Enlarged heart

Enlarged heart

Definition:

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

When to see a doctor
Enlarged heart is easier to treat when it's detected early, so talk to your doctor about any concerns you have about your heart health. If you don't have an enlarged heart, but are concerned about developing the condition, talk to your doctor about steps you can take to reduce your risk.
If you think you may have a problem with your heart based on new signs or symptoms you've been having, make an appointment to see your doctor.

Seek emergency medical care if you have any of these signs and symptoms, which may mean you're having a heart attack:

• Chest pain
• Severe shortness of breath
• Fainting

Causes:

An enlarged heart can be caused by conditions that cause your heart to pump harder than usual or that damage your heart muscle. Sometimes the heart enlarges and becomes weak for unknown reasons (idiopathic).
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:

The risk of complications from an enlarged heart depends on the part of the heart that is enlarged and the underlying cause.
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.

Treatments and drugs:

Treatments for enlarged heart focus on correcting the underlying cause.

Medications
If cardiomyopathy or another type of heart condition is to blame for your enlarged heart, your doctor may recommend medications. These may include:

• Diuretics to lower the amount of sodium and water in your body, which can help lower the pressure in your arteries and heart, such as furosemide (Lasix), or other diuretics, such as spironolactone (Aldactone), which can help prevent further scarring of your heart tissue
• Angiotensin-converting enzyme (ACE) inhibitors to lower your blood pressure and improve your heart's pumping capability, such as enalapril (Vasotec), lisinopril (Zestril), ramipril (Altace) or captopril (Capoten)
• Angiotensin receptor blockers (ARBs), such as losartan (Cozaar) and valsartan (Diovan), for those who can't take ACE inhibitors
• Beta blockers to lower blood pressure and improve heart function, such as carvedilol (Coreg) and metoprolol (Lopressor)
• Digoxin, which can help improve the pumping function of your heart and lessen the need for hospitalization for heart failure
• Anticoagulants, such as warfarin (Coumadin), to reduce the risk of blood clots that could cause a heart attack or stroke

Medical procedures and surgeries
If medications aren't enough to treat your enlarged heart, medical procedures or surgery may be necessary.

• Medical devices to regulate your heartbeat. For people who have a certain type of enlarged heart (dilated cardiomyopathy), a special pacemaker that coordinates the contractions between the left and right ventricle (biventricular pacing) may be necessary. In people who may be at risk of serious arrhythmias, drug therapy or an implantable cardioverter-defibrillator (ICD) may be an option. ICDs are small devices — about the size of a pager — implanted in your chest to continuously monitor your heart rhythm and deliver electrical shocks when needed to control abnormal, rapid heartbeats. The devices can also work as pacemakers. If the main cause of your enlarged heart is due to atrial fibrillation, then you may need procedures to return your heart to regular rhythm or to keep your heart from beating too quickly.
  
• Heart valve surgery. If your enlarged heart is caused by a problem with one of your heart valves, you may have surgery to remove the narrow valve and replace it with either an artificial valve or a tissue valve from a pig, cow or human-cadaver donor. If you have valve regurgitation, in which blood leaks backward through your valve, the leaky valve may be surgically repaired or replaced.
  
• Coronary bypass surgery. If your enlarged heart is related to coronary artery disease, your doctor may recommend coronary artery bypass surgery.
  
• Left ventricular assist device (LVAD). If you have heart failure, you may need this implantable mechanical pump to help your weakened heart pump. You may have an LVAD implanted while you wait for a heart transplant or as a long-term treatment if you have heart failure and you're not a good candidate for a heart transplant.
  
• Heart transplant. If medications can't control your symptoms, a heart transplant may be a final option. Because of the shortage of donor hearts, even people who are critically ill may have a long wait before having a heart transplant.