Enlarged Heart

Most people think that enlarged heart is a type of disease. However, it is not a disease, but rather a symptom of a disease called cardiomegaly. The condition can be diagnosed through X-rays. An enlarged heart is caused by a cardiomegaly condition. The heart becomes enlarged due to the muscle expanding, like any other muscle when worked too hard.

Sometimes, the heart becomes enlarged for no reason, but the enlargement of the muscle causes it to work harder than it should. The main function of the heart is to pump blood into the body, but an increase or decrease in blood pressure makes the heart’s work difficult. The heart has to over work, which results in its enlargement as well as uneven heart beats.

It is not a disease in itself but a symptom of underlying conditions, such as

• weakened heart muscle,
• coronary artery disease,
• heart valve problems or abnormal heartbeats.

Pregnancy can also cause enlarged heart. The underlying cause can be detected by tests other than chest X-ray.

Treatment involves identifying and correcting the underlying condition. The treatment options include medications, medical procedure or surgery. 

Enlarged Heart and Valve Defects

Defects or damages the four heart valves receive during stressful overworking cause the heart to enlarge. This is known as cardiomyopathy, which is when the heart muscle stiffens and thickens, thus reducing its movement. The enlargement is due to difficulty pumping blood, which results in an inadequate supply of blood to the body. Coronary artery disease, which causes plaque in the arteries, interferes with the blood supply and thus can also cause the heart to enlarge.

Pulmonary hypertension (high blood pressure in the pulmonary artery), which connects the lungs with the heart and forces the heart to work harder to transfer blood, can sometimes cause enlargement of the heart on the right side.

People suffering from hyper- or hypothyroidism can experience heart problems, including enlargement. Other causes of heart enlargement are the building of abnormal proteins in the heart, or its inability to process iron effectively. Also, chronic, untreated anemia can also cause the heart to overwork and thus enlarge it in a shorter span of time.

Most patients with an enlarged heart do not have any symptoms, but some patients complain of difficulty breathing or feeling dizzy. Patients sometimes have a cough with fluid retention, which causes persistent swelling.

If the left ventricle becomes affected, the heart may grow weak and thus not be able to pump blood into the body as required. It may lead to heart failure if the stress is too great. Also, enlargement of the heart leads to disruption of the heart rhythm, which could lead to cardiac arrest. Patients with enlarged heart are at risk of developing blood clots inside the heart, which could attach to the lining of the heart. The clots then break free and travel to other parts of the body, including the lungs, brain, and veins.

Symptoms of enlarged heart are:

• Difficulty breathing
• Irregular heartbeats (arrhythmia)
• Accumulation of fluid in your body (edema)

When to see a doctor?

Visit your doctor if you experience any signs and symptoms of enlarged heart. See your doctor immediately if you experience:

• Chest pain
• Severe breathlessness
• Fainting

An enlarged heart is caused when your heart pumps blood harder than normal or if your heart muscle is damaged.

But sometimes the cause for enlarged heart isn’t known. Conditions that are likely to cause enlarged heart are:

• A heart condition you are born with (congenital)
• Heart damage due to heart attack or an abnormal heartbeat (arrhythmia)
• High blood pressure
• Heart valve disease
• Cardiomyopathy (disease of the heart muscle)
• Pulmonary hypertension (increased blood pressure in arteries connecting your heart and lungs
• Pericardial effusion (fluid accumulation in sac enclosing your heart)
• Anemia (deficiency of red blood cell)
• Hypothyroidism (low thyroid hormones) or Hyperthyroidism (increased thyroid hormones)
• Hemochromatosis (excessive iron in the body)
• Amyloidosis (accumulation of abnormal protein called amyloid)

You may be referred to a cardiologist (a doctor who treats heart disease) by your general practitioner to receive a diagnosis of enlarged heart.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms.

Write down your key medical information. Include history of heart disease, stroke, high blood pressure or diabetes. Write down the names of all your medications, vitamins or supplements. Ask a friend or a family member to accompany you during the visit.

Make a list of the questions to ask your doctor

Some typical questions can be:

• What could be the most probable cause of my symptoms?
• What tests are needed?
• What are my treatment options?
• Should I restrict my diet or physical activity?
• How often do I need screenings for heart disease?
• For example, how often do I need to check cholesterol level?
• Should I see a specialist?
• Do my children need to be screened for this condition?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• When did you start noticing your symptoms and how severe are they?
• Do your symptoms occur continuously or they come and go?
• Does anything improve or aggravate your symptoms?
• Can you describe how your typical diet is like?
• Are you a drinker or a smoker?
• What’s your level of physical activity?
• Do you exercise regularly?
• Has anyone in your family been diagnosed with heart disease?
• Do you have other medical conditions?

Following tests may be performed to detect the cause of enlarged heart:

Chest X-ray

It helps to detect any abnormalities in heart or around lungs. If enlarged heart is seen on an X-ray, your doctor will order other tests.

