What is an Enlarged Heart?

An enlarged heart, also is called cardiomegaly or idiopathic dilated cardiomyopathy, is a condition that occurs when a heart becomes enlarged or dilated by factors such as infection, stress, or as a result of other heart conditions. People often need treatment for this condition throughout the rest of their life. However, there is often no known cause of an enlarged heart. Symptoms of an enlarged heart can improve, but most often, treatment to correct the cause of the enlargement is needed.

Baptist Health is known for advanced, superior care for patients with heart disease and the diagnosis, management and treatment of an enlarged heart. You will appreciate timely appointments and respectful attention to your concerns, all in a positive and friendly atmosphere. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Symptoms

Enlarged heart symptoms may not be present or may go unnoticed at first as the condition slowly progresses. That’s why regular checkups are important to detect an enlarged heart. See your physician if you have any cardiomegaly symptoms such as:

• Shortness of breath or a raspy voice may occur when physically active or lying flat
• Skipped heart beats or palpitations (arrhythmia)
• Swelling of the leg (edema)
• Fatigue
• Weight gain around the abdomen
• Dizziness
• Abdominal bloating

When to See a Doctor

If you have the following enlarged heart symptoms, seek emergency treatment immediately because you may be experiencing a heart attack:

• Chest pain
• Severe difficulty breathing
• Fainting or near-fainting spells

Causes

Enlarged heart can be caused by any condition that forces your heart to work harder, most commonly by heart diseases.Enlarged heart can also arise from factors that can include:

• Blocked arteries of the heart (coronary heart disease)
• Disease of the heart muscle (cardiomyopathy)
• High blood pressure
• High cholesterol
• High blood pressure in the artery leading to the heart and lung (pulmonary hypertension)
• Tobacco, alcohol and cocaine use

Risk Factors

You may have an increased risk of an enlarged heart if you have a predisposed condition. Enlarged heart risk factors can include:

• Anemia: A lack of red blood cells that carry oxygen to the blood can cause the heart to beat faster and enlarge the heart.
• Congenital heart disease: People can be born with a heart that has an abnormal structure that may cause an enlarged heart.
• Connective tissue disease: Conditions like Marfan Syndrome can contribute to an enlarged heart.
• Excessive iron in the body: When iron is not metabolized, it can collect in the heart and enlarge the left ventricle.
• Family history: If a patient’s parent or sibling has an enlarged heart, the risk increases for developing the condition.
• Fluid around the heart: Fluid can collect around the heart and cause the heart to pump harder, which causes enlargement.
• Heart attack: A previous heart attack can lead to an enlarged heart.
• Heart valve disease: Enlargement can happen when heart valves are affected by rheumatic fever, a congenital defect, infections, medications or radiation treatment. 
• Rare diseases: Certain conditions, including amyloidosis, can result in a buildup of protein that enlarges the heart.
• Thyroid disorders: An overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid can cause an enlarged heart.

Prevention

While some risk factors like heredity and infection can’t be controlled, there are ways to prevent worsening of an enlarged heart:

• Practice good heart health: Watch what you eat, limit salt intake, exercise and avoid tobacco and alcohol.
• Monitor your blood pressure: Controlling blood pressure can help improve heart disease.
• Sleep eight hours each night: Enough rest is critical to better heart health.
• Take your medications as prescribed: If you have high blood pressure, high cholesterol or diabetes, be certain to take medications as directed.

Diagnosis

Early diagnosis of an enlarged heart is critical to manage or improve the condition. During a physical exam, a physician may hear abnormal heart sounds or fluid in the lungs, or see swelling in the legs, ankles or abdomen. Advanced tests to effectively diagnose the condition, inform treatment and carefully monitor the condition can include:

• Blood test: Blood tests check the levels of certain fats, cholesterol, sugar and protein in the blood that could indicate heart conditions.
• Cardiac catheterization: A long, thin flexible tube is threaded through a blood vessel in the arm or groin and to the heart. Contrast material is injected through the tube and a type of X-ray video is taken to show how the heart functions and to look for heart blockages. A small piece of heart tissue may be taken for lab analysis.
• Chest X-ray: A common imaging test of the lungs, heart and aorta.
• Computed tomographic angiography (CT): This non-invasive test can show the arteries in the abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents.
• Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves.
• Electrocardiogram (EKG): An EKG measures the electrical activity of the heart and can detect an enlarged heart as well as determine if a heart is overworked or damaged. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.
• Magnetic resonance imaging (MRI): A large magnet, radio waves and a computer are used to produce pictures of the heart and blood vessels.
• Stress testing: This test is conducted during exercise. If a person can't exercise, medicine is given to increase heart rate. Used along with an EKG, the test can show changes to the heart’s rate, rhythm or electrical activity as well as blood pressure. Exercise makes the heart work hard and beat fast while heart tests are administered.

