Cardiomegaly (Enlarged Heart) – Symptoms, Causes And Treatment

Cardiomegaly is a medical condition in which the heart is bigger in size than its usual size. The condition is commonly termed as an enlarged heart. Cardiomegaly is in no way any type of disease, but a condition that is observed during an imaging test or a chest X-ray ^[1] . In some cases, you may temporarily develop an enlarged heart due to bodily stress (such as pregnancy, any medical condition or heart valve problems). An enlarged heart is the sign of another condition, which makes the heart work harder.

Older people, that is, individuals above the age of 60 are increasingly prone to developing cardiomegaly. The condition arises when any underlying ailments such as cardiomyopathy, heart valve problems, or high blood pressure increases the workload of your heart ^[2] .

The underlying causes the heart muscle to thicken, or the chambers of the heart to dilate. This results in the inefficient pumping of blood, thereby leading to complications such as heart failure or stroke. An enlarged heart can be temporary or in some cases, permanent ^[3] .

Symptoms Of Cardiomegaly

The signs of the condition arise only when the condition becomes severe. In the initial stages, there will be no symptoms that indicate the development of the condition.

During the moderate stage of the condition, the symptoms will be ^[4]

• swelling in the legs and ankles caused by fluid build-up (oedema),
• shortness of breath,
• fatigue,
• coughing,
• stomach bloating,
• an irregular heart rhythm (arrhythmia), and
• dizziness.

In the severe stage, the symptoms will include ^[5]

• dizziness,
• trouble catching your breath,
• chest pain, and
• pain in your arms, back, neck, or jaw.

Severe symptoms require immediate medical attention.

Causes Of Cardiomegaly

An enlarged heart can be the congenital or something that develops over time. While some people can be born with the condition, the number of people being affected by the condition with time is almost equal. Your heart can expand in size as a result of any disease that requires your heart to work hard and pump more blood. The most common causes of cardiomegaly are high blood pressure and ischemic heart disease ^{[6] [7]} .

The other causes of cardiomegaly are mentioned below.

1. Heart valve disease

Connective tissue diseases, infections and even some medications can cause damage to your valves. The valves direct the blood flow in the right direction through the heart. When you are suffering from a heart valve disease, the blood will flow backwards - thereby requiring the heart to do the extra work ^[8] .

2. Cardiomyopathy

A progressive type of heart disease, cardiomyopathy is of various types. This disease also causes the heart muscle to enlarge, causing damages in the heart. Cardiomyopathy causes your heart to become weak, resulting in it being unable to carry out its functions ^[9] .

3. Coronary artery disease

This causes fatty deposits or plaques to build up in the arteries and results in the narrowing of the arteries. Coronary artery disease causes a lack of oxygen supply.

4. High blood pressure (hypertension)

In this condition, the heart works extra as the blood is pumped with more force than the usual force. This puts a strain on your heart and arteries.

5. Thyroid disease

When an individual is affected by any disease related to the thyroid, such as overproduction (hyperthyroidism) and underproduction (hypothyroidism) of thyroid - it affects the blood pressure, heart rate and eventually the size of the heart.

The causes of cardiomegaly are as follows:^{[10] [11] [12]}

• Heart attack
• Irregular heart rhythm (arrhythmia)
• Patent ductus arteriosus (a hole in the aorta)
• Atrial septal defect (a hole in the wall separating the two upper chambers of the heart)
• Ebstein's anomaly (a problem with the valve that separates the two right chambers of the heart)
• Connective tissue diseases, like scleroderma
• Ventricular septal defect (a hole in the wall separating the two lower chambers of the heart)
• Coarctation of the aorta (a narrowing of the aorta, the main artery carrying blood from the heart to the rest of the body)
• Lung disease, including chronic obstructive pulmonary disease (COPD)
• Pulmonary hypertension
• Myocarditis
• Drug and alcohol use
• Anaemia
• Tetralogy of Fallot (TOF) (a combination of birth defects that disrupt the normal flow of blood through the heart)
• Cardiac ischaemia
• Obesity
• Pregnancy
• Lack of exercise
• Old age
• Excessive iron in the body (hemochromatosis)

Risk Factors Of Cardiomegaly

Some people are at more risk of developing the condition than others. Individuals with the following factors are more likely to get cardiomegaly.

The risk factors include ^[13]

• hypertension,
• diabetes,
• alcohol or drug abuse,
• inactive lifestyle,
• congenital heart disease,
• thyroid disorders,
• obesity,
• a family history of heart disease, and
• history of heart attack or heart disease.

Complications Of Cardiomegaly

The condition poses the risk of developing various complications, such as^[14]

• heart murmur,
• heart failure,
• blood clots, and
• cardiac arrest that can result in immediate death.

Diagnosis Of Cardiomegaly

In order to examine the condition, the doctor will carry out a number of tests. The initial step in the diagnosis will be a physical examination where the doctor will discuss regarding your symptoms. After that, the doctor will take a chest X-ray, so as to understand the enlargement of your heart. If enlargement is diagnosed, the doctor will carry out the following tests to understand the cause of enlargement ^[15] .

1. Electrocardiogram

This test will monitor the electrical activity in your heart. It helps in diagnosing an irregular heart rhythm, as well as ischaemia ^[16] .

2. Echocardiogram (ECG or EKG)

Under this test, sound waves will be used to examine and understand the problems present within the heart's chambers.

3. Blood tests

These tests will help in understanding if there are any issues within your blood, which can further indicate the presence of any issues ^[17] .

4. Stress test

This test will require you to work out on a treadmill or a bike while being hooked up to blood pressure and heart monitors. The stress test will help the doctor in understanding the functioning of your heart while carrying out any physical activity.

5. Computerized tomography (CT) scans

These tests will involve X-rays, which will be used to develop detailed images of your heart, as well as the other structures in your chest. CT scans will help the doctor in understanding the possible developments of any valve disease or inflammation ^[18] .

6. Magnetic resonance imaging (MRI)

This test will make use of strong magnets and radio waves to produce the images of your heart.

7. Cardiac biopsy

Under this method, a tube will be inserted into the groin, to the heart through the blood vessels. Using that, a sample of the heart tissue will be taken to examine and analyse.

Treatment For Cardiomegaly

The measures for treating the condition will be dependent upon the cause ^[19] .

For high blood pressure: ACE inhibitors, angiotensin receptor blockers (ARBs), and beta-blockers.

For heart valve problems: Surgery to fix or replaced the damaged valve.

For irregular heartbeat: Anti-arrhythmic drugs, pacemaker, an implanted cardioverter-defibrillator (ICD).

For narrowed coronary arteries: Percutaneous coronary intervention, coronary artery bypass grafting (CABG), and nitrates.

For heart failure: Diuretics, beta-blockers and inotropes, and in some people.

In severe cases, surgery will be advised by the doctor ^[20] .

• Heart valve surgery
• Heart transplant
• Left ventricular assist device (LVAD)
• Coronary bypass surgery

And some people will be required to use medical devices to regulate their heartbeat.

Lifestyle And Home Remedies For Cardiomegaly

You can improve your condition by adopting various means and measures. There is no way to cure it through changes in your lifestyle or by adopting the home remedies. However, you can manage the symptoms of the condition ^{[21] [22]} .

• Monitor your blood pressure.
• Limit salt in your diet.
• Quit smoking.
• Replace refined grains, such as white bread and pasta, with whole grain versions
• Avoid or eliminate alcohol and caffeine.
• Lose excess weight.
• Manage stress.
• Try to get eight hours of sleep.
• Control diabetes.
• Get modest exercise on most days of the week.
• Increase fruit and vegetable intake.