In general, signs of both left sided heart failure and right sided heart failure are present. Signs that represent acute left sided failure include cool clammy skin, cyanosis, rales and a gallop rhythm. Signs that represent right sided failure include an elevated JVP, pedal edema, ascites, hepatomegaly, a parasternal heave and hepatojugular reflux.

• The patient is often sitting upright and there may be labored breathing during an acute episode
• The patient’s weight should be recorded to ascertain how far they are from their “dry” weight

• Tachycardia may be present during an episode of acute heart failure

• A narrow pulse pressure (systolic blood pressure minus diastolic blood pressure is < 25 mm Hg) may be present

• Tachypnea (an increased rate of breathing) and an increased work of breathing may be present during an episode of acute heart failure

• The skin is cool and clammy consistent with hypoperfusion or cardiogenic shock may be present during an episode of acute heart failure
• Cyanosis is observed if severe hypoxemia is present during an episode of acute heart failure
• Anasarca may be present due to chronic heart failure

• Jugular vein distention is often present in both acute and chronic heart failure
• Central venous pressure > 16 cmH₂O is often present in both acute and chronic heart failure

• Pleural effusion with dullness to percussion at the bases may be present in both acute and chronic heart failure
• Rales is often present in both acute and chronic heart failure

• If the right ventricular pressure is increased, a parasternal heave may be present, signifying the compensatory increase in contraction strength.

• S3 and a gallop rhythm
• Underlying valvular causes of diastolic heart failure such as mitral stenosis, and aortic stenosis may be auscultated

• Hepatojugular reflux
• Hepatomegaly may be present as a result of chronic heart failure
• Ascites may be present as a result of chronic heart failure

• Bilateral ankle edema may be present as a result of chronic heart failure

• Confusion and altered mentation may be present in the setting of acute heart failure

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