Canadian Cardiovascular Society Functional Classification of Stable Angina Pectoris

Class 1Ordinary physical activity, such as walking and climbing stairs, does not cause angina. Angina comes with strenuous or rapid or prolonged exertion at work or during recreation.Class 2Slight limitation of ordinary activity occurs walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold, in wind, or when under emotional stress, or only during the few hours after awakening. Walking more than two blocks on level ground and climbing more than one flight of ordinary stairs at a normal pace and in normal conditions triggers angina.Class 3Marked limitation of ordinary physical activity occurs walking one to two blocks on level ground and climbing more than one flight of stairs under normal conditions.Class 4Patient is unable to carry on any physical activity without discomfort; anginal syndrome may be present at rest.

New York Heart Association (NYHA) Functional ClassificationClassFunctional Capacity: How a patient withcardiac disease feels during physical activity

IPatients withcardiac disease butresulting in no limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea or anginal pain.

IIPatients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea or anginal pain.

IIIPatients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea or anginal pain.

IVPatients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort increases.

ClassObjective Assessment

ANo objective evidence of cardiovascular disease. No symptoms and no limitation in ordinary physical activity.

BObjective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.

CObjective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest.

DObjective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest.