Which clinical manifestations are most commonly associated with left-sided heart failure? (Select all that apply)

A. Fluid accumulation in the alveoli due to pulmonary venous congestion results in crackles (rales) heard on auscultation, particularly in the lower lobes. This is a hallmark sign of left-sided heart failure. B. Jugular vein distension indicates systemic venous congestion, which is characteristic of right-sided heart failure, not left-sided. In left-sided failure, systemic venous pressure is usually normal unless there is biventricular involvement. C. Ascites develops from right-sided heart failure, where elevated venous pressures lead to fluid accumulation in the peritoneal cavity. It is not a primary manifestation of left-sided failure. D. Pulmonary congestion reduces gas exchange, leading to dyspnea, which may be worsened by exertion, lying flat (orthopnea), or awakening at night with sudden breathlessness (paroxysmal nocturnal dyspnea). E. Left-sided ventricular failure causes increased pulmonary venous pressure, resulting in pulmonary edema, impaired oxygen diffusion, and the sensation of air hunger. Pulmonary congestion is a core pathophysiologic feature of left-sided heart failure. F. Pulmonary edema can cause a moist, productive cough with frothy sputum, reflecting fluid accumulation in the alveoli and airways. This is a classic symptom of left-sided heart failure and is often worse at night. G. Peripheral edema is associated with right-sided heart failure due to systemic venous congestion, leading to fluid accumulation in the lower extremities, sacrum, or dependent areas. In isolated left-sided failure, peripheral edema is typically absent.