The Ross Heart Failure Classification was developed to provide a global assessment of heart failure severity in infants, and has subsequently been modified to apply to all pediatric ages. The modified Ross Classification incorporates feeding difficulties, growth problems, and symptoms of exercise intolerance into a numeric score comparable with the NYHA classification for adults.
NYHA and Modified Ross Heart Failure Classification for Children
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 HF at rest that worsen with any exertion Symptoms at rest such as tachypnea, retractions, grunting, or diaphoresis
HF: Heart failure; NYHA: New York Heart Association.
- Ross RD. The Ross classification for heart failure in children after 25 years: a review and an age-stratified revision. Pediatr Cardiol. 2012 Dec;33(8):1295-300. [Medline]
- Hsu DT, Pearson GD. Heart failure in children: part I: history, etiology, and pathophysiology. Circ Heart Fail. 2009 Jan;2(1):63-70. [Medline]
Created Dec 21, 2016.
More from my site