Congestive Heart Failure 101

Physical Exam Findings

When a physician examines someone with CHF, he or she may find the following:
  • Enlargement of the heart (cardiomegaly)
  • A third heart sound (S3) -- Normally, the heart makes two sounds (S1 and S2) often described as "lub dub, lub dub." In CHF there is a third sound, which is also called an S3 gallop because the three sounds are reminiscent of a horse galloping.
  • Sound of fluid in the lungs during inspiration (Rales)
  • Enlargement of the jugular vein in the neck (jugular venous distention) -- This occurs because CHF causes an increase in the amount of blood and pressure in veins.
  • Enlargement of the liver (hepatomegaly) -- This is caused by a back-up of blood from the heart.
  • Hepatojugular reflex -- When the liver is depressed, more blood travels into the jugular veins, causing them to become even more enlarged.
  • Edema -- This is usually located in the legs, ankles, feet. The term "pitting edema" is often used because applying slight fingertip pressure produces a temporary pit which resolves quickly.
  • Fast heart rate (tachycardia)
  • Increased rate of breathing (tachypnea)
  • High blood pressure (hypertension)
  • Low blood pressure (hypotension) -- When the cardiac output is severely decreased, then low blood pressure occurs. This is obviously an ominous sign and may mean death is imminent. This is also called cardiogenic shock.
  • Fluid in the abdominal cavity (ascites)
  • Fluid in the space between the lungs and the ribs (pleural effusion)