An Enlarged Heart

11/9/2020

An enlarged heart is a serious condition and if not properly diagnosed, can lead to a sudden and unexpected death. I have known a few people for which this has happened.  One person was a young man that was very active in competitive body building. He had the appearance of health and without any warning, he succumbed to cardiac arrest.

And while many of us participate in a fit-for-duty physical, these medical exams focus on our ability to perform our assigned work tasks, rather than an exhaustive examination of our personal health (just an FYI, the young man that I referred to in the above paragraph worked at the Hanford DOE Site where he had annual fit-for-duty occupational physical, which did not detect his serious cardio condition!).

An enlarged heart, referred to as cardiomegaly, isn’t a disease, but rather a sign of another condition. The term “cardiomegaly” refers to an enlarged heart seen on any imaging test, including a chest X-ray. Other tests are then needed to diagnose the condition that’s causing the heart to be enlarged.

An enlarged heart may be the result of a short-term stress on the body, such as pregnancy, or a medical condition, such as the weakening of the heart muscle, coronary artery disease, heart valve problems or abnormal heart rhythms. Certain conditions may cause the heart muscle to become thicker or cause one of the chambers of the heart to dilate, making the heart larger. Depending on the condition, an enlarged heart may be temporary or permanent.

An enlarged heart can be caused by conditions that cause your heart to pump harder than usual or that damage your heart muscle. Sometimes the heart gets larger and becomes weak for unknown reasons and is known as idiopathic cardiomegaly.

A heart condition you’re born with (congenital), damage from a heart attack or an abnormal heartbeat (arrhythmia) can cause your heart to enlarge. Other conditions associated with an enlarged heart include:

• High blood pressure. Your heart may have to pump harder to deliver blood to the rest of your body, enlarging and thickening the muscle.

High blood pressure can cause the left ventricle (the chamber that pumps blood via the aorta to the body) to enlarge, causing the heart muscle eventually to weaken. High blood pressure may also enlarge the upper chambers (atriums – the chambers that receive blood from the body (right) and lungs (left)) of your heart.

• Heart valve disease. Four valves in your heart keep blood flowing in the right direction. If the valves are damaged by conditions such as rheumatic fever, a heart defect, infections (infectious endocarditis), an irregular heartbeat (atrial fibrillation) connective tissue disorders, certain medications or radiation treatments for cancer, your heart may enlarge.
• Cardiomyopathy. This disease of the heart makes it harder for your heart to pump blood throughout your body. As it progresses, your heart may enlarge to try to pump more blood.
• High blood pressure in the artery that connects your heart and lungs (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.
• Fluid around your heart (pericardial effusion). Accumulation of fluid in the sac that contains your heart may cause your heart to appear enlarged on a chest X-ray.
• Blocked arteries in your heart (coronary artery disease). With this condition, fatty plaque in your heart arteries obstruct blood flow through your heart vessels, which can lead to a heart attack. When a section of heart muscle dies, your heart has to pump harder to get adequate blood to the rest of your body, causing it to 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. 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.
• 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 metabolize iron, causing it to build up in various organs, including your heart. This can cause an enlarged left ventricle due to weakening of the heart muscle.
• Rare diseases that can affect your heart, such as 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 and causing it to enlarge.

So, what can be done once one is diagnosed with an enlarged heart?  An enlarged heart may be treatable by correcting the cause. Treatment for an enlarged heart can include medications, medical procedures or surgery. Unfortunately, there are cases where there are no signs or symptoms and therefore this condition can be a silent killer. And while an enlarged heart may have signs and symptoms that, while may indicate a heart condition, such indicators are not specific to just an enlarged heart. They are 1) Shortness of breath, 2) Abnormal heart rhythm (arrhythmia) and, 3) swelling.

As one may suspect, an enlarged heart is easier to treat when it’s detected early, so talk to your doctor if you have concerns about your heart.

Preventative measures include controlling the typical risk factors for coronary artery disease. That is, tobacco use, high blood pressure, high cholesterol and diabetes.  You can help reduce your chance of developing heart failure by eating a healthy diet and not abusing alcohol or using illicit drugs. Controlling high blood pressure with diet, exercise and possibly medications also prevents many people who have an enlarged heart from developing heart failure.

A vigorous five-mile walk will do more good for an unhappy but otherwise healthy adult than all the medicine and psychology in the world

Paul Dudley White (American physician and cardiologist)