A. Symptoms
Shortness of breath (dyspnea) at rest and on minimal exertion, paroxysmal nocturnal dyspnea (awakened from sleep because of shortness of breath), weakness, fatigue, edema of both legs, and an increase in abdominal girth are common complaints of heart failure. Minor physical activities are hindered because of bothersome shortness of breath.
1. New York Heart Association Functional Class
This functional class is often used as a reference in pub¬lications and in medical reports.
• Class I: asymptomatic on ordinary physical activity associated with maximal oxygen consumption (VO2) is greater than 20 ml/kg/minute
• Class II: asymptomatic on ordinary physical activity with maximum oxygen consumption of 16–20 ml/kg/ minute
• Class III: asymptomatic on less than ordinary physical activity with maximum oxygen consumption of 10–15 ml/kg/minute
• Class IV: symptomatic at rest or on any activity with maximum oxygen consumption of less than 10 ml/kg/minute
B. Physical Signs
Physical signs of heart failure on examination of the patient include the following list.
• There is an increase in jugular venous pressure greater than 2 cm above the sternal angle. This is a sign of right and left ventricular failure. In some patients the venous pressure may be normal if the left ventricular failure is mild. The most common cause of right ventricular failure is left-sided heart failure. On auscultation a third heart sound or a combination of the third and fourth sound summation gallop is heard. Crackles (crepita¬tions) are heard on auscultation over the lower lung fields; if left ventricular failure is severe and pulmonary edema is present crepitations may be heard over most of the chest.

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