Symptoms:

• Cough (produces frothy or blood-tinged mucus)
• Decreased urine production
• Difficulty lying down; need to sleep with the head elevated to avoid shortness of breath
• Fatigue, weakness, faintness
• Irregular or rapid pulse
• Sensation of feeling the heartbeat (palpitations)
• Shortness of breath
• Waking up due to shortness of breath (paroxysmal nocturnal dyspnea)
• Weight gain from fluid retention

Symptoms in infants may include:

• Failure to thrive
• Poor feeding
• Weight loss

Signs and tests:

Physical examination may reveal an irregular or rapid heartbeat and increased breathing rate. The doctor may feel abnormal heart motion when touching the chest wall.

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 lower legs may be swollen and remain dimpled when pressed.

Tests may include:

• Blood tests to evaluate thyroid, liver, and kidney function
• Chest x-ray
• Coronary angiography
• Electrocardiogram (ECG)
• Heart stress test
• Ultrasound of the heart (echocardiogram)