Congestive heart failure stages is a classification that quantifies the patient’s capability of performing effort and how does effort influence the clinical state (if it produces shortness of breath, palpitations, fatigue, what kind of effort produces these symptoms-mild, moderate, great or if these symptoms appear in rest). In medical practice it is important to classify patients in one of the congestive heart failure stages because it allows doctors to follow the disease evolution and the response to treatment, also it gives information about the prognostic. Each one of the congestive heart failure stages assumes different type of treatment.
What are the congestive heart failure stages :
(today, the most popular classification is New York Heart Association (NYHA), which is a functional classification system; this system relates symptoms to everyday activities and the patient’s quality of life).
- stage I- Patients with congestive heart failure stage I have no limitation in performing physical activity. Ordinary physical activity does not cause fatigue, palpitation, or dyspnea (shortness of breath).
- stage II- In this stage, patients experience a mild limitation of physical activity. For these patients, ordinary physical activity cause fatigue, palpitation, or dyspnea, but there are no such symptoms during rest.
- stage III- In this stage there is a marked limitation of physical activity. Patients experience fatigue, palpitation, or dyspnea during ordinary activity, but they feel comfortable at rest.
- stage IV- Patients are unable to carry out any physical activity without discomfort. They have symptoms of cardiac insufficiency during rest.
Treatment in congestive heart failure stages assumes using different types of medication:
- for example, in stage 1 and 4, it is recommended to avoid using beta blockers like metroprolol, atenolol, etc., because this drugs may exacerbate the heart insufficiency;
- in more advanced congestive heart failure stages, where edema is present, diuretics like furosemide or spironolactone are necessary and limited salt intake.
- every patient, no matter to which of the congestive heart failure stages belongs, should receive a ACE inhibitors (angiotensin-converting enzyme inhibitors), a drug that inhibits cardiac muscle deterioration.
What are the recommendations for congestive heart failure stages, considering physical activity? If patients with congestive heart failure are stable, a moderate physical activity is recommended, assuming the patients are under a well controlled medical treatment, because it is thought to reduce hospital re-admissions for heart failure and also is associated with a lower risk of cardiac events like cardiac death, heart attack or malignant arrhythmias. Patients that perform exercise report a higher quality of life and the circulation of blood in the heart muscle can be improved by exercise. Also, exercise reduces the adverse effect of catecholamine, substances that worsen heart failure by increasing the risk of arrhythmias, palpitation, and ischemia. With exercise, blood circulation is improved not only in the cardiac muscle, but also in the skeletal muscle, increasing the ability of performing daily activities.
How to live with congestive heart failure? Patients with heart failure should pay regular visits to their physician; have regular reevaluation (EKG, echocardiography, effort tests, chest x-ray etc) and medication adjustments. They also have to respect their treatment, avoid infection, should respect their diet: reduce salt and fats intake, lose weight, control hypertension, diabetes, give up smoking and alcohol and adapt physical effort to their own tolerance. However, medical treatment slows the evolution of the disease and improves the quality of life, but the “cure” of heart failure can be obtained only by heart transplant.