trouble filling with blood between heartbeats.”

Left-sided heart failure is the most common type, but there are other forms of the disease, including:

• Right-sided heart failure. Dysfunction in the left ventricle can eventually reduce the right ventricle’s pumping capacity, which is known as right-sided heart failure. As a result, blood flowing toward the heart can back up in the veins, leading to fluid accumulation, also called congestion, in body tissues. Congestion often causes swelling.
• Congestive heart failure (CHF). This term is often used as a stand-in for heart failure. However, CHF has a distinct meaning. It refers to heart failure that causes tissue congestion. Swelling in the legs and ankles is common with CHF.

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Heart Failure Classification Systems

Several classification systems help physicians categorize heart failure patients, although an international group of experts has proposed a universal system. One of the most common classification systems is the New York Heart Association (NYHA) Functional Classification. Its classes include:

• Class I — You can do all normal physical activities without being hampered by symptoms of heart failure, such as fatigue and shortness of breath.
• Class II — You experience symptoms during ordinary physical activities, leading to slight limitations in what you’re able to do.
• Class III — Your physical activity is more limited because mild exertion causes symptoms.
• Class IV — You experience symptoms while participating in any physical activity as well as at rest.

The American College of Cardiology (ACC) and American Heart Association (AHA) developed stages of heart failure to classify patients. This classification system complements the NYHA system. The ACC/AHA stages include:

• Stage A — You have risk factors for heart failure, such as coronary artery disease — a type of heart disease — but not structural heart disease or heart failure symptoms. Structural heart diseases, such as aortic stenosis and mitral valve disease, affect the heart’s valves, muscles and other structures.
• Stage B — Structural heart disease is present, but not heart failure symptoms.
• Stage C — You have heart failure symptoms and structural heart disease.
• Stage D — You have advanced heart failure, which means the symptoms are difficult to manage and disrupt your daily life.

Early diagnosis and treatment of heart failure can help slow its progression. Treatment options range from healthy lifestyle changes to medications, cardiac rehabilitation and implantation of a mechanical device to help your heart function. A heart transplant may be an option in more severe cases.

Need an expert’s help managing heart failure? Find a cardiologist who can help you control symptoms and maintain your quality of life.