a 63-year-old woman with a 3-day history of hypertension, hyperlipidemia, and myocardial infarction presents to the emergency room with shortness of breath at rest. she has found it difficult to walk short distances due to shortness of breath. additionally, she complains of orthopnea, nocturnal dyspnea, and generalized abdominal discomfort. she denies cough, fever, chills, diaphoresis, anxiety, chest pain, pleurisy, cough, nausea, vomiting, diarrhea, rashes, lightheadedness, and syncope. she is well nourished and afebrile, but tachypnic and diaphoretic. there is a diminished first heart sound, s3 gallop, laterally displaced pmi, bibasilar rales and dullness to percussion, and expiratory wheezing noted. the abdominal exam reveals distension, with hepatomegaly in the right upper quadrant. there is 2 pitting edema of the lower extremities to the level of the mid calf, and the extremities are cool. question: what additional finding is expected in this patient?

Medicine
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