Intensive Care Medicine (ICM) Practice Exam

Which finding is likely to indicate right heart failure?

1. Jugular venous distension

2. Elevated liver enzymes

3. Decreased oxygen saturation

4. High blood pressure

The correct answer is: Jugular venous distension

Jugular venous distension is a key clinical sign that indicates increased central venous pressure, which is often a result of right heart failure. In right heart failure, the right ventricle is unable to effectively pump blood into the pulmonary circulation. Consequently, blood backs up into the right atrium and subsequently into the systemic circulation, leading to increased pressure in the veins that return blood to the heart. As the pressure builds up in the venous system, it causes the jugular veins to become engorged, which can be observed by physical examination. This finding not only reflects fluid overload characteristic of right heart failure but can also be indicative of conditions such as congestive heart failure, cardiac tamponade, or other forms of circulatory compromise. In contrast, elevated liver enzymes may occur due to hepatic congestion associated with right heart failure, but they are not specific to the condition alone as they can result from various hepatic problems. Decreased oxygen saturation is typically associated with respiratory issues or left heart failure rather than being a primary indicator of right-sided heart failure. High blood pressure can be seen in various conditions and is not specifically indicative of right heart failure; in fact, right heart failure may occur even with normal or low blood pressure due to volume