The patient should lie down in the supine position and be examined for signs of right heart failure or other vascular disease. (See chapter on GIT exam)
An enlarged liver or pulsatile liver can indicate right heart failure or severe tricuspid incompetence. In prolonged and severe cases, this may lead to jaundice and chronic liver disease (cardiac jaundice). Splenomegaly may indicate infective endocarditis. The examiner should rest the hand on the abdomen to note any pulsation that could indicate an aortic aneurysm (an insensitive but specific finding) and auscultate the abdomen for any bruits suggestive of vascular disease (e.g. renal artery stenosis, iliac stenosis). Blood on urinalysis may indicate nephritis related to infective endocarditis or a vasculitis (e.g. systemic lupus erythematosis).