Congestive Heart Failure Classification (NYHA) I: No limitation of physical activity.

. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea (shortness of breath) II: Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea IV: Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased Stages (American College of Cardiology / American Heart Association) A: high risk, no structural heart disease or sx B: structural heart disease, no signs or sx C: structural heart disease, prior or current sx D: refractory, specialized interventions needed Framingham clinical criteria for the diagnosis for heart failure 2 major OR 1 major + 2 minor criteria Major : PND, orthopnea, elevated JVP, pulmonary rales, S3, cardiomegaly on CXR, pulmonary edema on CXR, weight loss 4.5 kg in five days in response to treatment Minor: bilateral leg edema, nocturnal cough, DOE, hepatomegaly, pleural effusion, tachycardia (120), weight loss 4.5 kg in five days General treatment principles Mild (Classes I to II): <4g Na/day, less physical activity, loop diuretic, ACE inhibitor Mild to moderate (Classes II to III): loop diuretic + ACE inhibitor beta blockers Moderate to severe (Classes III to IV): loop diuretic + ACE inhibitor digoxin spironolactone