Heart Failure Symptoms: Understanding Left and Right Heart Failure

Heart failure does not have just three specific characteristics. Instead, it can be categorized into left-sided and right-sided heart failure, each with its own distinct symptoms and clinical features.

Left-Sided Heart Failure

1. Orthopnea

One of the key signs of left-sided heart failure is orthopnea, which refers to difficulty breathing while lying flat. Patients may initially experience a dry cough, especially at night when they are in a reclining position. Sitting up often relieves this sensation, making it a classic indicator of left heart failure.

2. Exertional Dyspnea

Shortness of breath during physical activity—such as walking or performing routine tasks—is another common symptom. Patients may feel out of breath or experience a sensation of being unable to catch their breath, which often worsens with exertion. This symptom is closely associated with left-sided heart dysfunction.

3. Reduced Cardiac Output

When the heart struggles to pump enough blood, it can lead to systemic symptoms like fatigue, generalized weakness, and dizziness. These signs are due to decreased oxygen delivery to muscles and vital organs, reflecting the heart's inability to meet the body's demands.

Right-Sided Heart Failure

Systemic Venous Congestion

Right heart failure primarily affects the venous system, causing systemic congestion. This often manifests as swelling in the lower extremities—known as peripheral edema—where pressing on the skin leaves an indentation. In more severe cases, patients may develop swelling in the scrotum or other dependent areas.

Additionally, congestion can occur in major organs such as the liver, gastrointestinal tract, and kidneys. This may lead to poor appetite, abdominal discomfort, and even hepatomegaly (enlarged liver). Some patients may progress to liver dysfunction or cirrhosis due to prolonged congestion.

Fluid Accumulation and Jugular Venous Distention

Excess fluid buildup can also cause effusions in multiple body cavities, including pleural effusion (fluid around the lungs), ascites (fluid in the abdomen), and pericardial effusion (fluid around the heart). Another notable sign is jugular venous distention, where the neck veins appear visibly swollen due to increased venous pressure.