Enlarged Heart (Cardiomegaly)

Cardiomegaly (an enlarged heart) describes a heart that’s bigger than what’s typical. Your heart may be unusually thick or dilated (stretched) due to another condition. An enlarged heart may be short-term or permanent, depending on the cause. Cardiomegaly can happen to your whole heart or just parts of it. Some complications are fatal.

An enlarged heart has trouble pumping blood well, making you feel tired or short of breath. Your heart may increase in size when something forces it to use more effort to circulate blood. It’s like walking uphill all the time instead of on level ground.

Cardiomegaly causes

Any disease that makes your heart work harder can enlarge it. Coronary artery disease, the most common cause of cardiomegaly, happens to many people.

Other causes include:

• Rheumatoid arthritis: A condition that can cause inflammation in your heart muscle
• Arrhythmia: Abnormal heart rhythms, like atrial fibrillation and atrial flutter
• Infiltrative diseases: Conditions like sarcoidosis, amyloidosis and hypothyroidism that deposit substances in your heart
• Diseases that make your heart pump a lot of blood: Conditions like anemia and hyperthyroidism
• Cardiomyopathy: Heart muscle problems from substance use, myocarditis or an inherited gene change
• Congenital heart disease: Heart problems you’re born with, like valve issues or a hole in the wall between the left and right sides
• Hypertensive heart disease: Damage in your heart from unmanaged, long-term high blood pressure
• Kidney failure: A condition that can cause fluid buildup, which means your heart has to pump more fluid
• Heart valve disease: Narrow or leaky valves, which keep blood from flowing normally
• Lung diseases: COPD, pulmonary hypertension and other problems that restrict your breathing

In some cases, elite athletes develop an enlarged heart from repeated exertion. In this case, the heart’s function is normal (or better) despite the enlargement.

Risk factors

You have a higher risk of cardiomegaly if you have:

• A history of the condition in your biological family
• Heavy alcohol use or a substance use disorder
• Tobacco use
• High blood pressure
• Personal or family history of heart attacks
• Little to no physical activity

How to lower your risk

If you have a family history of cardiomegaly, ask your healthcare provider what you can do to manage your risks. You may also make some lifestyle changes, like:

• Eating heart-healthy foods
• Being physically active for 150 minutes per week (30 minutes five times per week)
• Managing your blood pressure, blood sugar and cholesterol
• Maintaining a weight that’s healthy for you
• Avoiding the use of tobacco products and other addictive substances
• Sleeping eight hours each night
• Drinking alcohol in moderation

Symptoms of cardiomegaly

An enlarged heart might not cause any symptoms. But you might have these symptoms when you exert yourself:

• Chest pain
• Dizziness
• Fainting
• Swelling, especially in your legs, feet or belly
• Fatigue
• Heart fluttering
• Low energy
• Shortness of breath

Complications of an enlarged heart

Complications depend on the cause and which part of your heart the issue affects. Complications can include:

• Blood clots: Can block blood flow and lead to a heart attack, stroke or pulmonary embolism (clot in your lung)
• Heart failure: Can happen if the left side of your heart is enlarged (left ventricular hypertrophy) or dilated
• Heart murmur: Can happen if your heart valves don’t close as they should
• Sudden cardiac death: Can happen if an enlarged heart leads to abnormal heart rhythms that are deadly

How doctors diagnose this condition

A diagnosis starts with discussing your symptoms, biological family health history and physical activity. A healthcare provider may hear a heart murmur when they listen to your heart with a stethoscope. You may have other signs of heart failure, including leg swelling, crackles in your lungs due to fluid, or engorged neck veins from extra fluid in your body.

Your provider may request tests to see how well your heart works and check its size.

Some common tests include:

• Chest X-ray: Records images of your chest and heart
• Cardiac CT scan: Uses X-rays to create a video of your heart and blood flow
• Echocardiogram: Uses ultrasound to look at your heart chambers and valves
• Electrocardiogram (EKG): Records your heart’s electrical activity and can show anything unusual
• Exercise stress test: Raises your heart rate with medicine or exercise to learn how your heart responds and look for coronary artery disease
• Heart MRI: Uses magnets and radio waves to create detailed pictures of your heart
• Genetic testing: Can tell you if you have a genetic problem that causes an enlarged heart

How is it treated?

Cardiomegaly treatments manage the condition that’s causing the disease. Treatments may include daily habit changes, medications and procedures.

Changes to daily habits

Lifestyle changes may include:

• Reduce your salt intake.
• Avoid tobacco use.
• Eat heart-healthy foods.
• Get regular physical activity.
• Stay at a weight that’s healthy for you.
• Reduce alcohol intake.
• Manage your fluid intake.

Medications

Your healthcare provider may prescribe:

• Antiarrhythmics to keep your heart beating in a normal rhythm
• Angiotensin-converting enzyme (ACE) inhibitors to lower your blood pressure
• Angiotensin II receptor blockers (ARBs) to lower your blood pressure
• Anticoagulants to reduce your risk of blood clots
• Beta-blockers to manage blood pressure and improve heart function
• Diuretics (salt pills or water pills) to lower the amount of sodium and water in your body

Procedures or surgeries

These may include:

• Implanting a pacemaker to help your heart beat in a steady rhythm
• Placing an implantable cardioverter defibrillator (ICD), a device that can shock your heart back into rhythm
• Repairing or replacing a damaged heart valve
• Placing a stent or performing coronary artery bypass surgery

When should I see my healthcare provider?

See your provider right away if you develop symptoms like leg swelling, shortness of breath or chest pain. These could mean you have cardiomegaly.

Once you have a diagnosis, keep going to your regular checkups. These allow your provider to monitor your condition and see if you’re developing worse symptoms or complications.

Most of the time, an enlarged heart isn’t an emergency. But seek medical care right away if you have:

• Chest pain
• Pain or tingling in your arms, back, neck or jaw
• Fainting
• Trouble catching your breath, even at rest

What questions should I ask my doctor?

• What’s causing my enlarged heart?
• What’s the best treatment for me?
• How often do I need follow-up visits with you?
• Do my family members need screening?

What can I expect if I have this condition?

Cardiomegaly can be serious or mild. It depends on the condition that’s causing it.

If you have an enlarged heart because of a short-term factor like pregnancy or an infection, your heart will return to its usual size after treatment. If a chronic (ongoing) condition is causing the enlarged heart, it usually won’t go away. You need to continue medication or other treatment to manage symptoms.

Some complications of an enlarged heart can be fatal.

Many people effectively manage the symptoms of an enlarged heart. The earlier you receive care, the better your chances for a good outcome. Early cardiomegaly treatment can stop the condition from getting worse.