Enlargement of the heart

Description

An enlarged heart (cardiomegaly) isn't a disease, but rather a sign of another condition.

The term "cardiomegaly" refers to an enlarged heart seen on any imaging test, including a chest x-ray. Other tests are needed to diagnose the condition causing your enlarged heart.

Damage in the heart and certain types of heart disease can cause an enlargement of the heart. Sometimes short-term stress on the body, such as pregnancy, can cause the biggest heart. Depending on the condition, an enlarged heart can be temporary or permanent.

Treatment for an enlarged heart can include medications, medical procedures or surgery.

Symptoms

In some people, an enlarged heart (cardiomegaly) does not cause signs or symptoms. Others may have these signs and symptoms of cardiomegaly:

  • Shortness of breath, especially while lying down
  • Wake up short of breath
  • Irregular heart rhythm (arrhythmia)
  • Swelling (edema) in the abdomen or in the legs

When to see a doctor

An enlarged heart may be easier to treat when detected early. Talk with your health care provider if you have concerns about your heart.

Call 911 or the local emergency number if you have signs and symptoms of a possible heart attack:

  • Pain in the chest
  • Discomfort in other areas of the upper body, including one or both arms, the back, neck, jaw, or stomach
  • Severe shortness of breath
  • Fainting

Causes

An enlarged heart (cardiomegaly) can be caused by damage to the heart muscle, or any condition that causes the heart to pump harder than usual, including pregnancy. Sometimes the heart enlarges and becomes more weak, for unknown reasons. This condition is called idiopathic cardiomyopathy.

The conditions associated with an enlargement of the heart include:

  • Heart condition present from birth (congenital heart defect). Problems with the structure and function of the heart can cause the heart muscle to make it larger and weak.
  • The damage of a heart attack. Scars and other structural damage to the heart can make it more difficult for the heart to pump enough blood to the body. Stress can lead to swelling of the heart and eventually heart failure.
  • Diseases of the heart muscle (cardiomyopathy). Cardiomyopathy often causes the heart to rigid or thick. This may make it more difficult for the heart to pump blood.
  • Accumulation of fluid in the sac around the heart (pericardial effusion). A collection of fluid in the sac that contains the heart can cause heart enlargement that can be seen on a chest x-ray.
  • Heart valve disease. Four valves in the heart keep blood flowing in the right direction. Disease or damage to any of the valves can stop the flow of blood and cause the chambers of the heart to be bigger.
  • High blood pressure (hypertension). If you have high blood pressure, the heart has to pump harder to supply blood to the rest of the body. Stress can cause the heart muscle to grow larger and become weak.
  • High blood pressure in the arteries of the lungs (pulmonary hypertension). The heart has to work harder to move blood between the lungs and the heart. Stress can lead to a thickening or enlargement of the right side of the heart.
  • Low red blood cell count (anemia). In anemia, there is a lack of healthy red blood cells to carry adequate levels of oxygen to the tissues of the body. The heart has to pump more blood to compensate for the lack of oxygen in the blood.
  • Disorders of the thyroid. Both an underactive thyroid gland (hypothyroidism) and an overactive thyroid gland (hyperthyroidism) can lead to heart problems, including an enlarged heart.
  • Too much iron in the body (hemochromatosis). The iron can accumulate in various organs, including the heart. This can cause the lower left chamber of the heart to swell.
  • Unusual deposits of proteins in the heart (cardiac amyloidosis). This rare disease causes a protein called amyloid to build up in the blood and get stuck in the organs of the body, including the heart. Deposits of amyloid protein in the heart cause irreversible thickening of the heart wall. The heart has to work harder to fill with blood.
  • The aerobic exercise. In some athletes, the heart is enlarged as a response to the frequent and prolonged exercise. Generally, this type of enlargement of the heart is not considered a disease and do not need treatment.
  • The fat around the heart. Some people have excess fat around the heart that can appear on a chest x-ray. Unless there are other heart conditions associated with it, treatment is not necessary.

Risk factors

Things that may increase the risk of an enlarged heart (cardiomegaly) include:

  • A family history of heart muscle disease (cardiomyopathy). Some types of cardiomyopathy hereditary. Tell your health care provider if a parent or sibling has a history of a thick, stiff, or enlargement of the heart.
  • The high blood pressure. This means having a blood pressure higher than 140/90 millimeters of mercury.
  • Diseases of the heart. Any problem that affects the heart, including birth defects of the heart or of the heart valves, can lead to increased size of the heart. It is important to follow a healthy lifestyle and regular health screenings to manage the diseases of the heart.

