Skip to main content

NYHA classification..


The most commonly used classification for  Heart Failure  is the  one developed by the New York Heart Association. 
 There are 4 functional classes defined by the degree of effort needed to elicit symptoms of HF:
  • Class I - Asymptomatic.  The patient has a level of exertion comparable to that of a normal individual.
  • Class II - Slight limitation of physical activity.  The patient is comfortable at rest but ordinary exertion results in symptoms.
  • Class III – Marked limitation of physical activity. The patient is comfortable at rest but less-than-ordinary exertion results in symptoms.
  • Class IV- Symptomatic at rest.

Although it is widely used, there are some criticisms of this classification scheme:
  • Although functional class tends to decline over time, patients with chronic heart failure periodically develop acute decompensated heart failure and thus fluctuate between classes. 
  • Even in the absence of measurable changes in ventricular function, changes in medications and diet may have favorable or adverse effects and the NYHA class can vary.
  • The NYHA functional classification requires subjective assessment by the health care provider.
  • Treatment may not differ significantly across the classes, limiting its usefulness in guiding treatment recommendations.

In light of these limitations, the ACCF/AHA has endorsed a new classification scheme to complement the NYHA functional classification.  The new classification scheme aims to objectively identify stages of illness over the course of the progression of disease so that specific prevention measures and/or treatment can be recommended for each stage.  The system recognizes HF as a syndrome that starts with risk factors and then progresses to asymptomatic and symptomatic phases.
  • Stage A - at high risk for HF but without structural heart disease or symptoms of HF.
  • Stage B - structural heart disease but without signs or symptoms of HF.
  • Stage C - structural heart disease with prior or current symptoms of HF.
  • Stage D - refractory HF requiring specialized interventions. These are patients with advanced structural heart disease and marked symptoms of heart failure at rest despite maximal medical therapy.

Hunt SA, Abraham WT, Chin MH, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119(14):e391-479. Available at: http://www.ncbi.nlm.nih.gov.ezp-prod1.hul.harvard.edu/pubmed/19324966 [Accessed June 1, 2009].  
Labels:

Comments

Post a Comment

Popular posts from this blog

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Post a Comment
Read more

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

Lumbar and thoracic epidural in Pediatrics-Technical aspect

The midline approach is most commonly used. The ligamentum   flavum is considerably thinner and less dense in infants than in older children and adults. This makes recognition of engagement in the ligament more difficult and requires both extra care and slower, more deliberate passage of the needle to avoid subarachnoid puncture. The angle of approach to the epidural space is slightly more perpendicular to the plane of the back than in older children and adults, owing to the orientation of the spinous   processes in infants and small children. The loss of resistance technique should be used, but only with saline, not air. There are several reports of venous air embolism in infants and children when air was used to test for loss of resistance Use a short (5 cm) 18-gauge Tuohy needle and a 20- or 21-gauge catheter in infants and children. Epidural kits specifically for infants and children are available Maximum of 0.4 mg/kg/hr of bupivacaine after the initial block is estab...
Post a Comment
Read more