New York Heart Association (NYHA) Classification of Heart Failure

NYHA Class

Definition

Limitation

Example

I

Ordinary physical activity does not cause undue fatigue, dyspnea, or palpitations.

None

Can complete any activity requiring 7 MET:

  • Carry 11 kg up 8 steps

  • Carry objects weighing 36 kg

  • Shovel snow

  • Spade soil

  • Ski

  • Play squash, handball, or basketball

  • Jog or walk 8 km/hour

II

Ordinary physical activity causes fatigue, dyspnea, palpitations, or angina.

Mild

Can complete any activity requiring 5 MET:

  • Sexual intercourse without stopping

  • Garden

  • Roller skate

  • Walk 7 km/hour on level ground

  • Climb one flight of stairs at a normal pace without symptoms

III

Comfortable at rest; less than ordinary physical activity causes fatigue, dyspnea, palpitations, or angina.

Moderate

Can complete any activity requiring 2 MET:

  • Shower or dress without stopping

  • Strip and make a bed

  • Clean windows

  • Play golf

  • Walk 4 km/hour

IV

Symptoms occur at rest; any physical activity increases discomfort.

Severe

Cannot do or cannot complete any activity requiring 2 MET; cannot do any of the above activities

MET = metabolic equivalent of task, a measure of how much energy is expended compared to remaining at rest.

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