Question

Which of the following signs and symptoms, although not present in Howard’s initial examination, are also associated with right-side heart failure? Select all that apply.
Jugular vein distention
Orthopnea
Enlarged liver and/or spleen
Crackles in the lungs
Pulmonary edema

Answer 1

Right-sided heart failure is primarily associated with symptoms related to systemic venous congestion, while left-sided heart failure is associated with pulmonary congestion. Based on this understanding, the following signs and symptoms are typically associated with right-sided heart failure:

1. **Jugular vein distention** - This occurs due to increased venous pressure and fluid overload in right-sided heart failure.
2. **Enlarged liver and/or spleen** - Right-sided heart failure can cause congestion in the liver and spleen, leading to hepatomegaly and splenomegaly.

**Note:** The following symptoms are generally associated with left-sided heart failure:
- **Orthopnea** - Difficulty breathing when lying flat is related to pulmonary congestion, which is more characteristic of left-sided heart failure.
- **Crackles in the lungs** - Also associated with pulmonary congestion and indicative of left-sided heart failure.
- **Pulmonary edema** - A condition caused by left-sided heart failure leading to fluid accumulation in the lungs.

Therefore, the symptoms associated with right-sided heart failure from the provided options are:

- Jugular vein distention
- Enlarged liver and/or spleen