6th May 2025

Symptoms

Right ventricular symptoms	Left ventricular symptoms	Functional symptoms
Bloating Postprandial satiety Bilateral leg swelling	Breathlessness Paroxysmal nocturnal dyspnoea Orthopnoea Bendopnoea Cough Wheezing	Fatigue/weakness/lethargy Loss of appetite Decline in cognition Functional ability can be measured with the NYHA classification

Table 1: Main symptoms of heart failure

NYHA classification	Symptoms
Class I	Patients with cardiac disease with no resulting physical limitations. Asymptomatic with normal activities.
Class II	Patients with cardiac disease and some limitation of strenuous physical activity but are comfortable at rest.
Class III	Patients with cardiac disease and marked limitation of physical activity but are comfortable at rest. Symptomatic with less than ordinary physical activity.
Class IV	Unable to carry out physical activity without discomfort. May be symptomatic even at rest.

Table 2: New York Heart Association (NYHA) classification

Right ventricular signs	Left ventricular signs
Raised JVP (jugular venous pressure) Abdominal distension Shifting dullness Hepatomegaly Hepatojugular reflux Pitting oedema	Bibasal crackles on auscultation of the lungs Tachypnoea Neck vein distension Third heart sound Summation gallop with third and fourth heart sounds Displaced apex beat

Table 3: Key signs of heart failure

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