Complications

The risk of complications of an enlarged heart depends on the part of the heart affected and the cause. The complications of an enlarged heart can include:

  • Heart failure. Heart failure can occur if the lower left chamber of the heart (the left ventricle) is enlarged. In heart failure, the heart cannot pump adequate amounts of blood throughout the body.
  • The blood clots. Blood clots can form in the lining of the heart. A blood clot that forms in the right side of the heart may travel to the lungs (pulmonary embolism). If a blood clot blocks the flow of blood, you could have a heart attack or a stroke.
  • Leaking heart valve (regurgitation). Increase in the size of the heart can prevent the mitral valve and the tricuspid valve of the heart valves close, causing blood to leak backwards. The interrupted blood flow creates a sound called a heart murmur. Although it is not necessarily harmful, heart murmurs should be supervised by a health care professional.
  • Cardiac arrest and sudden death. An enlarged heart can cause the heart to beat too fast or too slow. The irregular heart rhythm (arrhythmia) can lead to fainting, cardiac arrest, or sudden death.

Prevention

Tell your health care provider if someone in your family has or has ever had cardiomyopathy or other health conditions that caused an enlargement of the heart. When diagnosed early, appropriate treatment of the underlying disease can prevent the enlargement of the heart from getting worse.

After a heart-healthy lifestyle can help prevent or manage some conditions that can lead to an enlarged heart. Take these steps to help prevent the enlargement of the heart:

  • Monitor and manage high blood pressure, high cholesterol, and diabetes.
  • Take any medications as prescribed.
  • Eat a nutritious, balanced diet.
  • Get regular exercise.
  • Avoid or limit consumption of alcohol.
  • Do not smoke.
  • Do not use illegal drugs.

Enlargement of the heart

Diagnosis

To diagnose an enlarged heart, a health care provider will usually do a physical exam and ask you questions about your symptoms and medical history.

The tests that can be done to help diagnose an enlarged heart (cardiomyopathy) and its cause are:

  • Blood tests. The blood tests can help to confirm or rule out conditions that can cause increased size of the heart. If an enlargement of the heart occurs with chest pain or other symptoms of a heart attack, blood tests may be done to check the levels of substances in the blood caused by the damage of the heart muscle.
  • X-ray of the chest. A chest x-ray can help to show the condition of the lungs and the heart. If the heart is enlarged on an X-ray, other tests will usually be needed to determine if the expansion is real and to find the cause.
  • Electrocardiogram (ECG or EKG). This quick and painless test that measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. The wires connect the electrodes to a computer, which displays the results of the test. An electrocardiogram (ECG) may show whether the heart is beating too fast or too slow. A health care provider can be seen in the patterns of the signals to detect signs of a thickening of the heart muscle (hypertrophy).
  • The echocardiogram. This non-invasive test that uses sound waves to create images of the heart in the size, structure and movement. An echocardiogram shows the flow of blood through the chambers of the heart and help to determine how well your heart is working..
  • Exercise tests or stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart is controlled. Exercise tests can help reveal how the heart responds to physical activity. If you're unable to exercise, you may be given drugs that mimic the effect of exercise on the heart.
  • Cardiac computed tomography (CT) or Magnetic resonance imaging (MRI).During a cardiacCTscan, usually found on a table inside a ring-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiacMRI, typically lie on a table inside a long tube machine that uses a magnetic field and radio waves to produce signals that create images of your heart.
  • The cardiac catheterization. A health care provider, threads a thin tube (catheter) through a blood vessel in the arm or in the groin to an artery in the heart and is used to inject a dye through the catheter. This makes the arteries of the heart are shown more clearly on x-rays. During a cardiac catheterization, the pressure within the heart chambers can be measured to see how forcefully pumped the blood through the heart. Sometimes a small piece of heart tissue is removed for examination (biopsy).

Cardiac computed tomography (CT) or Magnetic resonance imaging (MRI). During a cardiac ct scan, which usually is found on a table inside a ring-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.

In a cardiac mri , typically lie on a table inside a long tube machine that uses a magnetic field and radio waves to produce signals that create images of your heart.

Treatment

The treatment of an enlarged heart (cardiomegaly) depends on what is causing the problem of the heart.

