Backward failure in heart failure most directly leads to congestion in which circulatory beds?

• A. Cerebral perfusion increased.
• B. Coronary arteries stenosis.
• C. Pulmonary and systemic venous congestion.
• D. Renal artery vasodilation.

Answer: (C)

Backward failure happens when the ventricle can’t handle incoming blood, so pressure backs up into the veins that drain into that ventricle. That creates congestion in the upstream venous beds. If the left ventricle is involved, blood backs up into the pulmonary veins, causing pulmonary congestion and edema. If the right ventricle is involved, blood backs up into the systemic venous circulation, leading to systemic venous congestion (edema, JVD, liver congestion). Since backward failure directly increases venous pressures, the congestion occurs in both the pulmonary venous bed and the systemic venous beds. The other options describe effects that aren’t driven by venous back-pressure.