Background: Dilated cardiomyopathy (DCM) represents a heterogeneous group of myocardial disorders characterized by ventricular dilation and impaired contractility. Objective: This study aimed to analyze the clinical presentation, risk factors, and echocardiographic findings in patients with DCM at a tertiary care center in North India. Methods: In this hospital-based cross-sectional observational study conducted from January to December 2024, 100 patients diagnosed with DCM were evaluated. Diagnosis was based on established echocardiographic criteria including left ventricular ejection fraction <45%, fractional shortening <25%, and left ventricular end-diastolic dimension >112% of predicted value. Comprehensive clinical evaluation, laboratory investigations, chest X-ray, ECG, and echocardiography were performed for all patients. Results: The study population had a mean age of 60±14 years with male predominance (68%). Dyspnea was the universal presenting symptom (100%), followed by fatigue (73%) and palpitations (71%). The mean left ventricular ejection fraction was 36.2±5.2%. Major risk factors included ischemic heart disease (78%), diabetes mellitus (70%), and alcohol consumption (61%). Echocardiography revealed global hypokinesia in 81% of patients, secondary mitral regurgitation in 57%, and left atrial enlargement in 66%. The majority of patients (57%) presented in NYHA Class II. Conclusion: DCM predominantly affects middle-aged males and presents with significant cardiovascular risk factors. The high prevalence of modifiable risk factors, particularly ischemic heart disease and diabetes mellitus, emphasizes the need for aggressive risk factor management. Early recognition of symptoms and regular echocardiographic monitoring are crucial for optimal patient outcomes.