Isolated right heart failure commonly presents with which finding?

• A. Pulmonary edema
• B. Jugular venous distension
• C. Orthopnea
• D. Pleural effusion

Answer: (B)

Isolated right heart failure causes congestion of the systemic venous system because the right ventricle can’t effectively move blood into the pulmonary circulation. The hallmark sign reflects this elevated right atrial pressure: jugular venous distension. You’ll see prominent neck veins that stay distended at a 30–45 degree angle and don’t collapse with light pressure, signaling systemic venous congestion.

Pulmonary edema, orthopnea, and pleural effusion are more tied to left-sided pressures or combined failure. Pulmonary edema results from high left-sided pressures backing into the lungs, causing dyspnea worsened when lying flat (orthopnea). Pleural effusions can occur with right heart failure but are less specific than the clear sign of elevated jugular venous pressure. So, the finding that best reflects isolated right-sided congestion is jugular venous distension.