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appears
Fatigue
Dyspnea on exertion, shortness of breath
Orthopnea, paroxysmal nocturnal dyspnea
Increasing edema, weight, or abdominal girth
On physical examination, look for signs of hea rt failure and volume overload. Assess vital signs w ith specifi c attention to the following:
Tachypnea
Tachycardia
Hypertension
Signs of hypoxia (eg, cyanosis, clubbing)
Jugular venous distension (JVD)
Pulmonary edema (crackles and/or wheezes)
S 3 gallop
Enlarged liver
Peripheral edema
Cardiomegaly (broad and displaced point of maximal impulse, right
ventricular heave)
Murmurs (with appropriate manoeuvres)
S 2 at the base (paradoxical splitting, prominent P 2), S 3, and S 4
Irregularly irregular rhythm
Tachycardia
gallop
mitral regurgitation
Edema
pericardial friction rub.