clinical features of left ventricular failure

Last reviewed 09/2021

Possible symptoms:

  • exertional dyspnoea - this precedes orthopnoea and paroxysmal nocturnal dyspnoea
  • orthopnoea
  • paroxysmal nocturnal dyspnoea
  • fatigue
  • symptoms secondary to pulmonary oedema e.g. cough (sometimes with pink froth), haemoptysis, wheeze (cardiac asthma)

Most common signs:

  • tachycardia
  • basal crackles (the worse the heart failure the more widespread the crackles). If these are found then the examiner should ask the patient to cough so to confirm that they are not resolved and thus do represent pulmonary oedema.
  • gallup rhythm - a third heart sound and/or a fourth heart sound

Less common signs:

  • tachypnoea
  • cardiomegaly
  • peripheral cyanosis
  • pleural effusion
  • pulsus alternans (alternating of large and small pulse pressures)