Tachycardia and left parasternal or epigastric heaves of the right ventricle are observed. The second heart sound is emphasised and a pansystolic heart murmur can be heard, suggesting tricuspid insufficiency. Pulmonary insufficiency can occasionally be heard on auscultation. In the advanced stage, oedema of the legs, ascites, distention of the veins of the neck, hepatomegaly and cyanosis are also present as signs of right heart decompensation. Findings from auscultation of the lungs are usually normal.