Symptoms:

• Shortness of breath
• Difficulty lying down; need to sleep with the head elevated to avoid shortness of breath
• Sensation of feeling the heartbeat (palpitations)
• Irregular or rapid pulse
• Cough (produces frothy or blood-tinged mucus)
• Fatigue, weakness, faintness
• Weight gain from fluid retention
• Decreased urine production (oliguria)
• Infants may have poor feeding, weight loss, and failure to thrive

Signs and tests:

Physical examination may reveal an irregular or rapid heartbeat and increased rate of breathing. Listening to the heart may reveal heart murmurs or extra heart sounds, and listening to the lungs may reveal crackles or decreased breath sounds at the bottom. The skin of the legs may have excessive fluid and may remain dimpled when pressed.

Tests may include the following:

• Electrocardiogram (ECG) may show evidence of prior heart attack, an enlarged heart, or abnormal heart rhythm.
• Chest X-ray may show an enlarged heart and fluid in or around the lungs.
• Ultrasound of the heart (echocardiogram): poor pumping action of the heart, leaking or narrow heart valves.
• Blood tests to evaluate thyroid, liver, and kidney function.
• Stress test to evaluate for heart disease.
• Coronary angiography to evaluate blockages in the heart arteries.