The NYHA abbreviation comes from the New York Heart Association, i.e. the New York Society of Cardiology, which proposed the introduction of a system that allows for the classification of the severity of symptoms of heart failure.
Heart failure is a condition in which the heart, due to a malfunction or structure failure, is unable to provide blood flow in proportion to the body’s needs. The symptoms of heart failure vary widely and depend on its type (e.g. acute, chronic, transient, systolic, diastolic, left ventricular, right ventricular or biventricular failure). Symptoms include, for example, decreased exercise tolerance, weakness and permanent fatigue, swelling of the limbs, liver or entire body, shortness of breath with exertion or even lying down, sleep apnea, increased urination at night (nocturia), cold extremities, constipation, neurological symptoms ( disturbances of consciousness and perception), etc. Causes include hypertension, previous myocardial infarction, valvular and ischemic diseases, and cardiomyopathies. Heart failure should not be confused with circulatory failure, which is a disorder related directly to the circulatory system and manifests itself in reduced blood flow through tissues and organs.
NYHA scale – description of grades I, II, III and IV
The NYHA scale has gained recognition all over the world and is currently the most frequently used method of classifying people struggling with chronic heart failure. The simple scale system includes four levels (NYHA I, NYHA II, NYHA III, and NYHA IV), which are based on the number of characteristic symptoms and the reduction in exercise capacity at various levels of physical activity undertaken:
- NYHA I – the patient practically does not feel the typical disturbing cardiological symptoms, such as palpitations, angina pains or shortness of breath. Taking up physical activity has no effect on general well-being and does not lead to rapid and excessive fatigue. A sick person can regularly practice all kinds of sports without feeling any discomfort.
- NYHA II – the above symptoms appear in the patient during daily activities, so there is a slight impairment of physical activity. These symptoms do not occur while resting.
- NYHA III – cardiological problems make functioning difficult and appear while making small efforts accompanying simple activities such as, for example, dressing or washing. While resting, troublesome ailments disappear.
- NYHA IV – the patient suffers from severe impairment of physical activity. Minimal exertion results in fatigue, increased shortness of breath, angina pains and palpitations, which can also occur while resting. Figuratively speaking, a sick person doesn’t even have to get out of bed to feel faint.
Diagnosing the patient with the NYHA scale is of great importance, because it depends on how the patient will be treated. If he does not develop any of the standard symptoms (NYHA Grade I), it is known that he will not be treated in the same way as one who has been classified as Grade III, for example. Treatment of heart failure consists of pharmacological therapy in the form of medications such as diuretics (diuretics), beta-blockers, cardiac glycosides and angiotensin-converting enzyme inhibitors (ACEI). Sometimes it is necessary to undergo heart surgery. The prognosis of chronic heart failure is unfortunately not good. More than half of those affected by this progressive disease die within five years of diagnosis.
Currently, in order to diagnose chronic heart failure, medical history is collected, the etiology of the disease, morphology, electrocardiography (ECG), chest radiography (X-ray), BNP natriuretic peptide concentration, exercise test and echocardiography, i.e. ultrasound, are used. hearts. Ultrasound cardiography is a non-invasive imaging examination using ultrasound waves. One-, two- or three-dimensional transthoracic echocardiography is most commonly performed. It mainly consists in assessing the functioning and structure of the heart muscle, valves, the size of individual chambers of the heart, its contractility, as well as blood flow in the aorta, arteries, pulmonary veins and main veins, and the possible detection of a heart defect.
The NYHA scale describes four classes of severity of symptoms of heart failure depending on the circumstances of their appearance during physical activity or even while resting. If a patient is diagnosed with acute heart failure, the four-level Forrester classification is used, based on hemodynamic features (i.e. blood flow in blood vessels and the heart muscle) and clinical symptoms.