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so were thinking now about the clinical features in heart failure and on this side this person has got mostly left heart failure and on this side this persons got mostly right heart failure but of course in more established cases of heart failure it can be difficult to tell the difference between right and left failure because both the ventricles fair we get bilateral heart failure lets think first about the jugular venous pressure now we get the patient to turn their head to the right and we look at the jugular veins in the neck here and if the jugular venous pressure is increased that is a sign of heart failure and this is particularly prominent in someone with right heart failure we tend to get very prominent and jugular veins increased jugular venous pressure you can get it as well in patients that are predominantly left heart failure but usually very predominant in patients with with right heart failure now cardiomegaly is another feature the heart normally doesnt occupy more
