What is a common presentation of pulmonary congestion in heart failure?

The presentation of orthopnea in pulmonary congestion associated with heart failure is characterized by shortness of breath that occurs when a person is lying flat. This symptom results from the accumulation of fluid in the lungs when the body is in a supine position, leading to increased venous return and pulmonary venous pressure. As a result, patients often find relief by propping themselves up with pillows or sleeping in a more upright position.

While peripheral edema, palpitations, and syncope can also occur in heart failure, they are not directly indicative of pulmonary congestion. Peripheral edema is more related to right-sided heart failure and fluid retention. Palpitations can happen due to various factors, including arrhythmias that are not necessarily linked to pulmonary congestion itself. Syncope may result from insufficient cardiac output but is not a direct symptom of fluid accumulation in the lungs. Therefore, orthopnea stands out as a specific sign of pulmonary congestion in the context of heart failure.