Which finding best represents left-sided signs on exam?

• A. Pleural effusion
• B. Gargling
• C. Stridor
• D. Crackles

Answer: (D)

Left-sided problems, such as left ventricular failure, back up fluid into the lungs and cause pulmonary edema. That fluid in the alveoli and interstitium changes the way air moves when you breathe, and you hear crackles (often at the bases) with lung auscultation. Crackles are the classic lung sound indicating left-sided involvement because they directly reflect fluid in the lungs from the backward pressure of the failing left heart.

Pleural effusion can occur with heart failure too, but it isn’t as specific to left-sided pulmonary involvement and you’d expect decreased breath sounds or dullness to percussion over the affected area rather than the widespread crackling sounds of edema. Gargling and stridor come from the upper airway or throat and don’t indicate left-sided cardiac dysfunction.