Which assessment finding is most indicative of congestive heart failure?

Dyspnea on exertion is a key indicator of congestive heart failure (CHF) due to the heart's inability to pump efficiently, leading to fluid accumulation in the lungs, which causes shortness of breath during physical activity. In patients with CHF, the compromised cardiac output means that during exertion, the body requires more oxygen, but the lungs struggle to deliver that oxygen effectively due to the backed-up fluid. This results in the classic symptom of dyspnea, which is directly related to the heart's failing ability to meet the body's demands.

While swelling in the extremities can also be associated with congestive heart failure, it typically occurs later in the disease process and is more indicative of fluid overload rather than the immediate function of the heart. Elevated blood sugar levels are not a specific indicator of CHF; they may be seen in various conditions, including diabetes mellitus, but are not directly related to heart failure. Chest pain radiating to the arm is often associated with myocardial ischemia or heart attack rather than congestive heart failure. Therefore, dyspnea on exertion stands out as the most significant and specific symptom indicative of CHF.