Idiopathic dilated cardiomyopathy (IDCM), which represents ventricular chamber enlargement and contractile dysfunction is an often fatal cause of heart failure (HF) in young adults. In Yemen, the incidence and prevalence of dilated cardiomyopathy (DCM) appears to be increasing, whether secondary to improved detection or due to local factors, such as chronic khat use. In this prospective study, we sought to investigate the electrocardiographic and echocardiographic findings in patients with IDCM. A total of 50 patients with IDCM, from three hospitals in Aden were studied. The mean age of patients was 44.6 ±12 years, 39 were males and 11 were females. History of chronic khat use was found in 84% and family history of DCM was found in 32% of the patients. All secondary causes of DCM were excluded. Coronary artery disease (CAD) was excluded by coronary angiography. Electrocardiography (ECG) and two-dimensional (2D) echocardiography were done for all these patients using standard techniques. Diagnosis of DCM was one by echocardiography. Sinus tachycardia and ventricular ectopic beats were common ECG abnormalities, but atrial fibrillation, left bundle branch block, weak R wave progression in the chest leads were found to be associated with advanced left ventricular (LV) systolic dysfunction. There was a markedly dilated LV cavity with mean LV ejection fraction (EF) of 28%. While mitral regurgitation was seen in 40% of the patients, thrombus formation was found in 16% of patients with LVEF of <20%.