Which signs and symptoms are most typical of left-sided heart failure?

• A. Dyspnea and basilar crackles, orthopnea
• B. Peripheral edema and ascites
• C. JVD with hepatomegaly
• D. Weight gain

Answer: (A)

Left-sided heart failure causes a backup of pressure into the lungs, so the lungs become congested and gas exchange is impaired. This leads to shortness of breath (dyspnea) and difficulty breathing when lying flat (orthopnea) because more blood returns to a weakened left ventricle, increasing pulmonary venous pressure. In the lungs, fluid accumulation produces crackles heard at the bases on auscultation. These pulmonary signs are the hallmark of left-sided failure, especially in the presence of orthopnea and dyspnea.

Choices describing peripheral edema, ascites, or jugular venous distention with hepatomegaly reflect systemic venous congestion from right-sided heart failure, not the lung-focused symptoms of left-sided failure. Weight gain can occur with fluid retention in heart failure overall but isn’t specific to the left-sided picture.