National Physical Therapy Examination (NPTE) Practice Exam

What symptom is a patient with congestive heart failure and right ventricular involvement most likely to present with?

1. Pulmonary edema

2. Renal changes with increasing blood volume

3. Dependent edema

4. Progressive dyspnea

The correct answer is: Dependent edema

A patient with congestive heart failure (CHF) who has right ventricular involvement is most likely to present with dependent edema. In cases of right-sided heart failure, the heart is unable to effectively pump blood returning from the body, leading to an accumulation of blood in the venous system. This causes elevated venous pressure, which results in fluid leakage into surrounding tissues, particularly in dependent areas such as the lower extremities. As gravity pulls the fluid downwards in a standing or sitting position, this condition manifests as swelling in the ankles, feet, and lower legs, known as dependent edema. While pulmonary edema is often associated with left-sided heart failure, it is less prevalent in right-sided heart failure alone. Renal changes with increasing blood volume may occur in heart failure, but they are more a consequence of the heart’s inability to maintain adequate circulation rather than a direct symptom. Progressive dyspnea can be a symptom of left-sided heart failure and may also occur in right-sided heart failure, but it is not as specific a symptom as dependent edema in this context. Thus, dependent edema stands out as the most characteristic symptom for a patient experiencing right ventricular failure due to congestive heart failure.