Enlarged Heart: Symptoms, Causes & Treatment

An enlarged heart is not an illness, but rather the consequence of heart disease, like cardiac insufficiency, coronary artery disease, valvular problems or arrhythmia. These conditions can cause hypertrophy in the heart muscle, making it thicker. These conditions can also affect the chambers in the heart and cause them to dilate, which also makes the heart larger. 

This type of abnormality occurs more frequently in older adults, but it can also be noted in young adults or in children with heart problems. In its initial phases, it does not cause any symptoms. However, over time, an enlarged heart can affect how blood is pumped to the rest of the body, leading to intense fatigue and shortness of breath. 

Although this is a serious, life-threatening finding, it can be treated with medication or even surgery. It is curable if identified in its early phases.

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Main symptoms

Symptoms of an enlarged heart tend to emerge in phases. The main symptoms include: 

  • Shortness of breath during strenuous activity, when resting, or when lying down on your back 
  • Palpitations
  • Chest pain
  • Coughing, especially when lying down
  • Dizziness and fainting
  • Weakness and fatigue with minimal activity 
  • Constant fatigue 
  • Swelling in the legs, ankles or feet
  • Abdominal swelling 

In its beginning phases, cardiomegaly generally does not cause any symptoms. However, as it starts to evolve, the heart has more and more difficulty pumping blood efficiently to the rest of the body. 

You should either see a cardiologist if you notice these symptoms or proceed to the nearest emergency room, especially if you have symptoms of a heart attack, like chest pain and difficulty breathing. Read more about the symptoms of a heart attack that you should not ignore. 

Stages of cardiomegaly 

Depending on the size, an enlarged heart can be visualized with a chest x-ray and classified into 4 stages: 

Enlarged Heart Cardiothoracic Ratio
Stage I (Mild) 0.5 to 0.55
Stage II (Moderate) 0.55 to 0.60
Stage III (Moderate to severe) 0.60 to 0.65
Stage IV (Severe) > 0.65

Why does the heart get bigger?

The heart can grow in size due to conditions that cause systemic inflammation and promote oxidative stress. These factors contribute to thickening and stretching of the cardiac muscles. 

These changes affect the way the heart contracts, which forces the heart to work harder to pump blood to the rest of the body. This increased force increases the size of the heart muscle, leading to fatigue and cardiac insufficiency. 

Confirming a diagnosis 

Cardiomegaly is diagnosed based on clinical history and diagnostic tests like a chest x-ray, ECG, echocardiogram, CT scan or MRI. The doctor can also order bloodwork to look for any abnormalities that can alter heart function. 

The cardiologist can also order a catheterization to visualize the heart from the inside. A biopsy can also be done during the catheterization to assess for any cardiac cell abnormalities. 

Possible causes 

An enlarged heart can occur as a result of the following conditions: 

  • Systemic arterial hypertension
  • Coronary artery disease, like a block 
  • Cardiac failure
  • Cardiac arrhythmia
  • Cardiomyopathy
  • Myocardial infarct 
  • Valvular disease from rheumatic fever or a heart infection like endocarditis
  • Diabetes
  • Pulmonary hypertension
  • Chronic obstructive pulmonary disease
  • Kidney failure
  • Anemia 
  • Thyroid gland problems, like hypo or hyperthyroidism
  • High iron levels
  • Chagas disease
  • Alcohol abuse 

Some cancer medications, like doxorubicin, epirubicin, daunorubicin or cyclophosphamide can also cause cardiomegaly. 

Although it is not as common, it also possible to develop an enlarged heart during pregnancy. This has been noted in women with a history of heart disease, with advanced age, or who drink or consume drugs during pregnancy. This is considered to be a temporary finding in pregnancy, and typically resolves after a year of treatment. 

Can an enlarged heart return to its normal size? 

Some people may experience cardiomegaly as a result of a temporary condition, like an infection or pregnancy. In these cases, the heart can return to its normal size with the right treatment. 

However, cardiomegaly from a chronic disease may remain permanently. Therefore, it is important to follow prescribed treatment to control the symptoms related to this change. 

Treatment options

Treatment for cardiomegaly should be monitored by a cardiologist. Some treatment options include: 

1. Medications

Medications that the cardiologist can prescribe include: 

  • Diuretics, like furosemide or indapamide: These remove excess fluid in the body and prevent fluid accumulation that interferes with heart function These medications also reduce swelling in the abdomen, legs, feet and ankles. 
  • Anti-hypertensives, like captopril, enalapril, losartan, valsartan, carvedilol or bisoprolol: These medications help to dilate blood vessels, which increase blood flow and help reduce the overall load on the heart 
  • Anticoagulants, like warfarin or aspirin: These decrease the thickness of the blood, which can prevent the development of clots that cause blockages or strokes
  • Antiarrhythmics, like digoxin: These help to strengthen the cardiac muscle, to help with contractions and more efficient pumping of the blood. 

These medications should be used under a doctor’s supervision, with specific dosing prescribed for you.

2. Pacemaker

In some cases of cardiomegaly, especially in advanced stages, the doctor may recommend the placement of a pacemaker to coordinate electrical impulses and contraction of the heart muscle. A pacemaker can help with heart function and make it easier for the heart to pump blood. Learn more about how a pacemaker works and when it is recommended.

3. Cardiac surgery

The cardiologist may recommend surgery to correct any defects or abnormalities in the heart valves. The surgeon can either repair or substitute the affected valve. 

4. Coronary bypass surgery 

Coronary bypass surgery may be recommended if the enlarged heart is a consequence of coronary artery disease. 

This surgery corrects and redirects blood flow in the coronary arteries, and helps to control symptoms like chest pain and difficulty breathing. 

5. Cardiac transplant

A cardiac transplant may be considered if all other treatment options were unsuccessful in addressing cardiomegaly symptoms. A transplant is usually done as a last resort. 

Possible complications

Complications related to an enlarged heart include: 

  • Heart attack
  • Formation of blood clots
  • Cardiac arrest
  • Sudden death 

These complications depend on the part of the heart that is enlarged and the underlying cause. Therefore, if you suspect any heart issues, you should seek medical attention. 

How long can a person live with an enlarged heart? 

Because cardiomegaly can be caused by so many different factors, it is not possible to determine how long a person can live with this condition. It depends on the underlying cause and the person’s general health status. 

In addition, if appropriate treatment is not started, the severity of the condition can worsen. This can lead to a decreased quality of life and a risk for death. Therefore, it is always best to consult a cardiologist. 

Considerations during treatment 

Some important measures to consider during treatment for cardiomegaly are: 

  • Quit smoking
  • Maintain an ideal weight 
  • Manage blood sugar levels and follow diabetic treatment as prescribed 
  • Monitor blood pressure and manage high levels
  • Avoid consuming alcohol and caffeine
  • Avoid drugs like cocaine and amphetamines 
  • Engage in exercise as recommended by your doctor
  • Sleep at least 8 to 9 hours per night 

You should be monitored by a cardiologist on an ongoing basis. Diet changes, like decreasing fat, sugar and salt intake, may also be recommended. Check out tips on how to control blood sugar levels