Electrocardiogram (ECG)

Electrocardiogram records the electrical activity of your heart. Presence of abnormal ECG patterns indicates heart disease.

Echocardiogram

This test utilizes sound waves to create images of your heart. This test can reveal the working condition of your heart or any enlargement present in the heart.

Stress test

A stress test, also known as exercise stress test, is used to evaluate the condition of your heart during physical activities.

Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI)

CT scan or MRI creates a detailed image of your heart.

Blood tests

Blood tests are done to detect level of certain substances that are likely to cause a heart problem. Blood tests are also used to check if there is any other condition responsible for your symptoms.

Cardiac catheterization and biopsy

In cardiac catheterization, catheter (a thin tube) is inserted in artery or vein in your groin and moved up to blood vessels to your heart. A small sample of heart tissue (biopsy) can be removed for tests in laboratory.

Coronary angiogram (a special x-ray test) can be performed during catheterization to see if coronary arteries are narrowed or blocked.

Treatments for enlarged heart are aimed at correcting the underlying condition.

Medications used to treat any underlying heart condition include

• Diuretics (water pills) eliminate excess sodium and water from your body and hence lower your blood pressure.

• Angiotensin-converting enzyme (ACE) inhibitors reduce your blood pressure as well as increase the pumping ability of your heart.

• Angiotensin receptor blockers (ARBs) have beneficial effects similar to that of ACE inhibitors and opted if you can't tolerate ACE inhibitors.

• Beta blockers lower blood pressure and improve heart function.

• Digoxin increases the force of cardiac contraction and minimizes the incidence of hospitalization for heart failure.

• Anticoagulants prevent formation of blood clots and hence prevent heart attack or stroke.

• Anti-arrhythmic medication normalize your heartbeat.

Medical procedures and surgeries

They are opted if medications fail to treat your condition.

Heartbeat regulating devices

If you have dilated cardiomyopathy, a pacemaker may be used to normalize your heartbeat. Implantable cardioverter-defibrillator (ICD) is used in people with the risk of life-threatening arrhythmia or people who have enlarged heart due to atrial fibrillation.

ICDs can detect abnormal change in heart rhythm and send electrical shocks to restore normal heartbeat.

Heart valve surgery

If problems in heart valves are responsible for your enlarged heart, your doctor may perform surgery to repair or replace the valve.

Coronary bypass surgery

Coronary bypass surgery is chosen if your enlarged heart is associated with coronary artery disease.

Left ventricular assist device (LVAD)

It helps a failing heart to pump blood to the body. It can be used to treat heart failure or used temporarily before you get a new heart (heart transplant).

Heart transplant

It is opted when no other approaches work.

If the causes of enlarged heart are identified early, further deterioration may be prevented.

Inform your doctor if anyone in your family has heart disease, such as cardiomyopathy.

• Tobacco use,
• hypertension,
• high cholesterol,
• diabetes

increase the risk of coronary artery disease.

Controlling those risk factors reduces the chances of heart attack and hence lowers the risk of an enlarged heart and heart failure. Healthy diet and exercise can help maintain blood pressure and hence prevent heart failure as well as enlarged heart. 

There are different ways to adapt your lifestyle in coping with enlarged heart.

Following tips may be helpful if you have enlarged heart:

• Don't smoke.
• Maintain a healthy weight
• Limit salt intake
• Control blood sugar level and blood pressure
• Exercise regularly. Discuss with your doctor about appropriate physical activities for you
• Avoid alcohol and caffeine
• Get enough sleep

There are several risks and complications associated with enlarged heart.

Risks

• Hypertension: You are likely to have enlarged heart if your blood pressure is more than 140/90 millimeters of mercury.
• A family history of enlarged hearts or cardiomyopathy: If anyone in your family has had an enlarged heart, you are at increased risk.
• Blocked arteries in your heart (coronary artery disease): Deposition of fatty materials in your heart arteries impedes the normal blood flow, which can cause heart attack. Your heart may enlarge when your weakened heart has to pump blood harder to meet the demand of your body.
• Congenital heart disease: If you're born with abnormal structure of your heart, you may develop an enlarged heart.
• Valvular heart disease: Any disease that damages your heart valves may cause enlargement of your heart.
• Heart attack: Heart attack can increase your risk of having enlarged heart.

Complications

• Heart failure: Heart failure is more likely to occur in people with enlarged heart, particularly the left ventricle. In heart failure, your heart can't pump sufficient blood to your body because of weakened heart muscle. As a result, the ventricles dilate which further worsens the heart's function.
• Blood clots: You are more likely to have blood clots if you have an enlarged heart. The clots may enter bloodstream and obstruct blood flow to vital organs. This can result in heart attack or stroke. The clot may block arteries in the lungs causing pulmonary embolism.
• Heart murmur: People with enlarged heart may not have proper functioning valves. This can cause backflow of blood which creates heart murmurs.
• Cardiac arrest and sudden death: Sometimes your heart may have irregular heartbeats due to enlarged heart which can lead to cardiac arrest or sudden death.