• chest pain
  • experienced under the sternum
  • may radiate to the neck, jaw, back, shoulder, arm
  • may feel tight, pressure, crushing, squeezing
  • may or may not be relieved by rest or nitroglycerin
• sensation of feeling the heart beat (palpitations)
• irregular or rapid pulse
• shortness of breath, especially with activity
• shortness of breath that occurs after lying down for a while
• cough
• fatigue, weakness, faintness
• decreased alertness or concentration
• decreased urine output
• excessive urination at night
• overall swelling
• breathing difficulty when lying down

The physical examination may be normal, or it may reveal signs of fluid buildup (leg swelling, enlarged liver, "crackles" in the lungs, extra heart sounds, or an elevated pressure in the neck vein). There may be other signs of heart failure.

The diagnosis of this condition is usually made only if a test shows a decreased ejection fraction (the pumping function of the heart). A normal ejection fraction is around 55-65%. Most patients with this disorder have ejection fractions much less than this. Tests used to measure ejection fraction include:

• Echocardiogram
• Ventriculogram performed during a cardiac catheterization
• Gated SPECT
• MRI of chest

An ECG may show enlargement, previous heart attack, changes to the blood supply to the heart, arrhythmias, or other abnormalities.

A biopsy of the heart is rarely needed to rule out other disorders.

Lab tests that may be used to rule out other disorders and to assess the condition of the heart include:

• CBC
• Coronary risk profile
• Blood chemistries
• Cardiac biochemical markers (CK-MB, troponin)