[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Cardiovascular system](https://durgical.com/en/clinical-exam/#a-cardiovascular) › Heart failure syndrome: left- and right-sided signs [Clinical exam](https://durgical.com/en/clinical-exam/) · [Cardiovascular system](https://durgical.com/en/clinical-exam/#a-cardiovascular) # Heart failure syndrome: left- and right-sided signs - Syndrome When the heart cannot pump well, fluid builds up behind it: in the lungs if the left side fails, in the body if the right side fails. Updated 2026-11-01 **See it in 3D:** [Left ventricle](https://durgical.com/en/anatomy/left-ventricle/) · [Right ventricle](https://durgical.com/en/anatomy/right-ventricle/) · [Internal jugular vein](https://durgical.com/en/anatomy/internal-jugular-vein/) · [Liver](https://durgical.com/en/anatomy/liver/) ## Key points - Left-sided failure = pulmonary congestion (orthopnea, paroxysmal nocturnal dyspnea, crackles, S3). - Right-sided failure = systemic congestion (neck veins, hepatomegaly, edema, ascites). - The most common cause of right-sided failure is left-sided failure. - Framingham: two major, or one major and two minor. - In Latin America: think of Chagas disease and rheumatic heart disease. ## What it is Heart failure is a syndrome: the heart cannot maintain output without raising its filling pressures. The signs make sense as congestion behind the failing ventricle. The most common cause of right-sided failure is left-sided failure. ## Key findings - Left-sided: exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, basal crackles, S3, displaced apex, tachycardia, pleural effusion, pulsus alternans. - Right-sided: raised jugular pressure, positive hepatojugular reflux, tender hepatomegaly, ascites, bilateral dependent pitting edema. - Framingham criteria: the clinical diagnosis needs two major, or one major and two minor. - Framingham major: paroxysmal nocturnal dyspnea, jugular distension, crackles, cardiomegaly, acute pulmonary edema, S3, hepatojugular reflux. - For nursing: daily weight at the same time, fluid balance, orthopnea (number of pillows), edema and new dyspnea are charted and reported. ## Pathophysiology - Left-sided failure: pressure rises in the left atrium and pulmonary veins, fluid moves into the interstitium and alveoli: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles. - Right-sided failure: systemic venous pressure rises: distended neck veins, congested liver, leg edema, ascites. - Low output: fatigue, cool extremities, oliguria, confusion, hypotension in advanced stages. - Activation of the renin–angiotensin–aldosterone and sympathetic systems retains salt and water and worsens congestion. ## Common causes - Ischemic heart disease and hypertension: the most common causes. - Valve disease, especially rheumatic in Colombia and the region; Chagas cardiomyopathy in endemic areas; dilated cardiomyopathy. - Isolated right-sided failure: pulmonary hypertension, COPD (cor pulmonale), pulmonary embolism, right ventricular infarction. - Triggers of decompensation: infection, atrial fibrillation, ischemia, excess salt or fluid, stopping treatment, nonsteroidal anti-inflammatory drugs. ## Tests that confirm it - Natriuretic peptides (BNP or NT-proBNP): high values support the diagnosis; normal values make it unlikely. - Echocardiography: ejection fraction, chamber size, valves. - Chest X-ray: cardiomegaly, vascular redistribution, Kerley B lines, effusion. ECG: ischemia, arrhythmias. ## Test yourself Think of the answer, then tap the question to see it. ## Which signs point to congestion from left ventricular failure? Exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, basal crackles and S3. ## What is the most common cause of right-sided heart failure? Left-sided heart failure, which raises pulmonary pressures and overloads the right ventricle. ## Which cardiomyopathy should be considered in a patient from an endemic rural area of Colombia with heart failure and conduction blocks on the ECG? Chagas cardiomyopathy, caused by Trypanosoma cruzi. ## Which simple nursing record best detects fluid retention? Daily weight, at the same time on the same scale, together with fluid balance. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/heart-failure-syndrome-left-and-right-sided-signs/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Left ventricle](https://durgical.com/en/anatomy/left-ventricle/) - [Right ventricle](https://durgical.com/en/anatomy/right-ventricle/) - [Internal jugular vein](https://durgical.com/en/anatomy/internal-jugular-vein/) - [Liver](https://durgical.com/en/anatomy/liver/) ## Related - [Jugular venous pressure and the venous pulse](https://durgical.com/en/clinical-exam/jugular-venous-pressure-and-the-venous-pulse/) - [Hepatojugular (abdominojugular) reflux](https://durgical.com/en/clinical-exam/hepatojugular-reflux/) - [Heart sounds: S1, S2 and its splitting, S3 and S4](https://durgical.com/en/clinical-exam/heart-sounds-s1-s2-and-its-splitting-s3-and-s4/) - [Edema: pitting, grading and distribution](https://durgical.com/en/clinical-exam/edema-pitting-grading-and-distribution/) - [Adventitious sounds: crackles, wheezes, rhonchi, stridor and pleural rub](https://durgical.com/en/clinical-exam/adventitious-sounds-crackles-wheezes-rhonchi-stridor-and-pleural-rub/) - [Pleural effusion syndrome](https://durgical.com/en/clinical-exam/pleural-effusion-syndrome/) - [Ascites: shifting dullness and fluid wave](https://durgical.com/en/clinical-exam/ascites-shifting-dullness-and-fluid-wave/) - [Precordial inspection and palpation: apex beat, heaves and thrills](https://durgical.com/en/clinical-exam/precordial-inspection-and-palpation-apex-beat-heaves-and-thrills/) ## Related conditions - [Heart failure](https://durgical.com/en/conditions/heart-failure/) - [Chagas cardiomyopathy](https://durgical.com/en/conditions/chagas-cardiomyopathy/) - [Dilated cardiomyopathy](https://durgical.com/en/conditions/dilated-cardiomyopathy/) - [Hypertensive heart disease](https://durgical.com/en/conditions/hypertensive-heart-disease/) - [Rheumatic heart disease](https://durgical.com/en/conditions/rheumatic-heart-disease/) - [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/) - [Pulmonary hypertension and cor pulmonale](https://durgical.com/en/conditions/pulmonary-hypertension-and-cor-pulmonale/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Heart failure: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000158.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [24.3 Nursing Assessment - Clinical Nursing Skills | OpenStax](https://openstax.org/books/clinical-nursing-skills/pages/24-3-nursing-assessment) (OpenStax (Rice University), 2024); [18.2 Cardiovascular System - Clinical Nursing Skills | OpenStax](https://openstax.org/books/clinical-nursing-skills/pages/18-2-cardiovascular-system) (OpenStax (Rice University), 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/heart-failure-syndrome-left-and-right-sided-signs/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/heart-failure-syndrome-left-and-right-sided-signs/