Which one of the following finding is Not associated with left-sided hea failure?
A hepatojugular reflux indicates liver congestion caused by the backup of blood into the venous circulation, secondary to problems in the right hea (e.g., right-sided hea failure, tricuspid stenosis, tricuspid regurgitation) An S3 hea sound occurs during the rapid-filling phase of the ventricle in early diastole. In mitral valve incompetence and increased preload in the left ventricle, an S3 hea sound is an excellent indicator of ventricular failure. The increased left ventricular end diastolic pressure is reflected back into the left atrium, with a subsequent increase in the hydrostatic pressure in the pulmonary veins. When pulmonary venous pressure is greater than the pulmonary capillary onco tic pressure, a transudate leaks first into the interstitium (Kerley lines on a chest radiograph) and eventually into the alveoli, resulting in pulmonary edema and congestion. Dyspnea, or the sensation of difficult or uncomfoable breathing, is the most common symptom of left sided hea failure. When a patient with left-sided hea failure lies down, the reduced gravitational force increases venous return to the hea. Because the left ventricle cannot handle the increased load, the blood backs up into the lungs, producing dyspnea. Paroxysmal nocturnal dyspnea specifically refers to a choking sensation that wakens the patient at night. It usually subsides) to 20 minutes after the patient stands up, opens the window, and takes deep breaths. Another finding associated with left-sided hea failure is reduced renal perfusion, which occurs during the day due to the decreased cardiac output. Reduced cardiac output decreases the effective aerial blood volume and the glomerular filtration rate, allowing a greater reabsorption of urea in the proximal tubule. Because creatinine is neither reabsorbed nor secreted in the tubules, a reduction in the glomerular filtration rate causes a minor increase in serum creatinine. The dispropoionate increase in the blood urea nitrogen level over that of the serum creatinine is called prerenal azotemia. Ref - Harrison's principles of internal medicine 20e / pubmed.com
Pulmonary edema
Hepatojugular reflux
Paroxysmal nocturnal dyspnea
Prerenal azotemia
C.V.S