Canadian Cardiovascular Society Functional Classification of Stable Angina Pectoris

Class 1
Ordinary 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 2
Slight 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 3
Marked 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 4
Patient is unable to carry on any physical activity without discomfort; anginal syndrome
may be present at rest.

New York Heart Association (NYHA) Functional Classification
Class Functional Capacity: How a patient with cardiac disease feels during physical activity
I
Patients with cardiac disease but resulting in no limitation of physical activity. Ordinary physical activity does not
cause undue fatigue, palpitation, dyspnea or anginal pain.
II
Patients 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.
III
Patients 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.
IV
Patients 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.


Class Objective Assessment
A No objective evidence of cardiovascular disease. No symptoms and no limitation in ordinary physical activity.
B
Objective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary
activity. Comfortable at rest.
C
Objective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms,
even during less-than-ordinary activity. Comfortable only at rest.
D
Objective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at
rest.