A physical examination is performed to look for typical signs of pulmonary hypertension. These include altered heart sounds, such as a widely split S or second heart sound, a loud P or pulmonic valve closure sound (part of the second heart sound), (para)sternal heave, possible S or third heart sound, and pulmonary regurgitation. Other signs include jugular venous distension (enlargement of the jugular veins), peripheral edema (swelling of the ankles and feet), ascites (abdominal swelling due to the accumulation of fluid), hepatojugular reflux, and clubbing.