Patients with ischemic cardiomyopathy usually have symptoms of angina and heart failure.

Symptoms of angina include:

• Chest pain that occurs behind the breastbone or slightly to the left of it. It may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the neck, jaw, back, shoulder, or arm.
• A feeling of indigestion or heartburn
• Dizziness or light-headedness
• Nausea, vomiting, and cold sweats
• Sensation of feeling the heart beat (palpitations)
• Shortness of breath
• Unexplained tiredness after activity (more common in women)

Symptoms of heart failure usually develop slowly over time. However, sometimes symptoms start very suddenly and are severe. Common symptoms include:

• Shortness of breath, especially with activity
• Shortness of breath that occurs after lying down for a while
• Cough
• Fatigue, weakness, faintness
• Swelling of the abdomen (in adults)
• Loss of appetite
• Swelling of feet and ankles (in adults)
• Pulse may feel irregular or rapid, or there may be a sensation of feeling the heart beat (palpitations)

The physical examination may be normal, or it may reveal signs of fluid buildup:

• "Crackles" in the lungs
• Elevated pressure in the neck vein
• Enlarged liver
• Extra heart sounds
• Leg swelling

There may be other signs of heart failure.

This condition is usually diagnosed 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:

• ECG
• Echocardiogram
• Gated SPECT
• MRI of chest
• Ventriculogram performed during a cardiac catheterization

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 assess the condition of the heart include:

• Blood chemistries
• Cardiac biochemical markers (CK-MB, troponin)
• CBC
• Coronary risk profile