New York Heart Association (Grading for dyspnoea, palpitation, fatigue and angina in patients with cardiovascular disease)

The New York Heart Association (NYHA) Functional Classification in a Patient with Heart Disease 
Overview: The New York Heart Association (NYHA) developed a functional classification for patients with heart disease. 
Patients: Heart disease must be present. 
Parameters: 
(1) limitations on physical activity 
(2) symptoms (undue fatigue palpitations dyspnea and/or anginal pain) with ordinary physical activity  
(3) status at rest
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The NYHA classification above was introduced with the seventh edition of the manual. The AMA criteria for permanent impairment still uses an older classification.

where: 

• Symptoms include undue fatigue palpitations dyspnea heart failure or anginal pain. 

NOTE: If you combined both the old and newer classifications you would end up with 5 classed (class I = asymptomatic at increased activity levels; class V = symptomatic at rest).