| 
      Limitations to physical activity in each class may be due to increased dyspnea,
        | Class I: No limitation of ordinary    physical activity. |  
        | Class II: Mild limitation of ordinary    physical activity. No discomfort at rest. |  
        | Class III: Marked limitation of    physical activity even with less than ordinary activity. No discomfort at    rest. |  
        | Class IV: Unable to perform any    physical activity and symptomatic even at rest. |  chest pain, fatigue or syncope
 
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