Symptoms:

Patients with this condition often have had symptoms of angina or a heart attack. Sometimes, patients do not notice any symptoms.

Symptoms of heart failure usually develop slowly over time. Common symptoms include:

• Cough
• Fatigue, weakness, faintness
• Irregular or fast pulse, or a sensation of feeling the heart beat (palpitations)
• Loss of appetite
• Shortness of breath, especially with activity
• Shortness of breath that occurs after lying down
• Swelling of feet and ankles (in adults)
• Swelling of the abdomen (in adults)
• Waking up from sleep after a couple of hours due to shortness of breath

Signs and tests:

The physical exam may be normal, or there may be signs that fluid is building up in the body:

• "Crackles" in the lungs (heard with a stethoscope)
• Enlarged liver
• Extra heart sounds
• Leg swelling
• Raised pressure in the neck vein

There may be other signs of heart failure.

This condition is usually diagnosed if a test shows that the heart is not pumping as well as it should. This is called a decreased ejection fraction. A normal ejection fraction is around 55 - 65%. Many patients with this disorder have ejection fractions much less than this.

People with ischemic heart disease can have the symptoms and signs of ischemic cardiomyopathy even when their ejection fraction is normal or near normal. This is because the heart does not fully relax (impaired filling). It is sometimes called "diastolic heart failure" or "heart failure with preserved ejection fraction."

Tests used to measure ejection fraction include:

• Echocardiogram
• Gated SPECT
• MRI of heart
• Ventriculogram or cardiac blood pooling imaging

Biopsy of the heart is needed in rare cases to rule out other conditions.