Skill Checkup: A 62-Year-Old Black Male With History of Hypertension Experiences Mild Cognitive Impairment and Breathlessness

Jeffrey J. Hsu, MD


March 13, 2023

The patient's symptoms and ejection fraction of 37% indicate stage C/NYHA Class III HFrEF. According to AHA guidelines, a diagnosis of HFrEF is classified as stage C if the patient has prior or current symptoms of HF, but with preserved or only mildly reduced ejection fraction. NYHA Class III HFrEF refers to individuals who have marked limitations in physical activity and symptoms even with minimal exertion.

Stage A HF includes those without current or previous symptoms who are at risk for HF owing to factors such as comorbidities (cardiovascular disease, obesity, hypertension, and diabetes), a genetic variant for cardiomyopathy, family history of cardiomyopathy, or exposure to cardiotoxic agents. Stage B HF includes those with no current or previous symptoms of HF, but who exhibit structural heart disease, evidence of increased filling pressures, or risk factors plus increased natriuretic peptide levels or persistently elevated cardiac troponin in the absence of competing diagnoses. Stage D HF includes those with advanced disease that severely limits activity and requires recurrent hospitalizations despite ongoing efforts to optimize treatment.

The NYHA classification of HF symptoms and functional capacity is a subjective tool used by clinicians for assessment of patients with both symptomatic (stage C) or advanced (stage D) HF. HF patients characterized as NYHA Class I are asymptomatic; those considered NYHA Class II have mild symptoms that slightly limit physical activity, and NYHA Class IV is defined by severe symptoms even at rest.


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