Otherwise rhythm is regular. No murmur, rub, or gallop. A panniculus overlies the lower abdomen that rests on the upper thighs when the patient is sitting. The abdomen is soft. Nontender to palpation.
Bowel sounds are normally active.
Although it is difficult to palpate, there appears to be no hepatosplenomegaly. Exam deferred per patient request. Exam deferred at this time. The extremities show no cyanosis or edema. There are multiple scratches and scars noted on the lower limbs and on the hands.