Symptoms:

There are usually no symptoms until the disease is in an advanced stage. At that point, the symptoms occur due to heart failure and may include:

• Ankle, feet, and leg swelling
• Awakening during the night with shortness of breath (paroxysmal nocturnal dyspnea)
• Breathing difficulty while lying down (orthopnea)
• Cough containing mucus, or pink, frothy material
• Decreased alertness or concentration
• Decreased urine output (oliguria)
• Fatigue, weakness, faintness
• Irregular or rapid pulse
• Loss of appetite
• Need to urinate at night (nocturia)
• Overall swelling
• Sensation of feeling the heart beat (palpitations)
• Shortness of breath, especially with activity (dyspnea)

Signs and tests:

A health care provider will conduct a physical examination, which may show:

• Abnormal heart sounds
• Abnormal lung sounds
• Ankle swelling
• Enlarged liver
• Irregular or rapid heartbeat
• Low blood pressure
• Murmurs
• Swollen neck veins
• Weight gain

Alcoholic cardiomyopathy is usually diagnosed when chronic heavy drinking is discovered as a cause of heart failure.

The following tests may reveal signs of heart failure:

• Echocardiogram may show enlarged heart chambers, leaking valves, or reduced pumping efficiency
• ECG may show signs of enlarged heart chambers or rhythm abnormalities (arrhythmias)
• Cardiac catheterization and coronary angiography may rule out coronary artery blockages as the cause
• Chest x-ray or chest CT may show heart enlargement, fluid buildup in the lungs and valves, and reduced pumping function
• Complete routine laboratory study measures the hormone B-type natriuretic peptide (BNP)