Prognosis

The prognosis for people with an enlarged heart is good if medications are taken as prescribed and a heart-healthy lifestyle is adopted. An enlarged heart can be treated over time as it is stabilized and reduces size.

Treatment

Enlarged heart treatment will depend on the heart condition causing it. A medical procedure or surgery may be needed to treat an enlarged heart if your condition cannot be controlled by medications and lifestyle changes.

Medication

Medications can help treat the symptoms, or the causes, of cardiomegaly in order to

• Lower blood pressure
• Prevent blood clots
• Reduce the risk of heart attack or stroke
• Increase the strength and efficiency of heart contractions

Surgery

Your physician may recommend a medical procedure or surgery that can include:

• Coronary artery bypass grafting (CABG): This surgery improves blood flow, stops chest pain and prevents a heart attack by grafting arteries or veins taken from other parts of your body in order to bypass the narrowed coronary arteries.
• Ventricular assist device (VAD) surgery: This device can be implanted to help a weak heart pump more efficiently.
• Heart valve surgery: Heart valve surgery may be done to repair a problem with a valve, or replace it with an artificial valve or a tissue valve from a cow, pig or human.
• Heart transplant surgery: This surgery is the last option if your symptoms can’t be controlled.

Recovery

The length of your hospital stay depends upon the procedure.

• After coronary artery bypass grafting, you will spend one to two days in an intensive care unit, and another three to five days in another unit before you can go home. Full recovery may take 6-12 weeks. Your physician will tell you when you may be physically active again, including going back to work or resuming sexual activity.
• Recovery after ventricular assist device surgery depends upon your condition before surgery. You will spend one to two days in an intensive care unit, and another three to five days in another unit before you can go home. You will transition slowly from hospital to home, which may include being at home for the first day, but coming back to the hospital that evening. Your doctor will advise you on the level of activities you can participate in until you are fully recovered.
• After heart valve surgery, you will spend one to two days in an intensive care unit, and another three to five days in another unit before you can go home. Full recovery may take 6-12 weeks. Your physician will tell you when you may be physically active again.
• After heart transplant surgery, you will spend several days in an intensive care unit, and several weeks in another unit before you can go home. Once discharged, you must stay very close to the hospital for the first six weeks to maintain frequent follow-up visits and lab tests. Your doctor will advise you on the level of activities you can participate in until you are fully recovered.

Follow-Up Care After Enlarged Heart Surgery

Before leaving the hospital, your physician or nurse will discuss a follow-up plan that will probably include check-ups and tests. It is important you follow steps daily of a specific health plan daily aimed at reducing the risk of additional blocked arteries:

• Eat a diet low in fat, cholesterol and salt
• Get exercise daily
• Avoid use of tobaccos and cocaine
• Limit alcohol use
• Reduce stress
• Take medicines for high blood pressure and other conditions daily as prescribed.

Complications

If an enlarged heart is not diagnosed and treated early, complications of cardiomegaly can occur, including:

• Blood clots: Blood clots can weaken the heart and affect its ability to pump blood through the body. If a blood clot breaks loose, it could block a blood vessel anywhere in the body.
• Cardiac arrest and sudden death, stroke or pulmonary embolism: If a blood clot breaks off, it can cause a heart attack, stroke or pulmonary embolism in your lungs.
• Heart failure: As the left ventricle enlarges, the risk for heart failure increases. When heart failure occurs, the ventricles in the weakened heart are stretched and can’t efficiently pump blood.
• Heart murmur: Blood can flow back into mitral and tricuspid valves that do not close properly and create a sound called a heart murmur. Although it may not be harmful, a physician should monitor it regularly.