Classification of chronic heart failure - signs, degrees and functional classes

Classification of clinical forms and variations of chronic heart failure is necessary to distinguish the causes of the onset, the severity of the patient's condition, the features of the pathology.

This distinction should simplify the diagnostic procedure and the choice of treatment tactics.

In domestic clinical practice, the classification of CHF on Vasilenko-Strazhesko and the functional classification of the New York Heart Association are used.


  • 1 CHF on Vasilenko-Strazhesko( 1, 2, 3 stages)
  • 2 New York( 1, 2, 3, 4 FC)

CHF on Vasilenko-Strazhesko( 1, 2, 3 stages)

Classification accepted in 1935and is still being applied with some clarifications and additions. Based on the clinical manifestations of the disease in the course of CHF, three stages are distinguished:

  • I. Latent circulatory insufficiency without accompanying hemodynamic disorders. Symptoms of hypoxia occur with unusual or prolonged physical exertion. Possible shortness of breath, severe fatigue, tachycardia. Two periods A and B are isolated.

    Stage Ia is a preclinical version of the flow in which cardiac dysfunction has almost no effect on the patient's well-being. An instrumental examination reveals an increase in the ejection fraction during physical exertion. At stage 1b( latent CHF), circulatory insufficiency manifests itself during exercise and passes at rest.

  • II. In one or both circles of the circulatory system, stagnant phenomena that do not pass at rest are expressed. Period A( stage 2a, clinically expressed CHF) is characterized by symptoms of blood stagnation in one of the circulatory circles.
    The patient manifests acrocyanosis, peripheral edema, dry cough and others, depending on the localization of the lesion. In period B( stage IIb, severe), the whole circulatory system is involved in pathological changes.
  • III. The final stage of the development of the disease with signs of insufficiency of both ventricles. Against the background of venous congestion in both circles of blood circulation, severe hypoxia of organs and tissues is manifested. Multiorgan insufficiency, a strong puffiness, including ascites, hydrothorax develops.

    Stage 3a is treatable, with adequate complex therapy of CHF, partial restoration of the functions of the affected organs is possible, stabilization of the circulation and partial elimination of stagnant phenomena. Stage IIIb is characterized by irreversible changes in metabolism in affected tissues, accompanied by structural and functional disorders.

Introduction of additional gradations is partly due to the development and implementation of new methods of treatment that significantly increase the chances of patients to improve the quality of life.

The use of modern drugs and aggressive therapies quite often eliminates the symptoms of CHD corresponding to stage 2b before the preclinical state.

New York( 1, 2, 3, 4 FC)

The functional classification is based on the portability of physical exertion as an indicator of the severity of circulatory failure. Determination of the physical abilities of the patient is possible on the basis of a careful collection of anamnesis and extremely simple tests. By this feature, four functional classes are distinguished:

  • I FC .Daily physical activity does not cause dizziness, dyspnea, or other signs of impaired myocardial function. Manifestations of heart failure occur on the background of unusual or prolonged physical exertion.
  • II FC .Physical activity is partially limited. Everyday stress causes discomfort in the heart area or anginal pain, tachycardia, weakness, dyspnea. In a state of rest, the state of health is normalized, the patient feels comfortable.
  • III FC .Significant restriction of physical activity. The patient does not experience discomfort in a state of rest, but everyday physical exertion becomes unbearable. Weakness, pain in the heart, shortness of breath, tachycardia attacks are caused by loads less than usual.
  • IV FC .Discomfort occurs with minimal physical exertion. Attacks of angina pectoris or other symptoms of heart failure may also occur at rest without apparent presuppositions.

See the table of conformity of the CHF classifications for NYHA and N.D.Strazhesko:

Functional classification is useful for assessing the dynamics of a patient's state during the treatment of .Since the severity grades of chronic heart failure according to the functional sign and according to Vasilenko-Strazhesko are based on different criteria and do not exactly correlate with each other, the stage and class are indicated for diagnosis in both systems.

To your attention video about the classification of chronic heart failure: