Necropsy Findings:

Left-sided failure:

• Pulmonary congestion and edema
• Heart failure cells (haemosiderin-laded macrophages) appear in alveolar spaces
• Brown induration of lungs

Right-sided failure:

• Liver size is increased and increased weight. On sectioning, nutmeg pattern is seen on liver; congested centre of liver lobules followed by paler fatty peripheral regions.
• Congestion and hypoxia of kidney
• Anasarca, ascites, Hydropericardium
• Enlarged and cyanotic spleen

Diagnosis:

• On basis of physical examination and clinical findings
• On basis of ECG findings; prolonged QRS or P wave