Signs of RV failure include Nontender peripheral pitting edema (digital pressure leaves visible and palpable imprints, sometimes quite deep) in the feet and ankles Enlarged and sometimes pulsatile liver palpable below the right costal margin Abdominal swelling and ascites Visible elevation of the jugular venous pressure, sometimes with large a or v waves that are visible even when the patient is seated or standing (see figure) In severe cases of heart failure, peripheral edema can extend to the thighs or even the sacrum, scrotum, lower abdominal wall, and occasionally even higher.