Cardiomegaly – Causes, Treatment, Symptoms, Pictures, Types

It is a medical condition, which in layman’s terms, is an enlarged heart wherein the heart’s width is more than the half of the thorax’s total width. In addition to that, it has a characteristic of having a ratio of cardiothoracic of above 0.50.  It is associated with heart conditions such as high blood pressure, congestive heart failure, long term anemia and the like.  Hence, it is important that you have important facts pertaining to this kind of disease and also to attend regular health consultations for early detection and management.

Picture 1 – Image Showing the Difference of a Normal Heart to an Enlarged Heart

Cardiomegaly Symptoms

The symptoms that are associated with Cardiomegaly will greatly depend on the severity and etiological factors that are linked with this kind of disease condition. If in such case, the person suffers a mild to moderate case of Cardiomegaly, he or she may or may not exhibit symptoms associated with the disease. However, if a person suffers a severe and chronic kind of Cardiomegaly, the symptoms may manifest as:

• Experiencing shortness of breath
• Dizziness
• Arrhythmia
• Heart palpitations
• Fainting
• Pain in the chest region
• Dyspnea or difficulty breathing
• Edema in the limbs
• Tenderness in the region of the upper right quadrant
• Ascites

Cardiomegaly Causes

The etiological factors, which lead to acquiring or experiencing this kind of disease condition may be due to either one of the following:

1. Right ventricular hypertrophy

With right ventricular hypertrophy, what happens is that the right ventricular part of the heart hypertrophies or abnormally enlarges.  When this happens, the right ventricular portion of the heart thickens, which leads to a decrease in the blood circulation to the lungs, which leads to enlargement of the heart, if management is prolonged or if the person is not responding well to the therapy given.

2. Left ventricular hypertrophy

It may also be due to the hypertrophy or the enlargement of the left ventricular portion of the person’s heart, which will lead to having stenosis, systemic hypertension, and irregular heartbeat or worse, heart attack.

Picture 3 – Left Ventricular Hypertrophy

3. Dilation

When dilation is the primary etiological reason as to why a person suffers Cardiomegaly, it is then medically labeled as congestive cardiomyopathy or DCM, otherwise known as dilated Cardiomegaly. When this happens, the heart will become enlarged and weak, eventually problems delivering oxygenated blood to all the part of the human body will result to a far bigger complications. This kind of etiological cause happens most often in men.

4. Hypertension

Hypertension occurs when there is high blood pressure, causing the heart difficulty pumping blood throughout the body, making the heart muscle thicker and eventually leading to a hypertensive kind of Cardiomegaly.

5. Anemia

When a person has anemia, he or she has insufficient or lack of RBC or red blood cells (iron), which, if not treated can result in Cardiomegaly. When there is a lack of iron, the heart has to compensate by beating faster than its normal beat. If left untreated it can lead to further complications.

6. Valvular heart disease

Conditions causing valvular heart disease include, rheumatic fever, endocarditis, connective tissue disorder among others.  Cancer related therapies and medications can also cause problems in the heart valves.

7. Thyroid disorders

Hypothyroidism and hyperthyroidism leads to Cardiomegaly.

8. Dwarfism

A particular kind of dwarfism called morquio syndrome or otherwise known as mucopolysaccharidosis IV can result in Cardiomegaly.

9. Hemochromatosis

This is a metabolic disorder, particularly one where a person has improper iron metabolism, which leads to accumulation of too many iron stores.  This can weaken the heart muscles and lead to the enlargement of the left ventricular portion of the person’s heart.

10. Amyloidosis

It is the excess or abnormal protein, which leads to the enlargement of the person’s heart.

11. Other Etiological Reasons or Causes

Other reasons why Cardiomegaly is experienced can be due to a known side-effect of a particular pharmacological medication prescribed by a physician, infection, toxication of the person’s blood because of drug abuse and alcohol abuse and if a person is deficient in certain nutrients. Sometimes, it may be due to congenital reasons, which are common in newborns.

Cardiomegaly Pathophysiology

Normally, the heart pumps blood from the heart and back. The heart is made up of four chambers: the right ventricle, right atrium, left ventricle, and left atrium. The left atrium and ventricles are where the deoxygenated or the waste material of the blood or the carbon dioxide rich blood is absorbed and passed through. The lungs expel the carbon dioxide through exhalation. While the right atrium and ventricles are where the oxygenated or the clean blood is absorbed and distributed to every parts of the human body.

What happens in Cardiomegaly is that there is an abnormal enlargement of either the left or right ventricles or atrium  that will cause a blockage of the passageways for the blood to travel, which will result in a compilation of the waste material produced by the blood or perhaps block the passageway for the oxygenated blood.

Cardiomegaly Types (based on severity)

• Mild

When the patient has a mild case of Cardiomegaly, it simply means that there is a slight form of heart enlargement. Despite the condition being mild, it still needs to be treated because it has the possibility to get worse.

• Moderate

 A moderate type of Cardiomegaly may or may not manifest symptoms mentioned above. Still, like the mild type of Cardiomegaly there is a need for the person to be treated before reaching damaging effects.

• Severe

With the severe case of Cardiomegaly, the symptoms are clearly manifested and there is a greater risk and need for further evaluation, as well as treatment.

Cardiomegaly Diagnosis

The physician will be the one who will diagnose this disease condition. When diagnosing, the physician will order tests or examinations, which will include:

• Medical historical examination
• Physical examination
• X-ray examination
• Electrocardiogram or ECG or EKG
• Echocardiogram
• MRI or CT scan
• Stress Test
• Cardiac Catheterization
• Biopsy

Picture 4 – X-ray Showing Enlargement of the Heart

Cardiomegaly Treatment

The treatment for this kind of disease condition will rely on two treatment therapies or management, such as:

1. Pharmacological therapy

The medications often prescribed for persons with Cardiomegaly are the medications under the classification of ARBS, diuretics, beta blockers, digoxin and anticoagulants.

2. Surgical therapy and medical devices

It may include pacemaker implantation, and other implantation devices such as LVAD or left ventricular assist device, and ICD or Implantable Cardioverter Defibrilator.

Also, surgeries may be conducted depending on the assessment made by the physician and especially when the person suffers atrial fibrillation.

In addition to the treatment mentioned, the person will recover faster if the treatment is accompanied with measures to prevent further complications and permanent changes in the lifestyle, such as giving up alcohol or smoking, eating a low salt diet, physical exercise, a proper amount of sleep among other modifications.  By doing such activities, there is a bigger chance that the dangers associated with this kind of condition will be averted.