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NYHA Classification for Heart Failure
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Last Name:
First Name:
Date completing Form:
Symptoms to consider:
Fatigue, Palpitations, Chest Pain, Dyspnea, Syncope
NYHA Class I
No Symptoms with normal physical activity. Normal functional status.
NYHA Class II
Mild Symptoms with normal physical activity. Comfortable at rest. Slight limitation of functional status.
NYHA Class III
Moderate symptoms with less than normal physical activity. Comfortable only at rest. Marked limitation of functional status.
NYHA Class IV
Severe Symptoms with features of heart failure with minimal physical activity and even at rest. Severe limitation of functional status.
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