Which symptom is most commonly associated with left-sided heart failure?

• A. Abdominal pain
• B. Peripheral edema
• C. Shortness of breath
• D. Nausea

Answer: (C)

Left-sided heart failure usually shows up first with pulmonary symptoms because the backup of blood in the lungs raises pressures in the pulmonary capillaries, leading to edema and difficulty breathing. The most common presenting symptom is shortness of breath, often worsened with exertion and possibly accompanied by orthopnea or paroxysmal nocturnal dyspnea as fluid shifts when lying down. Abdominal pain and nausea are not typical primary features of left-sided failure, while peripheral edema is more characteristic of right-sided congestion (or advanced, biventricular failure). So, the symptom that best reflects the pulmonary congestion from left-sided dysfunction is shortness of breath.