Version October 2024
| NYHA | Ross | |
| Class I | No limitations of physical activity | No limitations or symptoms |
| Class II | May experience fatigue, palpitations, dyspnea, or angina during moderate exercise but not during rest | Infants – Mild tachypnea or diaphoresis with feeding Older children – Mild to moderate dyspnea on exertion |
| Class III | Symptoms with minimal exertion that interfere with normal daily activity | Infants – Growth failure and marked tachypnea or diaphoresis with feeding Older children – Marked dyspnea on exertion |
| Class IV | Unable to carry out any physical activity because they typically have symptoms of heart failure at rest that worsen with any exertion | Symptoms at rest such as tachypnea, retractions, grunting, or diaphoresis |
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