Which of the following is a classic symptom of right sided heart failure?

Hepatic enlargement is a classic symptom of right-sided heart failure due to the congestion of blood that occurs when the right side of the heart is unable to effectively pump blood to the lungs for oxygenation. This inefficiency leads to blood backing up into the systemic circulation, which can result in increased pressure in the blood vessels of the liver. As a result, the liver may become engorged or enlarged, a condition known as hepatic congestion.

This symptom often reflects the underlying pathology of right-sided heart failure, which can be associated with conditions like chronic obstructive pulmonary disease (COPD) and various forms of valvular heart disease. The process of blood pooling in venous circulation can also cause fluid accumulation in the abdomen (ascites) and swelling in the lower extremities.

Other symptoms listed, while they may be relevant in other contexts, do not represent the classic signs of right-sided heart failure. For instance, orthopnea, which is difficulty breathing when lying flat, is more commonly associated with left-sided heart failure. Chest pain can arise from various cardiac issues but is not specifically indicative of right-sided heart failure. Sudden fainting spells may be associated with significant cardiac events but do not characteristically indicate right-sided heart failure.