Pulmonary hypertension (PH) is rare, life-threatening lung disorder that affects the pulmonary arteries, which are responsible for transporting the blood from the right heart ventricle to the lungs. The disease is characterized by high blood pressure in the lungs, leading to the pulmonary arteries becoming narrowed and thickened. Due to pulmonary hypertension, the heart needs to work harder to properly pump the blood to the lungs, which can lead to enlargement and weakening of the organ, as well as potential right heart failure.
Shortness of breath (dyspnea), fatigue, dizziness or fainting spells (syncope), pressure or pain in the chest, swelling (edema) in the ankles, legs and abdomen (ascites), bluish color in the lips and skin (cyanosis), and irregular heartbeat. However, the symptoms are not always experienced, depending on the patient, stage and severity of the disease. Therefore, the pulmonary hypertension functional classification divides the stages of the disease into classes, helping physicians identify and diagnose the disease earlier and more effectively.
What Is Pulmonary Hypertension Functional Classification?
Divided into four different classes, the pulmonary hypertension functional classification is used to rate how sick patients are. It is extremely important to distinguish the class of each patient to evaluate the evolution and stage of the disease. The higher the class, the more severe the disease, but there can be reversals in class due to new or more intense treatments, or the disappearance of external factors that influenced developing it. However, pulmonary hypertension is a progressive disease, which means that it gets worse over time if not treated.
The most used and well-known functional assessment classifications are the ones defined by the World Health Organization (WHO) and by the New York Health Association (NYHA). In addition to these classification, there is a different one also created by the WHO, which is divided by groups. While the groups system divides the different types of pulmonary hypertension according to its causes, the classes system is focused on how affected the patients are by the disease.
World Health Organization Functional Classification
- Class I refers to patients that do not experience symptoms with exercise or at rest. It is very uncommon for patients to be diagnosed while being in this class, but a good response to proper treatment can make them return to it after being diagnosed in class II or III.
- Class II identified patients with no symptoms at rest but feel uncomfortable and shortness of breath with ordinary activities like climbing stairs, shopping for grocery, or making the bed.
- Class III includes patients who experience no symptoms at rest but feel limited in normal activities due to shortness of breath, fatigue, or near fainting.
- Class IV refers to patients whose symptoms are present even at rest and are severe with any activity. Fainting is also common among patients in this class, particularly while bending over with their heads lowered. Most patients also have edema in the feet and ankles as result of right heart failure.
New York Heart Association Functional Classification
- Class 1 includes patients that don’t experience any symptoms with ordinary physical activity.
- Class 2 refers to patients with symptoms while performing regular activities and slight limitation of activity.
- Class 3 is the one with patients that experience symptoms with less than normal activity, and marked limitation of activity.
- Class 4 is the last and includes people that suffer the symptoms of the disease with any activity or even at rest.
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