Which sign most strongly suggests right-sided heart failure?

• A. Peripheral edema alone.
• B. Jugular venous distension with peripheral edema and hepatomegaly.
• C. Pitting edema without JVD.
• D. Chest pain.

Answer: (B)

Right-sided heart failure causes systemic venous congestion, so signs reflect backflow into the venous system. Jugular venous distension signals elevated central venous pressure, which is the hallmark of the failing right ventricle trying to push blood into a congested venous system. When this is present together with peripheral edema and hepatomegaly, it shows that venous congestion is widespread—edema in the extremities and enlargement of the liver due to congested hepatic veins—which is classic for right-sided failure.

Peripheral edema by itself can occur for many reasons, such as dependent edema from gravity or venous insufficiency, and thus is less specific. Pitting edema without JVD doesn’t localize to the systemic venous congestion that characterizes right-sided failure. Chest pain points toward ischemic processes rather than heart failure per se.