**6. Physical examination**

Physical signs vary depending on the severity of the pulmonary hypertension and associated right heart failure. Cardiac auscultation may be notable for accentuated pulmonic valve closure, tricuspid regurgitant murmur, or possibly bruit over the lung fields caused by turbulent blood flow through partially occluded pulmonary arteries [55, 56]. At a late stage, clinical signs of right ventricular failure may be present (jugular venous distension, hepatoju‐ gular reflux, lower limb edema, enlarged liver, and ascites). [56, 57].
