Physical examination Cardiac dullness enlargement Apical impulse displaced leftward or inferiorly Sa or Sa, gallop(tachycardia) Murmurs of tricuspid or mitral regurgitation Pulmonary congestion Systemic congestion e tachypnea Engorgement of jugular vein Dullness and diminished Hepatomegaly, ascites breath sounds at lung bases Pedal edema Rales Shanghai Institute of Cardiovascular DiseasesCardiac dullness enlargement Apical impulse displaced leftward or inferiorly S3 or S4 , gallop (tachycardia) Murmurs of tricuspid or mitral regurgitation Pulmonary congestion • Tachypnea • Dullness and diminished breath sounds at lung bases • Rales Systemic congestion • Engorgement of jugular vein • Hepatomegaly, ascites • Pedal edema