NYHA class II or III

Carnett sign: A bedside maneuver used to help distinguish abdominal wall pain from visceral pain. The examiner identifies the point of maximal tenderness and maintains pressure while the patient tenses the abdominal muscles (by lifting the head/shoulders or raising the legs). Pain that remains unchanged or worsens with muscle tensing (positive Carnett sign) suggests an abdominal wall source, whereas decreased pain suggests intra-abdominal/visceral pathology. The sign is more specific than sensitive and is most useful in patients with localized tenderness and otherwise benign evaluation.