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New York Heart Association Class III/IV
The two most severe classes of cardiac dysfunction according to a classification system developed by the New York Heart Association to grade cardiovascular function and disability. These classes are defined as follows: Class III - patients with cardiac disease producing marked limitation of activity: comfortable at rest. Less than ordinary physical activity causes symptoms. Class IV - patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms may be present even at rest. (NCI Thesaurus)
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