Enlarged Heart

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Cardiomegaly, the abnormal enlargement of the heart muscle, is a serious disease that usually occurs as a result of an underlying disease and must be treated accordingly. There are a number of diseases in the course of which cardiomegaly occurs.

What is cardiomegaly?

Organ enlargement usually occurs as a result of another disease. However, too intensive a permanent physical strain (excessive sporting workouts) can also lead to it (athlete’s heart). Other terms for cardiomegaly are (acute) cardiac dilatation, heart hypertrophy and cor bovinum (ox heart). In cardiac dilatation, the interior of the heart widens into the chest.

The term “cardiac hypertrophy” indicates overgrown heart muscle tissue: Due to various causes of disease, the heart muscle has to pump more blood volume in order to supply all organs with sufficient oxygen. The effort results in increased growth of the heart muscle tissue. Since the increased muscle mass in turn requires more oxygen, an even greater blood flow must be pumped.

Since the body is often no longer able to do this, heart failure occurs. If the cardiomegaly remains within certain limits, it is symptom-free and is often not recognized. With advanced heart enlargement, cardiac arrhythmia and heart failure can occur. Heart hypertrophy occurs in two forms: right heart hypertrophy (RVH, cor pulmonale) and left heart hypertrophy (LVH, only the left ventricle is affected).

Causes

The underlying causes of cardiomegaly may be: Heart valve defects, hyperthyroidism, severe anemia, cardiomyopathy, pericarditis, hemochromatosis, cardiac amyloidosis and diphtheria. In addition, the heart muscle can grow due to excessive physiological stress (competitive sports, endurance sports).

Cardiomyopathy is a congenital chronic heart muscle disease that results in a weakened pump function. It is often associated with an enlarged liver, progressive muscle weakness and breathing problems. Pericarditis is the inflammation of the pericardium. Patients with rare hemochromatosis have too high an iron content in the blood.

In cardiac amyloidosis, a rare immune disease, the liver forms proteins that accumulate in the heart tissue and can no longer be broken down. Ongoing physical overload due to exercise can also lead to cardiomegaly. The enlarged heart muscle can then no longer be supplied with sufficient oxygen. In other cases, the conduction system is disturbed. Younger athletes in particular have an increased risk of suffering premature sudden cardiac death.

Diagnosis & History

If the patient does not feel any symptoms, the cardiomegaly is often only recognized by chance on the X-ray image (X-ray thorax in p.a. projection). The indicator for this disease is the cardiothoracic quotient (CTR). If the CTR value is above 0.5, the heart is abnormally enlarged. It relates the maximum transversal diameter of the heart silhouette to the maximum transversal inner diameter of the bony thorax.

However, since the CTR value can also be increased by other diseases, the physician must carry out further examinations. In mobile X-ray machines, cardiomegaly is recognized by the fact that the heart silhouette touches the left thoracic wall. In addition, the heart disease is diagnosed using echocardiography, which shows up in the form of a widened tip of the heart. The course of cardiomegaly is progressive if it is not detected and treated in time.

This leads to symptoms typical of cardiac insufficiency: Respiratory distress at rest and under stress, nocturnal seizures, respiratory distress, increased urination at night, oedema, especially at the shinbone and ankles, nausea, fatigue, abdominal pain, severe weight loss, muscle weakness, cardiac arrhythmia, limitations of brain performance, cardiac asthma, cough, pulmonary oedema, enlarged liver and spleen, ascites and cold extremities.

Complications

Cardiomegaly, i.e. an enlargement of the heart, can be pathological, but can also be physiological. Typically, endurance athletes usually have an enlarged heart, which does not lead to any further complications. A pathologically enlarged heart, as it can develop, for example, due to heart valve diseases or high blood pressure, can develop into cardiac arrhythmia or cardiac insufficiency.

Typical cardiac arrhythmias are, for example, atrial fibrillation or ventricular fibrillation. In atrial fibrillation, there is a high risk of thrombus formation, which can loosen and clog vessels. If the blood clots form in the left atrium, they are washed out into the lungs, resulting in pulmonary embolism, which is characterized by shortness of breath and shortness of breath.

From the right atrium, the thrombuses are usually washed out in the direction of the cerebral vessels, which can result in a stroke. The symptoms of loss depend on the location of the vascular occlusion. Further complications concern heart failure, which cannot be cured and significantly reduces the patient’s life expectancy.

Heart failure can quickly turn into shock symptoms with high heart rate and sharp drop in blood pressure. Blood congestion can also occur because the heart no longer pumps sufficiently. Edema is the result. There is also an increased risk of sudden cardiac death.

When should I see a doctor?

Cardiomegaly is always in need of treatment. As a rule, it cannot be diagnosed by the patient himself, but is usually diagnosed as a result of heart problems in an examination. Since cardiomegaly does not occur without a background, it must always be treated. It is the result of other cardiac debilitating causes and would be accompanied by cardiac death if left untreated.

If the diagnosis is made by your family doctor, he will advise you to consult a local cardiologist and make a referral. The fast action of the physicians is essential for the diagnosis, since the disease is already considered advanced in a cardiomegaly.

This information is given to the patient during a consultation and therapy discussion. It is the patient’s own responsibility to have the causes treated. Which treatment is advisable or necessary for those affected cannot be explained in this context; these always relate to the cause and can vary from drug administration to surgery.

Treatment & Therapy

Cardiomegaly is generally treated as follows: Determination of the Body Mass Index (BMI) and examination of the body composition means that the patient must either follow a reduction diet under medical supervision or, in the case of underweight, participate in an underweight programme. He receives antihypertensive medication and must undergo regular medical check-ups.

To prevent further heart damage, he is vaccinated against pneumococcus and influenza. He has to change his diet according to the underlying disease (increased amount of vegetables and fruit, lots of fibre, a fish dish twice a week to supply omega-3 and omega-6 fatty acids) and may also take a suitable dietary supplement. The beta-receptor blockers and cardiac glycosides prescribed by your doctor improve your heart function and reduce heart rate.

Drainage products remove excess fluid from the bloodstream. Cardiomegaly patients with aortic valve stenosis receive a new mechanical or biological aortic valve through surgery. They also have to take antihypertensive drugs. In the case of heart enlargement caused by alcohol abuse of many years’ standing, a withdrawal cure must be carried out.

In pericarditis, the underlying virus or bacterial infection or autoimmune disease is treated accordingly. In the case of hemochromatosis, monthly bloodletting is helpful; in the case of heart amyloidase, heart transplantation is necessary.

Congenital heart defects such as foramen ovale can also only be removed surgically. If the patient has an isolated right-sided heart enlargement, the causing COPD (chronic obstructive pulmonary disease) and pulmonary fibrosis are treated. Cardiac arrhythmias require the insertion of a pacemaker.