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Pulmonary Heart - Classification
Last reviewed: 06.07.2025
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V. P. Silvestrov, based on the results of clinical and functional studies, identified 4 functional classes of chronic pulmonary heart disease.
I FC - initial changes (latent hypertension), has the following characteristics:
- the clinical picture is dominated by symptoms of chronic bronchopulmonary disease;
- moderate impairment of the pulmonary ventilation function or, more often, isolated small bronchial obstruction syndrome;
- in the genesis of pulmonary hypertension, the leading role is played by hypoxic vasoconstriction and restructuring of hemodynamics with the formation of increased cardiac output (compensatory);
- hyperkinetic type of hemodynamics;
- pulmonary hypertension is detected only under conditions of physical exertion (latent pulmonary hypertension);
- compensatory reactions of the immune system (increase in T-suppressors);
- there is no respiratory failure (RF0);
- there is no circulatory failure (NC0).
II FC - stable pulmonary hypertension moderate, has the following manifestations:
- the clinical picture is dominated by symptoms of bronchopulmonary disease;
- moderate obstructive respiratory disorders (sometimes significant);
- alveolar hypoxia, hypoxic vasoconstriction, and increased pulmonary vascular resistance participate in the formation of pulmonary hypertension;
- pulmonary hypertension stable moderate;
- restructuring of central hemodynamics, increase in cardiac output (compensatory), overload of the right ventricle;
- type of hemodynamics hyperkinetic;
- depletion of the compensatory capabilities of the immune system;
- DN 0-I st;
- NK 0.
III FC - significant pulmonary hypertension, has the following features:
- symptoms of the underlying disease and severe respiratory failure are joined by signs of incipient heart failure (constant shortness of breath, tachycardia, swelling of the jugular veins);
- there is pronounced pulmonary hypertension caused by the above-mentioned mechanisms and disruption of the architecture of the bronchial and vascular tree;
- ECG and radiographic signs of hypertrophy and dilation of the right heart appear;
- eukinetic type of hemodynamics;
- secondary immunodeficiency;
- DN II-III st.
- NK 0-I st.
IV FC - severe pulmonary hypertension is characterized by the following features:
- the compensatory capabilities of the respiratory and cardiovascular systems are exhausted;
- pulmonary hypertension is pronounced, caused by the underlying disease, alveolar hypoxemia, vasoconstrictor reactions and pronounced structural changes in the pulmonary vascular bed, increased blood viscosity, polycythemia;
- hypokinetic type of hemodynamics;
- secondary immunodeficiency;
- DN II-III
- NK II-III
The classification of pulmonary hypertension in chronic pulmonary disease by N. R. Paleeva successfully complements the classification of pulmonary heart disease by B. E. Votchal.
- In stage I (transient), an increase in pulmonary arterial pressure occurs during physical exertion, often due to an exacerbation of the inflammatory process in the lungs or worsening bronchial obstruction.
- Stage II (stable) is characterized by the existence of pulmonary arterial hypertension at rest and outside of exacerbation of pulmonary pathology.
- At stage III, stable pulmonary hypertension is accompanied by circulatory failure.
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