COMPLETE CARDIAC DIAGNOSIS

BY Dr. Roberto Roldan Guzman

MUST BE DONE ON ALL CARDIAC PATIENTS

1. Etiologic
2. Anatomic
3. Physiologic
4. NYHA Functional Class I-IV
5. Therapeutic Class A-E
6. AHA/ACC Heart Failure Class A-D

ETIOLOGIC DIAGNOSES
Hypertensive CV Disease Ischemic Heart Disease Thyrotoxic Heart Disease
Rheumatic Heart Disease Coronary Artery Disease Valvular Heart Disease
Congenital Heart Disease Atherosclerotic Heart Disease Cardiomyopathy

ANATOMIC DIAGNOSES
1. CHAMBER INVOLVED
Concentric LVH Left atrial dilatation
Eccentric LVH Right atrial dilatation
Right ventricular hypertrophy/ dilatation
Biventricular hypertrophy Bi-atrial dilatation

2. VALVE/S INVOLVED
Mitral Stenosis Aortic Stenosis Tricuspid Stenosis Pulmonic Stenosis
Mitral Regurgitation Aortic Regurgitation Tricuspid Regurgitation Pulmonic Regurgitation

3. VESSEL/S INVOLVED
Aortic Aneurysm Culprit Vessel/s in Myocardial Infarction cases
Aortic Dissection RCA, LM, LAD, LCx

4. LOCATION OF MYOCARDIAL INFARCTION

Septal Anterior Extensive Anterior True Posterior
Anteroseptal Anterolateral Inferior

5. PERICARDIAL EFFUSION

6. CONGENITAL ANOMALY/ ANOMALIES

VSD Ebstein’s anomaly of the TV
ASD Coarctation of the Aorta
PDA Tetralogy of Fallot

PHYSIOLOGIC DIAGNOSES
1. All dysrhythmias must be specified- ST, SB, SA, AV-blocks (specify), SA-node dysfunction (specify), etc.

2. Heart Failure- HFpEF, HFrEF, RV-failure

3. Myocardial ischemia- Stable angina, Unstable angina, Non-ST elevation MI

NYHA FUNCTIONAL CLASSIFICATION
Class I. No symptom even with extraordinary physical activity
Class II. Symptom/s experienced with ordinary physical activity
Class III. Symptom/s experienced with less than ordinary physical activity
Class IV. Symptomatic even at rest

PHYSICAL THERAPEUTIC CLASSIFICATION

Class A. No restriction of physical activities
Class B. Avoid extraordinary physical activities
Class C. Avoid ordinary physical activity
Class D. Avoid less than ordinary physical activity
Class E. Complete bed rest

AHA/ ACC HEART FAILURE CLASSIFICATION

Class A (Functional)- Presence of risk factors only without structural heart disorder, and without symptom
- Hypertension, type 2 DM, lipids, obesity, sedentary life, depression, alcoholism
(Therapeutic)- Risk factor modification ( BP, control T2DM & lipids, avoid excess alcohol intake, reduce
weight, exercise programs)

Class B (Functional)- Presence of risk factors with structural heart disorder, but without heart failure symptom
- Previous MI, LV-remodeling, LVH, functional mitral regurgitation
(Therapeutic)- β-blockers, ACEIs, ARBs, etc.

Class C (Functional)- Presence of risk factors, structural heart disorders, & heart failure signs/ symptom/s
- Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, easy fatigability
(Therapeutic)- diuretics, aldosterone antagonists, therapeutic ARNI, SGLT2 antagonist, coronary artery
intervention

Class D (Functional)- Advanced symptomatic or refractory heart failure requiring aggressive therapy/
Specialized intervention/s
(Therapeutic)- chronic inotropics, ventricular assist device, heart transplantation, other surgery