Enlarged heart

Symptoms

In some people, an enlarged heart causes no signs or symptoms. Others may have these enlarged heart symptoms:

• Breathing difficulties
• Shortness of breath
• Dizziness
• Abnormal heart rhythm (arrhythmia)
• Swelling (edema)
• Cough

Causes

Sometimes, an enlarged heart develops for no apparent reason (idiopathic) but it can also be caused by a condition that can cause your heart to pump harder than usual. These conditions can 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 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.
• Weakness 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.
• 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 use 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.
• Protein buildup in your heart (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.

Risk factors

You may have a greater risk of developing an enlarged heart if you have any of the following risk factors:

• High blood pressure. Having a blood pressure measurement higher than 140/90 millimeters of mercury puts you at an increased risk of developing an enlarged heart.
• A family history of enlarged heart or cardiomyopathy. If an immediate family member, such as a parent or sibling, has had an enlarged heart, you may be more susceptible to developing an enlarged heart.
• Blocked arteries in your heart (coronary artery disease). If you have coronary artery disease, fatty plaques in the arteries of your heart make it so blood can't easily flow through the vessels of your heart. Your heart has to pump harder to get an adequate amount of blood to the rest of your body, causing it to enlarge.
• Congenital heart disease. If you're born with a condition that affects the structure of your heart, you may be at risk for developing an enlarged heart, especially if your condition isn't treated.
• Valvular heart disease. The heart has four valves — the aortic, mitral, pulmonary and tricuspid valves — that open and close to direct blood flow through your heart. Valves may be damaged by a variety of conditions leading to narrowing (stenosis), leaking (regurgitation or insufficiency) or improper closing (prolapse). Any of these conditions may cause the heart 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. One of most serious types of enlarged heart is an enlarged left ventricle leading to the possibility of heart failure.

• 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.

Other complications of enlarged heart can include:

• 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.

Diagnosis

If you have symptoms of a heart problem, your doctor will perform tests to determine if your heart is enlarged and to find out the underlying cause of your condition. In addition to a physical exam, these tests may include:

• Chest X-ray. X-ray images help your doctor see the condition of your lungs and heart. If your heart is enlarged it might first be detected by a chest X-ray, but other tests will usually be needed to find out the specific cause. Your doctor can also use an X-ray to diagnose conditions other than enlarged heart that may explain your signs and symptoms.
• Electrocardiogram. This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack as well as give clues to other types of heart disease.
• Echocardiogram. An important test for diagnosing and monitoring an enlarged heart is the echocardiogram. An echocardiogram uses sound waves to produce a video image of your heart. In this test all of the chambers of the heart can be evaluated to determine if you do have an enlarged heart and to try and determine the cause. This test determines how efficiently your heart is pumping, assesses your heart valves, can look for evidence of previous heart attacks and can determine if you have congenital heart disease.
• Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). Although more commonly used to check for heart failure, more doctors are using these tests to diagnose heart problems. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine called a gantry. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. Images of your heart are created from these signals, which your doctor will look at to determine the cause of your enlarged heart.
• Blood tests. Your doctor may order blood tests to check the levels of certain substances in your blood that may signal that you have an enlarged heart. Blood tests can also help your doctor rule out other conditions that may cause your symptoms.
• Cardiac catheterization and biopsy. In this procedure, a thin tube (catheter) is inserted in your groin and threaded through your blood vessels to your heart, where a small sample (biopsy) of your heart can be extracted for analysis in the laboratory. Pressure within the chambers of your heart can be measured to see how forcefully blood pumps through your heart. Pictures of the arteries of the heart can be taken during the procedure (coronary angiogram) to ensure that you do not have any blockage.

Treatments and drugs

Enlarged heart treatment focuses on correcting the underlying condition.

Medications

If cardiomyopathy or another cause of a weak heart muscle is to blame for your enlarged heart, your doctor may recommend medications to treat heart failure symptoms. These 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, lisinopril (Zestril), ramipril 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 and metoprolol 
• Digoxin, which can help improve the pumping function of your heart and lessen the need for hospitalization for heart failure

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 options. ICDs are small devices — about the size of a box of matches — 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.
• 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. 

Lifestyle remedies

While you can't cure your enlarged heart with home remedies, there are some things you can do to improve your condition. Your doctor may recommend adopting the following lifestyle changes:

• Quit smoking.
• Lose excess weight.
• Eat a low-salt diet.
• Control diabetes.
• Monitor your own blood pressure.
• Get modest exercise, after discussing with your doctor the most appropriate program of physical activity.
• Eliminate or minimize the amount of alcohol you drink.
• Try to sleep eight hours each night.

Prevention

In most cases you can't prevent your heart from enlarging. Let your doctor know if you have a family history of conditions that can cause an enlarged heart, such as cardiomyopathy. If cardiomyopathy or other heart conditions are diagnosed early, treatments may prevent the disease from worsening.

You can help reduce your chance of developing heart failure by avoiding some of the conditions that can contribute to a weak heart, including the abuse of alcohol or cocaine, or not getting enough vitamins and minerals. Controlling high blood pressure with diet, exercise, and possibly medications also prevents many people who have an enlarged heart from developing heart failure later in life. Controlling risk factors for coronary artery disease — tobacco use, high blood pressure, high cholesterol and diabetes — helps to reduce your risk of an enlarged heart and heart failure by reducing your risk of heart attack.

References:

https://en.wikipedia.org/wiki/Cardiomegaly

http://www.medicinenet.com/script/main/hp.asp

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/heart-disease-enlarged-heart

http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/About-Heart-Failure_UCM_002044_Article.jsp#.V0wx01dlnGI

http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.8526789/k.33D1/Heart_disease__Enlarged_heart.htm

http://www.bloodpressureuk.org/BloodPressureandyou/Yourbody/Enlargedheart