The character of the JVP, by assessing JVP waves.
![bounding pulse bounding pulse](http://image.slidesharecdn.com/cardiacassessment-131223000907-phpapp01/95/cardiac-assessment-35-638.jpg)
![bounding pulse bounding pulse](https://image.slidesharecdn.com/atrialregurgitation-160319082853/95/atrial-regurgitation-7-638.jpg)
Palms: Osler nodes, Janeway lesions (see “ Clinical features of infective endocarditis ”).Central cyanosis (see features of “ Cyanotic congenital heart defects ” and “ Congestive heart failure ”).Features of rheumatic fever: migrating polyarthritis, erythema marginatum, subcutaneous nodules.Syndromic features (e.g., in trisomy 21, trisomy 18 associated with congenital heart defects).Palpitations : an unpleasant awareness of one' s own heartbeat can feel like a fluttering or pounding in the chest.Chest pain (see “ Cardiovascular causes of chest pain ”).