The different stages of heart failure are established by the New York Heart Association (NYHA) functional classification system. Another staging system is the American Heart Association (AHA) Classification of Chronic Heart Failure. The NYHA heart failure stages are one through four and the AHA Classification system uses the letters A through D. The former is based on symptoms alone, and the latter begins with risk factors for heart failure.
First Stages of Heart Failure
Stage one heart failure is the least severe form of the disease. Symptoms are considered mild. Patients in stage one heart failure have no difficulty performing activities of daily living. Regular physical activity is possible and should not lead to shortness of breath or unusual physical fatigue. Heart failure patients can experience irregular heart rates (cardiac arrhythmias). In the first stages of heart failure activity is not associated with danger from cardiac arrhythmias.
The first stage of heart failure from the AHA, stage A, is based on heart failure risk factors that include high blood pressure, diabetes mellitus, coronary artery disease and family history of enlarged heart known as cardiomyopathy.
Second Stage Heart Failure
The second stage of heart failure, stage II, leads to shortness of breath and fatigue with physical activity per the NYHA. Symptoms are absent at rest. Climbing stairs and the ability to walk any distance becomes limited. The AHA describes the second stage of heart failure, stage B, as asymptomatic, occurring in individuals who have had heart attack, experience left ventricular dysfunction (LVH), or diseases of the heart valves that can lead to fluid buildup in the lungs and body tissues associated with uncompensated heart failure. Heart rhythm disturbance becomes a concern.
Stage III and Stage C Heart Failure
Stage C heart failure is symptomatic, using both classification systems. According to the AHA, individuals in stage C are those with changes in the structure of the heart. Shortness of breath, impaired exercise tolerance and fatigue are present. Stage III heart failure from the NYHA is similar and includes shortness of breath, fatigue and difficulty performing normal activities. Cardiac rhythm disturbances may require intervention or devices, such as implantable cardiac defibrillators to "shock" the heart back into rhythm, pacemakers or implantable assitive devices to improve the pumping action of the heart.
Advanced Heart Failure
Individuals with stage IV or stage D heart failure require maximum therapy even at rest. Discomfort and symptoms of shortness of breath are almost always present with any sort of activity. Oxygen, worn continuously, might be prescribed. The pumping action of the heart is so impaired that blood pressure can be low causing dizziness on standing and risk of falls. Quality of life becomes severely impaired. Patients classified with advanced heart failure may require heart transplant to sustain life and will already have used all recommended therapies.
