Which sign suggests right-sided heart failure in pulmonary hypertension?

• A. Jugular venous distention
• B. Diminished breath sounds
• C. Pleural effusion on X-ray
• D. Hyperresonant percussion note

Answer: (A)

Jugular venous distention shows elevated venous pressure from the failing right heart. In pulmonary hypertension, the right ventricle has to pump against high pressure, and over time it may fail, causing blood to back up into the systemic venous circulation. This back-pressure manifests as distended neck veins that are visible when examining the patient, especially with the head of the bed elevated. It’s a direct sign of right-sided congestion and correlates with right-sided heart failure.

Diminished breath sounds can occur for many lung reasons and aren’t specific to right heart failure. A pleural effusion on X-ray can be seen with heart failure but isn’t a bedside sign of right-sided failure itself. Hyperresonant percussion suggests air in the chest, such as pneumothorax or emphysema, not venous congestion from right-heart failure.