Classification of heart failure

Acute and chronic heart failure can be left ventricular and right ventricular, but more often, failure of both ventricles develops simultaneously, i.e. total heart failure. Currently, our country uses two classifications in assessing heart failure in adults.

The classification of N.D. Strazhesko and V.Kh. Vasilenko suggests the following stages.

• Stage I - latent heart failure, revealed only during physical exertion.
• Stage II - severe long-term heart failure (congestion in the small and/or large circulation), symptoms are expressed at rest:
  • II A - hemodynamic disturbances are weakly expressed, in one of the sections (in the large or small circle of blood circulation):
  • II B - profound hemodynamic disturbances - end of a long stage, involvement of the large and small circles of blood circulation:
• Stage III, final - dystrophic changes in organs with severe hemodynamic disturbances, persistent changes in metabolism and irreversible changes in the structure of organs and tissues.

The New York Heart Association functional classes are as follows.

• Class I - patients with heart disease, but without restrictions on physical activity; normal physical activity does not cause inappropriate fatigue, palpitations, shortness of breath or angina.
• Class II - activity is moderately limited due to the appearance of shortness of breath, palpitations, fatigue during normal daily activities. Patients feel well at rest.
• Class III - significant limitation of physical capabilities. Symptoms of heart failure or angina appear with a load lower than daily.
• Class IV - patients are unable to perform any physical activity without feeling discomfort. Symptoms of heart failure or angina may occur at rest.

The presented classifications do not contain nuances characterizing the features of blood circulation in children: centralization of blood circulation and extreme lability of blood circulation, which is especially pronounced in young children. This is especially true for the New York classification, which is based largely on the subjective sensations of the patient. In the USA, a method for determining functional classes by the distance of a 6-minute walk has been developed. The condition of patients who are able to overcome from 426 to 550 m in 6 minutes corresponds to mild chronic heart failure, from 150 to 425 m - moderate, and those who are unable to overcome even 150 m - severe decompensation.

Therefore, we consider it appropriate to use the classification proposed in 1979 by N.A. Belokon as a working one for assessing heart failure in children. This classification assumes clinical variants of heart failure according to the left ventricular and right ventricular types.

Signs and degrees of heart failure in children

Degree	Failure
	Left ventricular	Right ventricular
I	Signs of heart failure are absent at rest and appear after exercise in the form of tachycardia or shortness of breath
IIA	Heart rate and the number of respiratory movements per minute are increased by 15-30 and 30-50%, respectively, relative to the norm.	The liver protrudes 2-3 cm from under the costal arch
II B	Heart rate and the number of respiratory movements per minute are increased by 30-50 and 50-70%, respectively, relative to the norm; possible: acrocyanosis, obsessive cough, moist fine-bubble wheezing in the lungs	The liver protrudes 3-5 cm from under the costal arch, swelling of the jugular veins
III	Heart rate and the number of respiratory movements per minute are increased by 50-60 and 70-100% or more, respectively, relative to the norm: clinical picture of pre-edema and pulmonary edema	Hepatomegaly, edema syndrome (edema of the face, legs, hydrothorax, hydropericardium, ascites)

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