Cardiomegaly (Enlarged Heart)

People with cardiomegaly usually don't have any symptoms until their condition becomes more severe. If the heart cannot pump enough blood, patients may get signs of congestive heart failure. The various symptoms are:

• Shortness of breath
• Chest pain
• Heart palpitations
• Arrhythmia (irregular heartbeat)
• Dizziness
• Fainting and loss of consciousness
• Rapid exhaustion while indulging in physical activity
• Swelling
• Weight gain

Various health conditions that cause heart enlargement are:

• Coronary Artery Disease
• Heart valve Disease
• Cardiomyopathy
• Heart attack
• Pulmonary hypertension 
• Infection of the heart
• HIV infection
• Thyroid disorders
• Kidney disease
• Genetic or inherited conditions
• Pregnancy (peripartum cardiomyopathy or PPCM)
• High blood pressure

Other causes of Cardiomegaly

Other possible causes of an enlarged heart comprise of:

• Myocarditis
• Pulmonary hypertension
• Anaemia
• Connective tissue diseases, like scleroderma
• Drug and alcohol consumption
• Chronic Obstructive Pulmonary Disease and other lung diseases (COPD)

If a patient presents symptoms of a heart problem, the doctor will perform a physical examination, suggest tests to determine if the heart is enlarged and try to find the possible cause of this condition. Some of these tests are:

• Chest X-ray- X-ray images help doctors analyse the condition of the lungs and the heart. If the heart is enlarged on the X-ray, other tests will be advised to find the cause.
• Electrocardiogram- An electrocardiogram measures the heart's electrical activity by electrodes placed on the skin at various places. This test helps to diagnose heart rhythm issues and damage to the heart from a heart attack.
• Echocardiogram- It is a video image of the heart. All four chambers of the heart can be evaluated with this test.
• Stress test- Stress tests, also known as exercise stress test, gives information about how well the heart works while subjected to strenuous physical activity, like riding a stationary bike or walking on a treadmill, while parameters like heart rhythm, blood pressure levels, and breathing pattern are observed.
• Cardiac CT or Magnetic Resonance Imaging (MRI)- In cardiac MRI and cardiac CT, with the help of signals and magnetic waves, images of the heart and chest are obtained and evaluated for any abnormality.
• Blood tests- The doctor may recommend blood tests to check levels of certain substances in the blood, which may indicate a heart problem. 
• Cardiac catheterization and biopsy- During this procedure, a catheter is put in the groin and passed via the blood vessels towards the heart, where the doctor takes a heart biopsy.

Pressure in the heart's chambers can be checked to see how forcefully blood pumps through the heart. Images of the heart's arteries can be taken during a coronary angiogram to check for a blockage.

Treatments for an enlarged heart emphasise treating the main cause involved. It comprises medications, and if cardiomyopathy or any other form of heart condition is to blame for the enlarged heart, the doctor may recommend the following drugs:

• Diuretics decrease the amount of sodium and water, which helps lower the pressure in the arteries and the heart. 
• ACE inhibitors lower blood pressure levels and improve the heart's pumping efficiency
• Angiotensin II receptor blockers provide the benefits of ACE inhibitors to those who cannot take ACE inhibitors
• Beta-blockers lower blood pressure levels and improve heart function.
• Anticoagulants decrease the risk of blood clots that may result in a heart attack or even a stroke
• Antiarrhythmics keep the heart pumping with a usual rhythm

Cardiomegaly Surgery or other procedures

Certain medical procedures or surgical interventions may be necessary if medications aren't effective enough to treat an enlarged heart.

• Medical devices to regulate the heartbeat- A pacemaker may be required for a specific type of enlarged heart, like dilated cardiomyopathy. For people at risk of arrhythmias, drug therapy or an ICD (Implantable Cardioverter-Defibrillator) may be an option.
• Heart valve surgery- If the enlarged heart is caused due to a problem that lies with one of the heart valves, then the patient may have to undergo surgery to repair or replace the affected valve.
• Coronary bypass surgery- If an enlarged heart is due to coronary artery disease; doctors may recommend this surgery. 
• Left ventricular assist device (LVAD)- If patients have heart failure, they may need an implantable mechanical pump to help the weakened heart pump.

Patients are at an increased risk of an enlarged heart if they have any of the following risk factors:

• High blood pressure- Having a blood pressure level higher than 140/90 millimetres of mercury.
• A family history of cardiomyopathy- If an immediate family member, like a parent or sibling, has had an enlarged heart, others in the family may be more susceptible.
• Congenital heart disease-If people are born with a condition that affects the heart structure, then they may be at increased risk.
• Heart valve disease- The heart comprises four valves, aortic, mitral, pulmonary, and tricuspid, that open and close to direct blood flow through the heart. Conditions that damage the valves may cause the heart to enlarge.

Complications of an enlarged heart include:

Heart failure- An enlarged left ventricle is one of the more severe kinds of enlarged heart; it can increase the risk of heart failure.  Blood clots- An enlarged heart may make a person more vulnerable to forming blood clots in the heart's inner lining. Clots that enter the bloodstream can block blood flow to vital organs and may cause a heart attack, stroke, or even pulmonary embolism. Heart murmur- For people with heart enlargement, two of the heart's four valves, i.e., the mitral and tricuspid valve, may not close properly, leading to a backflow of blood. This flow creates sounds called heart murmurs. 
• Cardiac arrest and sudden death- Sometimes, an enlarged heart can disrupt the heart's rhythm. It can cause the heart to pump blood too slowly or too fast; it does not permit the heart to beat properly, resulting in fainting or, in some cases, cardiac arrest or sudden death.

Patients may be unable to prevent congenital conditions (conditions that occur before birth). But they can prevent damage to the heart that can make it enlarge by following these steps:

• Consuming a heart-healthy diet high in whole grains, vegetables, fruits, lean poultry, fish and low-fat dairy
• Limiting salt intake and saturated and trans fats
• Avoiding tobacco and alcohol
• Doing aerobic and strength-training exercises regularly
• Regularly checking blood pressure and cholesterol levels and working with a doctor to lower them, if they're high

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