The complications that occur in the heart due to hypertension are left ventricular hypertrophy, diastolic dysfunction and cardiac failure. There is also associated coronary artery disease. The examination of the heart should be directed to the detection of these findings. The aortic closure sound is accentuated. There may be a heaving apical impulse. Abnormal apex beat, S3 and S4 gallop sounds, loud aortic closure sound (A2). Pulmonary crepitations and elevated JVP denotes heart failure. In the later stages with heart dilatation murmurs of mitral and or tricuspid regurgitation may be heard and there may be a paradoxical split of the second heart sound. ECG can reveal LVH and myocardial ischemia. Echocardiography is one of the most useful methods in the assessment of hypertensive cardiac involvement. The thickness of the left ventricle is increased.