Clinical Features

• Nocturia

• Fatigue

• Tachycardia, various arrhythmias

• S3/S4 gallop on auscultation

• Pulsus alternans

• Cachexia

Pulmonary congestion

• Dyspnea , orthopnea (a sensation of shortness of breath that occurs upon lying down and is relieved by sitting up)

• Pulmonary edema

• Paroxysmal nocturnal dyspnea

  • Nocturnal bouts of coughing and acute shortness of breath

  • Caused by reabsorption of peripheral edema at night → increased venous return

• Cardiac asthma

  • Increased pressure in the bronchial arteries → airway compression and bronchospasm

  • Symptoms mimic asthma, with shortness of breath, wheezing, and coughing.

• Bilateral basilar rales may be audible on auscultation.

• Laterally displaced apical heart beat (precordial palpation beyond the midclavicular line)

• Coolness and pallor of lower extremities

Symptoms of fluid retention and increased CVP

• Peripheral pitting edema: as a result of fluid transudation due to increased venous pressure

• Hepatic venous congestion symptoms

  • Abdominal pain

  • Jaundice

• Other symptoms of organ congestion (e.g., nausea, loss of appetite in congestive gastropathy

• Jugular venous distention: visible swelling of the jugular veins due to an increase in CVP and venous congestion

• Kussmaul sign

• Hepatosplenomegaly: may result in cardiac cirrhosis and ascites

• Hepatojugular reflux: jugular venous congestion induced by exerting manual pressure over the patient's liver → ↑ right heart volume overload → inability of the right heart to pump additional blood → visible jugular venous distention that persists for several seconds