Asymptomatic dilated cardiomyopathy may first manifest itself as an enlarged heart shadow on a chest x-ray or an abnormal ECG finding. If previously undiagnosed heart failure or left ventricular dilatation is noted, the patient must undergo echocardiography. Typical symptoms in the early stages include dyspnoea on exertion, arrhythmias and chest pain that is not related to exercise. As the disease progresses, the patient will develop heart failure and associated oedema. Pharmacological therapy is similar to that used in heart failure of any aetiology; ACE inhibitors and angiotensin receptor blockers are the drugs of choice. The identification of atrial fibrillation and initiation of anticoagulation is important in order to prevent cardiogenic embolism. If no obvious cause is identified for dilated cardiomyopathy, such as a history of chemotherapy, it is recommend that the first-degree adult relatives of the patient, even if they are asymptomatic, are referred to a cardiologist for clinical assessment and echocardiography.