A patient with left-sided heart failure would most likely have which of the following findings on chest auscultation?

• A. Bibasilar crackles
• B. Pulmonary edema
• C. Cardiomegaly
• D. Normal breath sounds

Answer: (A)

Left-sided heart failure increases pressure in the pulmonary circulation, pushing fluid into the interstitium and alveoli. That fluid disrupts normal air-tissue interfaces and causes fluid to cause small airway reverberations, which you hear as crackling sounds, especially at the bases where fluid tends to accumulate with gravity. So bibasilar crackles are the classic auscultatory finding in this setting. Pulmonary edema describes the fluid overload itself, and while it can accompany crackles, the specific auscultation finding you’d identify is crackles. Cardiomegaly is an enlarged heart seen on imaging or with a displaced impulse, not a lung sound, and normal breath sounds would be unlikely when edema is present.