Enlarged heart (Cardiomegaly) : Causes, Symptoms, Tests & Diagnosis

Enlarged heart (cardiomegaly) isn’t a disease, but rather a symptom of another condition.

The term “cardiomegaly” most commonly refers to an enlarged heart seen on chest X-ray before other tests are performed to diagnose the specific condition causing your cardiomegaly. You may develop an enlarged heart temporarily because of a stress on your body, such as pregnancy, or because of a medical condition, such as the weakening of the heart muscle, coronary artery disease, heart valve problems or abnormal heart rhythms.

While having an enlarged heart may not always be preventable, it’s usually treatable. Treatment for enlarged heart is aimed at correcting the underlying cause. Treatment for an enlarged heart can include medications, medical procedures or surgery.

Symptoms:

In some people, an enlarged heart causes no signs or symptoms. Others may have these signs and symptoms:

• Shortness of breath
• Dizziness
• Abnormal heart rhythm (arrhythmia)
• Swelling (edema)
• Cough
• Chest pain

Causes:

Conditions associated with an enlarged heart include:

• High blood pressure. Having high blood pressure can make it so that your heart has to pump harder to deliver blood to the rest of your body, enlarging and thickening the muscle.
• Heart valve disease. Four valves within your heart keep blood flowing in the right direction. If the valves are damaged by such conditions as rheumatic fever, a heart defect, infections (infectious endocarditis), connective tissue disorders, certain medications or radiation treatments for cancer, your heart may enlarge.
• Disease of the heart muscle (cardiomyopathy). Cardiomyopathy is the thickening and stiffening of heart muscle. In early stages of cardiomyopathy, you may have no symptoms. As the condition worsens, your heart may enlarge to try to pump more blood to your body.
• Heart attack. Damage done during a heart attack may cause an enlarged heart.
• A heart condition you’re born with (congenital heart defect). Many types of congenital heart defects may lead to an enlarged heart, as defects can affect blood flow through the heart, forcing it to pump harder.
• Abnormal heartbeat (arrhythmia). If you have an arrhythmia, your heart may not pump blood as effectively as it would if your heart rhythm were normal. The extra work your heart has to do to pump blood to your body may cause it to enlarge.
• High blood pressure in the artery connecting your heart and lungs (pulmonary hypertension). If you have pulmonary hypertension, your heart may need to pump harder to move blood between your lungs and your heart. As a result, the right side of your heart may enlarge.
• Low red blood cell count (anemia). Anemia is a condition in which there aren’t enough healthy red blood cells to carry adequate oxygen to your tissues. Left untreated, chronic anemia can lead to a rapid or irregular heartbeat. Your heart must pump more blood to make up for the lack of oxygen in the blood when you’re anemic. Rarely, your heart can enlarge if you have anemia for a long time and you don’t seek treatment.
• Thyroid disorders. Both an underactive thyroid gland (hypothyroidism) and an overactive thyroid gland (hyperthyroidism) can lead to heart problems, including an enlarged heart.
• Excessive iron in the body (hemochromatosis). Hemochromatosis is a disorder in which your body doesn’t properly metabolize iron, causing it to build up in various organs, including your heart muscle. This can cause an enlarged left ventricle due to weakening of the heart muscle.
• Rare diseases that can affect your heart, such as amyloidosis. Amyloidosis is a condition in which abnormal proteins circulate in the blood and may be deposited in the heart, interfering with your heart’s function. If amyloid builds up in your heart, it can cause it to enlarge.

Complications of enlarged heart can include:

• Heart failure. One of most serious types of enlarged heart, an enlarged left ventricle, increases the risk of heart failure. Heart failure occurs when your heart can’t pump enough blood to meet your body’s needs. Over time, the heart can no longer keep up with the normal demands placed on it. The heart muscle will weaken, and the ventricles stretch (dilate) to the point that the heart can’t pump blood efficiently throughout your body.
• Blood clots. Having an enlarged heart may make you more susceptible to forming small blood clots in the lining of your heart. If clots are pumped out of the heart and enter your circulatory system, they can block the blood flow to vital organs, including your heart and brain causing a heart attack or stroke. If clots develop on the right side of your heart, they may travel to your lungs, a dangerous condition called pulmonary embolism.
• Heart murmur. For people who have an enlarged heart, two of the heart’s four valves — the mitral and tricuspid valves — may not close properly because they become dilated, leading to a backflow of blood. This flow creates sounds called heart murmurs. Heart murmurs are not necessarily harmful, but they should be monitored by your doctor.
• Cardiac arrest and sudden death. Some forms of enlarged heart can lead to disruptions in your heart’s beating rhythm. Some of these heart rhythms are too slow to move your blood, and some are too fast to allow the heart to beat properly. In either case, these abnormal heart rhythms can result in fainting or, in some cases, cardiac arrest or sudden death.

Tests and Diagnosis :

If you have symptoms of a heart problem, your doctor will perform tests to determine if your heart is enlarged and to find out the underlying cause of your condition. In addition to a physical exam, these tests may include:

• Chest X-ray. X-ray images help your doctor see the condition of your lungs and heart. If your heart is enlarged, it might first be detected by a chest X-ray, but other tests will usually be needed to find out the specific cause. Your doctor can also use an X-ray to diagnose conditions other than enlarged heart that may explain your signs and symptoms.
• Electrocardiogram. This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack as well as give clues to other types of heart disease.
• Echocardiogram. An important test for diagnosing and monitoring an enlarged heart is the echocardiogram. An echocardiogram uses sound waves to produce a video image of your heart. In this test, all of the chambers of the heart can be evaluated to determine if you do have an enlarged heart and to try and determine the cause. This test determines how efficiently your heart is pumping, assesses your heart valves, can look for evidence of previous heart attacks and can determine if you have congenital heart disease.
• Stress test. A stress test, also called an exercise stress test, is used to gather information about how well your heart works during physical activity. Because exercise makes your heart pump harder and faster than it does during most daily activities, an exercise stress test can reveal problems within your heart that might not be noticeable otherwise. An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored.
• Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine called a gantry. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. Images of your heart are created from these signals, which your doctor will look at to determine the cause of your enlarged heart.
• Blood tests. Your doctor may order blood tests to check the levels of certain substances in your blood that may signal that you have a heart problem. Blood tests can also help your doctor rule out other conditions that may cause your symptoms.
• Cardiac catheterization and biopsy. In this procedure, a thin tube (catheter) is inserted in your groin and threaded through your blood vessels to your heart, where a small sample (biopsy) of your heart can be extracted for analysis in the laboratory. Pressure within the chambers of your heart can be measured to see how forcefully blood pumps through your heart. Pictures of the arteries of the heart can be taken during the procedure (coronary angiogram) to ensure that you do not have any blockage.