Which of the following symptoms is most commonly associated with left-sided heart failure?
A. Crackles
B. Arrhythmias
C. Hepatic engorgement
D. Hypotension
Correct Answer: A. Crackles
Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. The left ventricle of the heart no longer pumps enough blood around the body. As a result, blood builds up in the pulmonary veins (the blood vessels that carry blood away from the lungs). This causes shortness of breath, trouble breathing, or coughing – especially during physical activity.
Option B: Arrhythmias can be associated with both right- and left-sided heart failure. Heart failure can result if the heart is pumping ineffectively for a prolonged period due to bradycardia or tachycardia, such as atrial fibrillation. Sometimes controlling the rate of an arrhythmia that’s causing heart failure can improve the heart’s function.
Option C: Increased pressure in the sublobular branches of the hepatic veins causes engorgement of venous blood, and is most frequently due to chronic cardiac lesions, especially those affecting the right heart (e.g., right-sided heart failure), the blood being dammed back in the inferior vena cava and hepatic veins.
Option D: Left-sided heart failure causes hypertension secondary to an increased workload on the system. Patients with left heart failure may present with complaints of shortness of breath (often on exertion, a sensitivity of 89%), orthopnea (specificity of 89%), paroxysmal nocturnal dyspnea and/or symptoms of volume overload (e.g., leg swelling, weight gain, increased abdominal girth, or right upper quadrant pain due to liver congestion).
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