Drugs

If the cardiomyopathy or other type of heart disease is the cause of an enlarged heart, a health care provider may recommend medication, including:

  • Diuretics. These drugs reduce the amount of sodium and water in the body, which can help lower blood pressure.
  • Other blood pressure drugs. Beta-blockers, inhibitors of the angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin II receptor blockers (arbs) can be used to lower blood pressure and improve heart function.
  • A blood thinner. Blood-thinning medications (anticoagulants) may be administered to reduce the risk of blood clots that could cause a heart attack or a stroke.
  • The heart rate of the drug. Also called anti-arrhythmics, these medicines help control your heartbeat.

Surgery or other procedures

If the medications are not enough to treat an enlarged heart, medical devices and surgery may be necessary.

Surgery or other procedures to treat an enlarged heart can include:

  • Pacemaker. A pacemaker is a small device that is usually implanted near the collarbone. One or more of the electrodes with tip of the pacemaker leads through the blood vessels in the interior of the heart. If the heart rate is too slow or if it stops, the pacemaker sends out electrical impulses that stimulate the heart to beat at a steady pace.
  • An Implantable cardioverter defibrillator (ICD). If the heart is enlarged is causing serious heart rhythm problems (arrhythmias), or you're at risk of sudden death, a surgeon can implant an implantable cardioverter defibrillator (ICD). An ICD is a battery-the unit that is placed under the skin near the collarbone — similar to a pacemaker. One or more electrodes at the tip of the wires of the ice run through the veins to the heart. The ICD continuously monitors the heart rhythm. If the ICD detects an irregular heartbeat, sends low-or high-energy shock to reset the heart rhythm.
  • Heart valve surgery. If an enlargement of the heart is caused by heart valve disease, surgery may be needed to repair or replace the affected valve.
  • Coronary bypass surgery. If an enlarged heart is due to a blockage in the coronary arteries, this open-heart surgery can be done to redirect blood flow around a blocked artery.
  • Left ventricular assist device (LVAD). If you have heart failure, your doctor may recommend an implantable mechanical pump to help his heart pump. You can have a left ventricular assist device (LVAD) implanted while waiting for a heart transplant or, if you are not a candidate for a heart transplant, as a long-term treatment of heart failure.
  • Heart transplant. A heart transplant is the last option of treatment for enlargement of the heart that can't be treated in any other way. Due to the shortage of donor hearts, even people who are severely ill may have a long wait before undergoing a heart transplant.

Self-care

If you have an enlarged heart or any type of heart disease, your doctor will probably recommend after a heart healthy lifestyle. A style of life typically includes:

  • Reduce or avoid the salt
  • Limit saturated and trans fats
  • Eat plenty of vegetables, fruits and whole grain foods
  • Avoid or limit consumption of alcohol and caffeine
  • Regular exercise and weight control
  • The control of cardiovascular risk factors, such as diabetes, high cholesterol, and high blood pressure

Preparing for your appointment

If you think you may have an enlarged heart or you are concerned about your risk of heart disease because of their family history, to make an appointment with your health care provider. You may be referred to a doctor trained in heart disease (cardiologist).

Here's some information to help you prepare for your appointment.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there is something that you need to do in advance, such as restrict your diet or fasting prior to the exams.
  • Write down your symptoms , including any that may seem unrelated to an enlargement of the heart or heart disease.
  • Write down key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and the major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you are taking, including dosage.
  • Have a family member or friend along, if possible. Someone who goes with you may remember something that you missed or forgot.
  • Write questions to ask their health care provider.

Make a list of questions will help you make the most of your time with your health care provider. For an enlarged heart or heart disease, some basic questions to ask your health care provider include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What tests do I need?
  • What is the best treatment?
  • What foods should I eat or avoid?
  • What is an appropriate level of physical activity?
  • There are restrictions that I should follow?
  • How often should I be screened for heart disease? For example, how frequently do I need a cholesterol test?
  • I have other health conditions. How can I best manage them together?
  • You should see a specialist?
  • Should my children be screened for this condition?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there brochures or other printed material that I can take? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask questions such as:

  • When did your symptoms begin?
  • Do you always have symptoms, or the symptoms come and go?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, in any case, it makes your symptoms worse?
  • What is the typical diet?
  • Do you drink alcohol? How much?
  • Do you smoke?
  • How often do you exercise?
  • Have you been diagnosed with other health conditions?
  • Do you have a family history of heart disease?
Symptoms and treatment of Enlargement of the heart