Left atrial enlargement (LAE) is when the left side of the heart enlarges or swells, leading to breathlessness, fatigue, and other symptoms. It often affects people with high blood pressure and heart valve issues.

The left side of the heart receives newly oxygenated blood from the lungs and pumps it to the rest of the body.

Several heart problems may cause the left atrium to swell. When this happens, doctors call it left atrial enlargement (LAE). LAE has links with several conditions, including atrial fibrillation (A-fib) and heart failure.

In this article, learn about the causes of LAE, associated conditions, symptoms, and treatments.

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Doctors must explore the underlying condition or conditions causing LAE to help people manage symptoms and improve their quality of life.

There is no treatment for LAE, and at present, there is no therapy to reverse the condition.

A person will receive treatment for each specific cause to help with the symptoms, as these likely link to LAE.

LAE can help doctors predict cardiovascular events such as heart attacks.

Research from 2021 found a link between LAE and high blood pressure (hypertension).

Diagnosing LAE can help doctors determine the risk of a heart attack in people with high blood pressure.

Treatment for hypertension

Hypertension is the most common modifiable risk factor for cardiovascular diseases. Certain treatments may help treat hypertension and, in turn, help a person with LAE. These include:

Oxygenated blood passes through the mitral valve from the left atrium to the left ventricle. Problems with the mitral valve can lead to LAE.

One possible condition is mitral stenosis, where the valve narrows and makes it difficult for blood to pass from the atrium to the ventricle. Another condition, mitral regurgitation, occurs when blood leaks from the left ventricle back into the left atrium.

Usually, the mitral valve only flows one way, passing from the atrium to the ventricle.

If mitral stenosis or regurgitation is severe, it may be difficult for the blood to pass to the ventricle. The left atrium may then enlarge to compensate for the increased pressure.

Treatment for valvular abnormalities

Various medical therapies and surgical treatments are available to relieve symptoms of mitral valve stenosis and regurgitation.

Treatments for mitral stenosis and regurgitation

To treat mitral stenosis, a doctor may recommend:

Problems with the left ventricle may mean it cannot take blood from the left atrium.

Left ventricular dysfunction with or without any valvular disease can increase both pressure and volume in the left atrium. The increased pressure can cause the atrium to enlarge.

Treatment for left ventricle dysfunction

Medical therapy is particularly important for treating left ventricle dysfunction. Some methods include:

An ICD is a battery-powered device implanted under the skin with thin wires to the heart. It tracks a person’s heart rate and uses an electrical impulse to correct any dangerous heart rhythms. The electrical impulse causes the heart muscles to contract.

Research has suggested that training can lead to both left and right atrial enlargement, especially in endurance sports.

Although research shows LAE is a common condition in athletes who do endurance sports, limited data exist on the long-term consequences for a person’s health.

Treatment

If high impact activity is the cause of a person’s LAE, a doctor may recommend reducing the intensity or frequency of exercise. Many professional bodies, including the Federation Internationale de Football Association (FIFA), recommend that athletes undergo heart screening to detect if any players are at risk.

Another possible cause of LAE is aortic stenosis. This is the narrowing of the aortic valve, which can lead to blood backup from the left ventricle to the left atrium.

With aortic stenosis, LAE severity is a predictor of mortality.

Treatment for aortic stenosis

Studies have shown that medical therapy does not significantly affect disease progression in aortic stenosis.

Aortic valve replacement (AVR) is superior to medical therapy. Doctors will recommend AVR for severe symptomatic aortic stenosis and also for people with mild symptoms.

A ventricular septal defect (VSD) is an opening or hole between the ventricles.

An electrocardiogram (ECG) can provide evidence of changes such as right ventricular hypertrophy, combined ventricular hypertrophy, and occasionally LAE.

An echocardiogram produces actual pictures of the same changes described above.

If the VSD is large, an X-ray can also show enlargement of the heart. However, ECG and chest X-ray results are typically normal if the hole is small.

Treatment for VSD

Doctors use a minimally invasive surgical method to treat congenital heart defects such as VSD. Recent advances in treatment include the periventricular approach and transcatheter techniques.

The periventricular approach simplifies VSD closure using echocardiography guidance. The research found that it is a feasible and safe approach for certain people.

However, percutaneous transcatheter closure challenges this method. Although the periventricular approach is minimally invasive, it has several undesirable aspects since it uses radiation from X-ray imaging.

Myxomas are the most common primary cardiac tumor. Experts estimate that more than 75% of myxomas originate in the left atrium.

Treatment for atrial myxoma

At present, surgical removal of tumors is the only treatment that can be successful. It has very few complications and a low recurrence rate.

The surgical approach a doctor chooses will depend on the location and size of the mass.

Health conditions associated with LAE do not always cause symptoms, and a person may only discover a heart condition during a test for another problem.

While a person can live with LAE, the underlying cause may continue to develop over time and become serious or even fatal in some cases.

Symptoms associated with other heart conditions include:

A doctor will use an echocardiogram to look for LAE. This test uses high-frequency sound waves or ultrasound imaging to produce pictures of the heart.

For this test, a person will lie on a table while a specially trained technician attaches small metal disks called electrodes to their chest. The electrodes check an electrocardiogram that traces the heart’s rhythm.

The technician will pass a small probe that produces sound waves over the chest. These sound waves bounce off the heart and echo back to the probe, making images.

An ECG and echocardiogram are not necessarily done at the same time.

An echocardiogram does not hurt, causes no internal harm, and has no side effects.

A doctor may also recommend an MRI or CT scan for diagnosis.

Common complications of LAE include:

A-fib

A-fib refers to frequent irregular heartbeats, called arrhythmia. It affects around 2.7 million Americans.

A-fib can lead to blood clots, stroke, heart failure, and other heart problems.

Research has identified a link between LAE and A-fib. In general, the larger the left atrium grows, the higher the chances of experiencing A-fib.

Stroke

Stroke is a leading cause of death in the United States. It can also cause severe complications and disability.

While the link between LAE and stroke is complex, having A-fib increases a person’s chance of stroke.

There is also evidence of an enlarged left atrium being a predictive marker of stroke without any A-fib signs.

Heart failure

The most common cause of heart failure occurs when the heart is weak and enlarged.

Heart failure occurs when a person’s heart cannot pump enough blood to meet the body’s needs.

It can lead to the following symptoms:

  • fatigue
  • weight gain
  • buildup of fluid in the lungs, liver, and legs

It can cause shortness of breath and an irregular heartbeat as it progresses.

Some lifestyle changes may lower the risk of developing conditions associated with LAE. These include:

  • managing high blood pressure and high cholesterol
  • eating a balanced diet rich in fruits and vegetables
  • reducing or eliminating alcohol
  • quitting smoking
  • exercising regularly
  • maintaining a moderate weight
  • practicing good stress management

While many people who have LAE experience no symptoms, it may be a sign of an underlying heart condition.

Treatment of the heart conditions associated with LAE can vary from lifestyle changes to surgical approaches, so it is essential to receive a correct diagnosis from a medical professional.