Which clinical sign is most associated with left-sided heart failure?

Left-sided heart failure is primarily characterized by its effect on the lungs and pulmonary circulation. When the left ventricle fails to effectively pump blood, it can lead to an accumulation of blood in the pulmonary circulation, resulting in increased pulmonary venous pressure. This condition causes pulmonary congestion and edema, which manifests clinically as shortness of breath, decreased exercise tolerance, and symptoms of respiratory distress.

In contrast, the other signs listed are more associated with right-sided heart failure or systemic issues rather than being primary manifestations of left-sided heart failure. For instance, peripheral edema typically indicates right-sided heart failure due to fluid retention in the extremities. Jugular venous distention is a sign that often reflects elevated right atrial pressure, commonly seen in right-sided heart failure. Hepatomegaly, or liver enlargement, can occur if there is significant congestion in the venous system associated with right heart failure.

Thus, pulmonary congestion is the hallmark clinical sign of left-sided heart failure, directly linking it to the ineffective pumping of the left ventricle and its impact on lung function.