What is an enlarged heart?
An enlarged heart, a condition called cardiomegaly, is an increase in the size of the heart. It is not a disease per se, but rather a sign that another health problem is affecting your heart. Certain conditions, such as pregnancy, increase the workload of the heart. Other disorders can thicken the muscle in the walls of the heart or stretch the chambers of the heart (dilate them), making the heart bigger.
Heart enlargement types:
- Dilation: The walls of the heart becomes thin, stretch (expand), and weaken, which enlarges the heart. Dilated cardiomyopathy can lead to heart failure, where the heart loses its ability to pump blood properly.
Hypertrophy: The walls of the heart thicken, making the heart less efficient. This can occur in athletes and pregnant women, whose hearts experience a high workload for long periods of time. Left ventricular hypertrophy (LVH) is thickening of the muscle in the lower left chamber (ventricle) of the heart, which is the main chamber that pumps blood. It can be caused by high blood pressure or aortic stenosis.
What causes an enlarged heart?
Health conditions that can cause your heart to enlarge are:
- High blood pressure: The more effort the heart makes to pump blood, the more risk it puts on the heart. In fact, the heart might get enlarged and obtain thick muscles because of high blood pressure.
- Coronary artery disease: This occurs when the arteries face a blockage due to a fat plaque. In other words, a blocked artery causes the heart to exert more effort pumping blood to reach all body parts. Therefore, the heart might enlarge and a heart stroke is possible.
- Valve disease: The heart contains 4 valves that are meant to prevent the backflow of blood. Thus, a damage to these valves leads to an enlarged heart. As a matter of fact, the damage may be resulting from an abnormal heartbeat, heart defect, etc...
- Cardiomyopathy: Enlargement of the heart occurs since the heart tries hard to pump more blood to all the body due to this disease.
- Heart attack: The damage caused by a heart attack causes the enlargement.
- Pulmonary hypertension: This means high blood pressure in the arteries that carry blood from the heart to the lungs. Therefore, the heart tries hard to keep blood exchange with the lungs which leads to enlargement of the heart.
- Heart infection: Also includes endocarditis, mayocarditis, and pericarditis. The infectious agents are viruses, bacteria and fungi which damage or inflame the heart causing enlargement.
- HIV infection: HIV related cardiomyopathy leads to ventricular dilatation.
- Thyroid disorders: Whether it's hypothyroidism (underactive thyroid gland) or hyperthyroidism (overactive thyroid gland), they both cause an enlarged heart.
- Kidney disease: A kidney disease means a most probable heart disease and vice versa.
- A genetic or hereditary disease: Inheritance of cardiomegaly is possible when there's a family history with the disease.
- Peripartum cardiomyopathy: It occurs during pregnancy.
Symptoms of enlarged heart:
People with cardiomegaly may have no symptoms until their condition worsens. Possible symptoms include:
- Shortness of breath
- Chest pain
- Heart palpitations (rapid, irregular or frenzied heartbeat)
- Arrhythmia (an irregular heartbeat)
- Early exhaustion during physical activity
Diagnosis of enlarged heart:
To make a diagnosis of cardiomegaly, your doctor will perform a physical exam and assess.
A physical exam includes checking the patient's:
- Signs and symptoms
- Medical history
- Family history
- Test results
Some of the tests used to make the diagnosis of enlarged heart are:
- Echocardiogram: A video of the heart including the four chambers activity can be seen by utilizing sound waves.
- Electrocardiogram (ECG): The doctor attaches electrodes on your skin to assess the electrical activity of the heart.
- Chest X-ray: Indeed, an X-ray shows the condition of the lungs and the heart. If the heart shows an enlargement, then the underlying cause needs detection through tests.
- Exercise electrocardiogram (the stress test): Shows how the heart acts during a physical activity by testing the heart rhythm, breathing and blood pressure. To clarify, the physical activity includes a treadmill walk or riding a stationary bike.
- Magnetic resonance imaging (MRI): This imaging test conducts pictures of the heart where the patient is placed through a machine that resembles a tube. It utilizes radio waves and a magnetic field.
- Blood tests: to check for thyroid or infectious disease.
Prevention and lifestyle changes:
You can reduce your risk of developing heart disease or having a stroke by controlling your blood pressure, diabetes and blood cholesterol levels. It is also important to have a healthy lifestyle.
- Do not smoke.
- Be active.
- Maintain a healthy weight (like following a special diet that reduces the risk of heart disease and stroke)
- Adopt a healthy and balanced diet.
- Reduce your alcohol consumption.
- Reduce your stress.
Above all, talk to your doctor about lifestyle changes you can make to stay healthy.
Treatment for cardiomegaly depends on the underlying medical condition causing the problem and the degree of enlargement of the heart. Its purpose is to alleviate symptoms and prevent further complications. Treatment may include medication, surgery, and lifestyle changes. You will discuss treatment options with your doctor and decide with him the best solution for you.
- Diuretics: These lower the pressure inside the heart and arteries by lowering water and sodium levels.
- Angiotensin converting enzyme (ACE) inhibitors: Also to lower the blood pressure and help the heart to function better.
- Beta-blockers: These enhance the heart activity by reducing blood pressure.
- Antiarrhythmics: To maintain a normal heart rhythm.
- Other blood pressure medications
Surgeries and other procedures:
- Valve intervention: fixing or replacing the damaged heart valves is necessary whether they are responsible for the enlarged heart or they are caused by it.
- Coronary bypass surgery: This is only if a coronary heart disease is causing an enlarged heart.
- Heart transplant (transplantation): This is the last option when all medication fails.
- Cardioverter Defibrillator (ICD): A small device (also a pacemaker) implanted into the chest to prevent rapid heartbeats by giving an electrical shocks when necessary.
- Left ventricular prosthesis: a mechanical pump for patients with heart failure to help with their weak heart..