Symptoms:

• Chest pain
  • Under the chest bone
  • May move (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

Signs and tests:

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 that the pumping function of the heart is too low. This is called a decreased ejection fraction. 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
• ECG
• Biopsy of the heart is needed in rare cases 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)