Hepatojugular reflux

Physical examination findings may include pulmonary crackles, an S3 gallop, cool extremities, Cheyne-Stokes respiration, tachycardia, narrow pulse pressure, cardiomegaly, symptoms of pulmonary edema (extreme breathlessness, anxiety, sometimes with coughing pink, frothy sputum), peripheral edema, jugular venous distention, hepatojugular reflux, and hepatomegaly. 

The efficacy of diuretic treatment is evaluated by disappearance of the signs and symptoms of excess fluid retention. Physical examination should focus on body weight, extent of jugular venous distension, presence of hepatojugular reflux, and presence and severity of pulmonary congestion (rales, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea) and peripheral edema. 

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