Symptoms are usually absent until the disease is in an advanced stage. At that point, the symptoms occur because of heart failure. Patients also often show muscular weakness because of a direct alcohol effect on muscles (alcoholic myopathy).

• Ankle, feet, and leg swelling
• Overall swelling
• Loss of appetite
• Shortness of breath, especially with activity
• Breathing difficulty while lying down
• Fatigue, weakness, faintness
• Decreased alertness or concentration
• Cough containing mucus, or pink, frothy material coughed up
• Decreased urine output (oliguria)
• Need to urinate at night (nocturia)
• Sensation of feeling the heart beat (palpitations)
• Pulse may feel irregular or rapid

The examination and tests are directed at diagnosing and evaluating heart failure . Alcoholic cardiomyopathy is usually diagnosed when chronic heavy drinking is discovered as a cause of the heart failure.

Alcoholic patients often also have vitamin deficiencies, especially thiamin deficiency. (The more severe form of this deficiency is beriberi.) Thiamin deficiency also causes alcoholic brain damage (Korsakoff's syndrome, Wernicke-Korsakoff syndrome).

The physical examination may reveal an irregular or rapid heartbeat. There may be distended neck veins, enlarged liver, swelling of the arms and legs, and signs of pleural effusion (fluid around the lungs). Listening to the chest with a stethoscope may reveal lung crackles or abnormal heart sounds. Blood pressure may be low or may drop when the patient stands.

Heart failure may show on these tests:

• Echocardiogram
• Chest X-ray
• Chest CT
• A cardiac catheterization and coronary angiography
• An ECG may show heart enlargement or arrhythmias.
• A myocardial biopsy may be helpful to distinguish alcoholic cardiomyopathy from other diseases that may cause cardiomyopathy
• CPK test