Which sign or symptom is not expected in a patient with acute heart failure?

• A. Bilateral wheezing
• B. Orthopnea
• C. Bibasilar crackles
• D. Elevated jugular venous pressure

Answer: (A)

In acute heart failure, the body’s fluid overload and venous congestion produce classic signs such as orthopnea, bibasilar crackles from pulmonary edema, and elevated jugular venous pressure from increased right-sided pressures. These findings reflect fluid backing up into the lungs and systemic circulation as the failing heart can’t keep up.

Bilateral wheezing is not a typical or defining sign of acute heart failure. While some patients may have wheezes or a “cardiac asthma” component if airway reactivity or edema is present, wheezing is more characteristic of obstructive airway diseases like asthma or COPD. In the setting of acute HF, the expected signs are the others mentioned above, making bilateral wheezing the not-typical choice.