Classically, the patient with heart failure often presents with shortness of breath, fatigue, and swollen ankles and feet. However, these signs may be subtle or absent in people with diabetes, with dyspnoea being the only symptom [Gray and Yudkin, 1997]. Because of these milder symptoms, it may be difficult to distinguish between heart failure and angina as the patient describes the chest tightness or pain they have been experiencing. Therefore, the presence of exertional breathlessness should raise suspicion of left ventricular dysfunction [Shaw, 1996].

On initial examination, auscultation may identify lung congestion or abnormal heart sounds, warranting further investigation [Shaw, 1996].

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