Physical finding	Technique
Abdominojugular reflux	Patient position: supine, so that the top of the jugular venous pulsation is seen in the right side of the neck
	Encourage the patient to relax and breathe normally. apply firm steady pressure (25 to 30 mm Hg) to the midabdomen for 30 seconds. The test is positive if there is a sustained (≥ 10-second) 4-cm rise in the venous pressure.
Displaced cardiac apex	Patient position: supine or 45-degree-angle left lateral decubitus
	Palpate the fourth and fifth left intercostal space during expiration. The test is positive if the impulse is outside the midclavicular line.
Gallop rhythm	Patient position: 45-degree-angle left lateral decubitus
	Listen with the bell of the stethoscope lightly applied to the chest wall.
Jugular venous distention	Patient position: supine at 45-degree angle, with head turned to the right
	Perform this test in a well-lit room. adjust the incline of the bed until the top of venous pulsation is visible above the angle of the jaw. measure the distance to the level of the angle of louis.