The New York Heart Association (NYHA) Functional Classification provides a simple way of classifying the extent of heart failure. It places patients in one of four categories based on how much they are limited during physical activity; the limitations/symptoms are in regards to normal breathing and varying degrees in shortness of breath and or angina pain:
| NYHA Class | Symptoms |
|---|---|
| I | Cardiac disease, but no symptoms and no limitation in ordinary physical activity, e.g. shortness of breath when walking, climbing stairs etc. |
| II | Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity. |
| III | Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20–100 m). Comfortable only at rest. |
| IV | Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients. |
Another frequently used functional classification of cardiovascular disease is the Canadian Cardiovascular Society grading scale of angina pectoris.
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“New York is a woman
holding, according to history,
a rag called liberty with one hand
and strangling the earth with the other.”
—Adonis [Ali Ahmed Said] (b. 1930)
“One hand stiff—heaviness of forties & menopause reduced
by one heart stroke, lame now—wrinkles—a scar on
her head, the lobotomy—ruin, the hand dipping downwards to
death—”
—Allen Ginsberg (b. 1926)
“An association of men who will not quarrel with one another is a thing which has never yet existed, from the greatest confederacy of nations down to a town meeting or a vestry.”
—Thomas Jefferson (1743–1826)
“Stay-at-home mothers, . . . their self-esteem constantly assaulted, . . . are ever more fervently concerned that their offspring turn out better so they won’t have to stoop to say “I told you so.” Working mothers, . . . their self-esteem corroded by guilt, . . . are praying their kids turn out functional so they can stop being defensive and apologetic and instead assert “See? I did do it all.””
—Melinda M. Marshall (20th century)