Dilated cardiomyopathy often

appears
Fatigue
Dyspnea on exertion, shortness of breath
Orthopnea, paroxysmal nocturnal dyspnea
Increasing edema, weight, or abdominal girth

On physical examination, look for signs of hea rt failure and volume overload. Assess vital signs w ith specifi c attention to the following:

Tachypnea
Tachycardia
Hypertension
Signs of hypoxia (eg, cyanosis, clubbing)
Jugular venous distension (JVD)
Pulmonary edema (crackles and/or wheezes)
S 3 gallop
Enlarged liver
Peripheral edema
Cardiomegaly (broad and displaced point of maximal impulse, right
ventricular heave)
Murmurs (with appropriate manoeuvres)
S 2 at the base (paradoxical splitting, prominent P 2), S 3, and S 4
Irregularly irregular rhythm

Signs and symptoms of HCM can

include the following
Sudden cardiac death (the most devastating presenting
manifestation)
Chest pain
Dyspnoea (the most common presenting symptom)
Syncope and pre-syncope
Palpitations
Orthopnoea and paroxysmal nocturnal dyspnoea (early signs of
congestive heart failure [CHF])
Dizziness

Physical findings may include the

following:
Double apical impulse or triple apical impulse (less common)
S3 gallop is common in children but signifies decompensated CHF
in adults S4 is frequently heard
Jugular venous pulse revealing a prominent a wave
Double carotid arterial pulse
Apical precordial impulse that is displaced laterally and usually is
abnormally forceful and enlarged
Ejection Systolic ejection - crescendo-decrescendo murmur
Holosystolic murmur at the apex and axilla of mitral regurgitation
Diastolic decrescendo murmur of aortic regurgitation (10% of
patients)

restrictive cardiomyopathy (RCM) often present

at an advanced stage of disease with pronounced
cardiopulmonary symptoms
gradually worsening shortness of breath, progressive
exercise intolerance, and fatigue.
Paroxysmal nocturnal dyspnea
ascites,
liver tenderness
profound bilateral peripheral edema..
Chest pain
Palpitations
Clinically mimics constrictive Pericarditis

 Weight loss and cardiac cachexia.

Easy bruising, periorbital purpura, macroglossia, carpal tunnel syndrome amyloidosis.
Increased jugular venous
Kussmauls sign
Pitting edema of the lower extremities.
The liver is usually enlarged Cardiovascular system examination
A loud early diastolic filling sound (S3)
Murmurs due to mitral and tricuspid valve
Breath sounds are decreased due to pleural effusion, frequently bilateral,
and large in amyloidosis. Crepitation or rales are rarely heard, even in
advanced heart failure

myocarditis usually present with

signs and symptoms
acute decompensation of heart failure

Tachycardia
gallop
mitral regurgitation
Edema
pericardial friction rub.

 Sarcoid myocarditis - Lymphadenopathy, also with

arrhythmias
Acute rheumatic fever - erythema marginatum,
polyarthralgia, chorea, subcutaneous nodules (Jones
criteria)
Hypersensitive/eosinophilic myocarditis - Pruritic
maculopapular rash and history of using offending drug