Which sign may suggest a patient with heart failure is nearing an exacerbation?

Increased difficulty breathing while lying flat, known as orthopnea, is a significant sign that may indicate a patient with heart failure is nearing an exacerbation. Patients with heart failure often experience fluid retention and pulmonary congestion, which can worsen when they are in supine positions due to gravity’s effect on fluid distribution in the body. When a patient begins to have increased difficulty breathing while lying flat, it is an indicator that their heart failure is potentially worsening, prompting the need for further evaluation and possible intervention.

The other options do not reflect immediate concern for worsening heart failure. Feeling great after starting a new medication could suggest effective treatment, loss of appetite that occurs infrequently may not be associated with a significant change in the patient’s condition, and a stable weight over the last month usually indicates that the patient's fluid status is managed effectively. These signs neither suggest an acute exacerbation nor the immediate need for medical reassessment.