Coughing and wheezing are common. Rales and rhonchi are variable but not uncommon, and frank pulmonary edema with frothy, blood-stained sputum is rare. Increased respiration results in fatigue and increased metabolic demands, leading to poor feeding, inadequate intake, and failure to thrive, although head circumference and growth in length are not usually compromised. Growth failure may be partially masked by fluid retention and decreased urine volume that lead to inappropriate weight gain. Other symptoms include restlessness, irritability, and excessive sweating.
Cardiomegaly occurs, except with constrictive pericarditis and severe pulmonary venous obstruction.
Poor myocardial function is reflected in poor heart sounds, gallop rhythm, signs of poor peripheral perfusion with cool extremities and with decreased pulse volume and capillary filling, and a gray rather than blue color. In RV failure, hepatomegaly is a common and reliable sign in infancy and a sensitive guide to the effectiveness of therapy. Pain and tenderness secondary to hepatic engorgement and an abnormal jugular venous pulse, although useful signs in older children, are not reliable in infants. Peripheral edema occasionally occurs, particularly on the backs of hands and feet and in the periorbital area. Few laboratory findings in HF are specific.