The side that fails decides where the fluid backs up. Left → lungs. Right → rest of the body.
Heart Failure: Left vs. Right
The side that fails decides where the fluid backs up. Left → lungs. Right → rest of the body.
Left-sided: backs up into the LUNGS
- Shortness of breath, worse lying flat (orthopnea)
- Waking up breathless at night
- Crackles in the lungs, cough
- Pink, frothy sputum: pulmonary edema, an emergency
- S3 heart sound
- Fatigue, confusion, less urine (low output)
Right-sided: backs up into the BODY
- Jugular vein distention (JVD)
- Swelling in the legs, ankles, or sacrum
- Weight gain from fluid
- Enlarged liver, fluid in the abdomen (ascites)
- Feeling full, poor appetite, nausea
- The most common cause is left-sided failure
The core medicines (reduced ejection fraction)
| Medicine | Examples | Watch for |
|---|---|---|
| ACE inhibitor, ARB, or ARNI | lisinopril, losartan, sacubitril-valsartan | Low BP, high potassium, dry cough (ACE), facial swelling |
| Beta blocker | carvedilol, metoprolol succinate, bisoprolol | Slow heart rate, low BP, fatigue |
| Aldosterone blocker (MRA) | spironolactone, eplerenone | High potassium, kidney function |
| SGLT2 inhibitor | dapagliflozin, empagliflozin | Genital yeast infections, dehydration |
| Loop diuretic (for fluid) | furosemide, bumetanide | Low potassium, low BP, daily weight, intake and output |
Sources
- Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145:e895–e1032.
- MedlinePlus (U.S. National Library of Medicine). Heart failure: what to ask your doctor; daily weight monitoring guidance.
For exam study only. In clinical practice, follow your facility's policies, the prescriber's orders, and current references. Free to print and share for personal and classroom study; not for resale. NCLEX® is a registered trademark of NCSBN, which does not endorse NCLEXSim.
More med-surg visual sheets
The diagnostic numbers from the 2024 consensus, the treatment order (fluids, potassium, insulin), insulin onset and peak, and the rule of 15.
Low vs. high for the four big electrolytes: what you'll see, the ECG clues, common causes, and the first nursing actions.
Read any blood gas in three steps with ROME, see the four disorders and their common causes, and check yourself with two worked examples.
Hypovolemic, cardiogenic, distributive, and obstructive shock side by side, the numbers to watch, and the sepsis first-hour steps.
Spot it with BE-FAST, tell ischemic from hemorrhagic, the first-hour checklist with BP limits, and left- vs right-brain deficits.
How they differ, rescue vs. controller inhalers, peak-flow zones, the 88–92% oxygen target in COPD, and the red flags.
Practice the way the NCLEX tests you
1,059 fact-checked questions, a full adaptive exam that stops by the real rules, a proctored test-day mode with an integrity report, 8 NGN case studies, bedside simulations, and ACLS megacodes. Free. Already paying for a question bank? Keep it, and rehearse test day here.