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Appendix 1: New York Heart Association (NYHA) Functional Classification

NYHA CLASS PATIENT SYMPTOMS
Class I (Mild) No limitations of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea.
Class II (Mild) Slight limitations of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation or dyspnea.
Class III (Moderate) Marked limited of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation or dyspnea.
Class IV (Severe) Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.
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