Which finding is associated with right-sided heart failure?

• A. Hepatomegaly
• B. Pulmonary edema
• C. S3/S4
• D. Peripheral edema

Answer: (D)

Right-sided heart failure causes blood to back up into the systemic venous circulation, leading to congestion outside the heart. This raises pressure in peripheral capillaries, so fluid leaks into dependent tissues, producing edema in the legs and ankles (and can be seen as sacral edema in someone who is seated or bedbound). Hepatic congestion can cause hepatomegaly, and ascites may occur with more advanced disease. The peripheral edema is the most recognizable and classic sign of this systemic venous congestion.

Pulmonary edema arises from backward pressure into the lungs and is characteristic of left-sided failure, not right-sided. S3/S4 are abnormal sounds that can appear with heart failure in general but are not specific to the right side. Hepatomegaly can occur with right-sided failure, but edema is the most prominent, specific finding associated with right-sided congestive failure.