Key aspects to knowing this is dilated caridomyopathy:

• S3 - S3 is a heart sound associated with dilated cardiomyopathy and heart failure (increased filling pressures, may also be associated with mitral and aortic regurg but those would be associated with a murmur, FA2020 p287)
• Displaced apical impulse and cardiomegaly - dilated cardiomypathy makes a big heart (FA2020 p308)
• Reduced ejection fractions, swelling, shortness of breath - signs of decompensated heart failure, reduced ejection fraction is a sign of systolic dysfunction (not diastolic dysfunction as seen with resrtictive diseases, p309)