Which of the following is a classic sign of fluid retention in heart failure?

• A. Elevated liver enzymes
• B. Tinnitus
• C. Polyuria
• D. Pitting edema

Answer: (D)

Fluid overload from heart failure most clearly presents as pitting edema—the classic sign of fluid retention. When venous pressure is elevated and kidneys retain sodium and water, fluid shifts into the interstitial spaces, especially in dependent areas like the ankles and legs. Pressing on the skin leaves a dent that takes time to rebound, signaling excess extracellular fluid. This peripheral swelling is a hallmark of fluid overload and often responds to diuresis and body position changes.

Elevated liver enzymes can occur with hepatic congestion in advanced heart failure, but they’re not the immediate, recognizable sign of fluid retention. Tinnitus and polyuria aren’t typical indicators of fluid overload in heart failure.