Expansion
Left failure causes pulmonary congestion; right failure causes systemic congestion
Expansion
Left heart failure - congestion behind the left ventricle, in the lungs
- Breathlessness, orthopnoea, paroxysmal nocturnal dyspnoea
- Fine bibasal crackles, pink frothy sputum
- Third heart sound, displaced apex beat
- Fatigue from low forward output
Right heart failure - congestion behind the right ventricle, in the systemic veins
- Raised jugular venous pressure
- Peripheral oedema, sacral in the bed-bound
- Tender hepatomegaly, ascites
- Hepatojugular reflux
The commonest cause of right heart failure is left heart failure, because raised left atrial pressure is transmitted back through the pulmonary circulation. When right failure results from primary lung disease instead, it is called cor pulmonale.
Congestive cardiac failure describes the combined picture.