Cardiac hypertrophy helps improve systolic function and unload cardiac muscle fibers. This eventually leads to dilated cardiomyopathy and cardiac cell death. Presenting Signs and Symptoms Direct manifestations of decreased cardiac output are the presenting symptoms in some patients. Fatigue, weakness, malaise, lightheadedness, and lethargy are common. Vascular congestion results in pulmonary venous hypertension, with symptoms of cough, dyspnea on exertion, shortness of breath, orthopnea, and paroxysmal nocturnal dyspnea.
Pulmonary edema is the most severe manifestation of pulmonary venous congestion.
Patients typically present with anxiety, dyspnea, and tachypnea. Tachycardia and hypotension are often seen. If severe, a frothy pink sputum and cyanosis are seen. Diaphoresis, skin pallor, and livedo reticularis secondary to vasoconstriction are noted. Auscultation of the lung fields may reveal rales, bronchi, and wheezing.