NREMT Paramedic Practice

Which of the following is a sign of left-sided heart failure?

1. Fluid accumulation in serous cavities

2. Tachycardia

3. Pulsus alternans

4. Crackles in the lungs

The correct answer is: Crackles in the lungs

Crackles in the lungs, often referred to as rales, are a classic sign of left-sided heart failure. This condition leads to a backlog of blood in the left atrium and subsequently the pulmonary circulation. When the left ventricle fails to pump effectively, pressure builds up in the pulmonary capillaries, causing fluid to leak into the alveoli of the lungs. The presence of this fluid creates the characteristic crackling sounds heard during auscultation. These sounds often indicate pulmonary congestion, which is a direct consequence of the heart's inability to manage its volume load. Other possible signs of left-sided heart failure, such as fluid accumulation in serous cavities, tachycardia, or pulsus alternans, can relate to different cardiovascular or systemic conditions but are not as specific to left-sided heart failure as crackles in the lungs. Hence, recognizing crackles during a physical exam is crucial for diagnosing and managing patients with left-sided heart failure effectively.