A thorough physical examination can help in diagnosing cardiomyopathy. Particular attention should be given to the cardiac exam, the lung exam, the extremities for edema, and in assessing for other signs of heart failure such as jugular venous distension.

The most important physical exam aspects of cardiomyopathies include:^[1]

• It is always very important to measure vital signs in all patients with any cause of cardiomyopathy.

• jugular venous distension might be noted when the right atrial pressures are elevated.
• A bifid carotid upstroke might be noted in HCM.

• Apical impulse might be displaced in dilated cardiomyopathy or forceful in HCM.
• A systolic murmur might be heard at the apex, radiating to the axilla, which might indicate LV outflow obstruction in HCM or the presence of mitral regurgitation.
• The systolic murmur of HCM is increased by valsalva maneuver or standing.

• Crackles in the lungs may be a sign of heart failure, which often develops in the later stages of cardiomyopathy.

• Edema of the ankles, feet, legs and abdomen.