Cardiomegaly is an enlarged heart. It is not a disease, but a sign of another condition. Less severe forms of cardiomegaly are referred to as mild cardiomegaly.
As mild cardiomegaly does not always cause symptoms, many people with a slightly enlarged heart are unaware of the problem. For some people, cardiomegaly is just temporary and will resolve on its own.
However, other people may have permanent cardiomegaly. It is vital that this symptom and the underlying cause of it are treated to prevent more serious damage to the heart. Treatments include medication, surgery, and lifestyle changes.
Cardiomyopathy is a disease of the myocardium or heart muscle that causes cardiomegaly. There are 2 types of cardiomyopathy
- Dilative cardiomyopathy: This type is characterized by a wide, poorly functioning left ventricle, which is the heart’s primary pumping chamber. Dilative cardiomyopathy is the main reason for an enlarged heart.
- Hypertrophic cardiomyopathy: In this form of cardiomyopathy, the cells of the heart muscle get larger, and the walls of the ventricles become thicker. This thickening of the ventricle wall can hinder blood flow.
In most cases, symptoms typically appear when the cardiomegaly becomes moderate or severe.
Symptoms, when noticeable, include:
- abnormal heart rhythms
- chest pain
- extreme tiredness
- shortness of breath
- stomach bloating
- swelling of the ankles, feet, and legs
Mild cardiomegaly can result from conditions that overwork or damage the heart, such as:
- abnormal heart valve
- amyloidosis, a rare condition that can interfere with heart function
- cardiomyopathy, a disease of the heart muscle
- inherited heart conditions
- heart valve disease
- hemochromatosis, which causes too much iron in the body
- history of heart attack
- high blood pressure
- overactive thyroid
- underactive thyroid
- obstructive sleep apnea
- pericardial effusion, the buildup of fluid around the heart
- a fast heart rate
Often, however, the cause of mild cardiomegaly is unknown.
Causes of temporary mild cardiomegaly
Medical treatment may be necessary in some cases, and the causes of temporary cardiomegaly can include:
- Excessive alcohol intake or drug use: Substance abuse can cause a form of mild cardiomegaly. Treatment will help reverse this condition.
- Extreme stress: Stress can lead to acute stress-induced cardiomyopathy. Approximately 75 percent of people with the condition have undergone emotional or physical stress.
- Pregnancy: The heart can sometimes become larger around the time of delivery. This type of cardiomegaly may be called peripartum cardiomyopathy.
- Viral infection of the heart: Antiviral medications may be required to treat viral infections of the heart that cause cardiomegaly.
Some people are more at risk than others of developing mild cardiomegaly. Factors that can increase risk include:
- alcohol or drug abuse
- congenital heart disease
- family history of heart disease
- history of heart attack or heart disease
- inactive lifestyle
- thyroid disorders
Possible complications include:
- Blood clots: People with cardiomegaly are at risk of blood clots forming in the heart’s lining. If the clots enter the bloodstream, they can hinder the flow of blood to the rest of the body. In some cases, this can lead to stroke or heart attack.
- Cardiac arrest and sudden death: An enlarged heart may contribute to a malfunction in the heart’s electrical system, which causes a cardiac arrest. This can sometimes result in sudden death.
- Heart failure: Dilative cardiomyopathy can lead to a weakening of the heart muscle, which reduces the heart’s ability to pump blood around the body. This is known as heart failure.
- Heart murmur: Some of the heart’s valves may not shut correctly due to cardiomegaly. This causes a backflow of blood, which leads to sounds called heart murmurs. Heart murmurs may be harmless but should be monitored.
Complications of cardiomegaly depend on the reason for it and the level of the enlargement.
Diagnostic tests may include one or more of the following:
- Blood tests: These tests can show up markers in the blood that indicate an issue.
- Stress test: A stress test involves working out on a treadmill or exercise bike while hooked up to heart and blood pressure monitors. Results demonstrate heart function during physical activity.
- X-ray: A chest X-ray can show the condition of the heart and lungs. Further tests will usually be needed to determine the cause.
- Echocardiogram: This test uses sound waves to produce a video image of the heart to allow doctors to assess the state of its chambers. It demonstrates any enlargement, congenital heart disease, damage from heart attacks, and the efficiency at which the heart is pumping.
- Other imaging tests: A CT scan or MRI scan may be used to collect images of the heart and chest.
- Electrocardiogram (ECG): An ECG is used to record the heart’s electrical activity and to diagnose abnormalities in its rhythm.
- Cardiac biopsy: A tube is inserted into the groin and through the blood vessels to the heart. From here, a small sample of heart tissue is taken and analyzed.
Mild cardiomegaly is typically diagnosed through both a physical examination and additional tests.
Though mild cardiomegaly will often resolve itself, treatment options include:
Recommended medications depend on the condition that is causing the enlarged heart. Medication may be prescribed to treat abnormal heart rhythms and high blood pressure. Diuretics may be prescribed to lower pressure in the arteries, while anticoagulants can reduce the risk of blood clots.
Other underlying conditions, such as anemia or thyroid disorders, can also be treated with medication.
If medications do not effectively treat mild cardiomegaly, or if symptoms become moderate or severe, it may be necessary for someone to be fitted with a medical device.
A pacemaker may be fitted to regulate heartbeat in those with dilative cardiomyopathy. People with severe arrhythmias may require an implantable cardioverter-defibrillator (ICD) to deliver shocks to control the heart rhythm.
Surgery is usually reserved for more severe cases of cardiomegaly, or for those that do not respond to other treatments. Depending on several factors, the following surgeries may be recommended for people with cardiomegaly:
- heart valve surgery
- coronary bypass surgery
- heart transplant
Lifestyle changes and home remedies
People with cardiomegaly may be able to alleviate their symptoms with the following lifestyle and dietary changes:
- stopping smoking
- maintaining a healthy weight
- monitoring blood pressure regularly
- doing physical activity most days of the week
- limiting alcohol and caffeine
- sleeping 7 to 9 hours a night
- increasing fruit and vegetable intake
- replacing refined grains, such as white bread and pasta, with whole grain versions
- cutting out processed, high-sugar, and high-fat foods
- consuming no more than 1,500 milligrams of salt daily
- getting help for addiction to alcohol and drugs
It is possible to reduce the risk of experiencing an enlarged heart by:
- Discussing cardiomegaly with a doctor, particularly if symptoms are experienced, or there is a family history of heart conditions.
- Managing conditions associated with cardiomegaly, such as diabetes, high blood pressure, and obstructive sleep apnea.
- Leading a heathy lifestyle by quitting smoking, maintaining a healthy weight, eating a balanced diet, and staying physically active.
It is not always possible to prevent cardiomegaly, for example, in the case of inherited heart diseases.
Many forms of cardiomegaly are permanent and will require ongoing care to prevent their progression. Other, temporary forms can be resolved by eliminating the cause, such as by addressing stress or seeking treatment for drug or alcohol abuse.
Therefore, it is important to see a doctor if any of the signs or symptoms of cardiomegaly are noticed. Seek emergency medical treatment if any of the symptoms of a heart attack are experienced, such as:
- severe chest pain
- shortness of breath
- discomfort or sensations in the arms, back, neck, or stomach
The outlook for people with mild cardiomegaly depends on the underlying cause. Even though mild cardiomegaly is not as serious as moderate or severe cardiomegaly and does not always cause symptoms, it is still important to attend to the underlying condition.