Enlarged Heart (Cardiomegaly)

What is an enlarged heart?

An enlarged heart (cardiomegaly) describes a heart that’s bigger than what is typical. Your heart may be unusually thick or dilated (stretched). An enlarged heart may be temporary or permanent, depending on the cause. Cardiomegaly can happen to your whole heart or just parts of it.

Heart enlargement can be your heart’s reaction to something that forces it to use more effort to circulate blood. It’s like walking uphill all the time instead of on level ground. In some cases, your heart becomes enlarged due to an underlying problem with the heart itself.

Who does an enlarged heart affect?

You have a higher risk of developing cardiomegaly if you have:

• Family history of an enlarged heart.
• Heavy alcohol use or a substance use disorder.
• Tobacco use.
• High blood pressure (hypertension).
• History of heart attacks in yourself or family members.
• Sedentary lifestyle.

How common is cardiomegaly?

Coronary artery disease, the most common cause of cardiomegaly, happens to many people. It affects an estimated 18 million people aged 20 and older in the United States. Congestive heart failure, which is often caused by a dilated heart, is the leading cause of hospitalization over the age of 65 in the United States.

What happens if you have cardiomegaly?

An enlarged heart has trouble pumping blood efficiently. For this reason, having an enlarged heart increases your risk for heart complications, such as heart failure or stroke.

Is cardiomegaly serious?

Yes, cardiomegaly can be serious. It depends on the condition that’s causing it. Some of these conditions are chronic. That means they last a long time and require treatment for many years.

What are the symptoms of an enlarged heart?

In some people, an enlarged heart doesn’t cause any symptoms. Other people with an enlarged heart might experience:

• Dizziness.
• Edema (swelling), especially in the legs, feet or abdomen.
• Fatigue, or being unusually exhausted.
• Heart fluttering.
• Low energy.
• Shortness of breath.

What causes cardiomegaly?

Any disease that makes your heart work harder can enlarge it. Just like your arm or leg muscles get bigger when you work out, your heart gets bigger when it has to work harder. However, unlike your arm or leg muscles, your heart doesn’t always become more effective just because it gets bigger.

Many disease processes can cause the heart to dilate due to problems with the underlying heart muscle. In these cases, despite the heart being bigger, its function actually worsens.

The most common cause of an enlarged heart is coronary artery disease (which can lead to a heart attack).

Other enlarged heart causes include:

• Anemia.
• Pregnancy.
• Rheumatoid arthritis.
• Arrhythmia (abnormal heart rhythm).
• Sarcoidosis.
• Cardiomyopathy.
• Congenital heart disease.
• Hypertensive heart disease.
• Kidney failure.
• A viral infection that causes myocarditis.
• Heart valve disease.
• Hyperthyroidism.
• Hypothyroidism.
• Lung diseases like COPD and pulmonary hypertension.

In some cases, elite athletes will develop an enlarged heart just due to repeated exertion. In this case, the heart’s function will be normal (or even better than normal) despite the enlargement.

How is an enlarged heart diagnosed?

A diagnosis starts with discussing your symptoms and family health history. They’ll ask you about your exercise history. Your 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 the lungs due to fluid, or engorged neck veins due to extra fluid in the body as the heart can’t pump efficiently. They may order tests to assess your cardiomegaly and rule out other conditions.

Some common tests include:

• Chest X-ray to record images of your chest and heart.
• Cardiac CT scan, using X-rays to create a video of your heart and blood flow.
• Transthoracic echocardiogram uses ultrasound to check your heart’s size and how well it’s working.
• Electrocardiogram (EKG) to study your heart’s electrical activity.
• Exercise stress test, raising your heart rate with medicine or exercise to learn how your heart responds.
• Heart MRI, using magnets and radio waves to create detailed pictures of your heart.
• Genetic testing, to see if you have an underlying genetic problem causing an enlarged heart.

How is an enlarged heart treated?

Enlarged heart treatment focuses on managing the condition that’s causing cardiomegaly. Your healthcare provider may prescribe medications to treat any underlying heart conditions.

Lifestyle changes include:

• Reducing your salt intake.
• Quitting smoking.
• Reducing alcohol intake.
• Controlling your fluid intake.

Common heart medications include:

• 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 control blood pressure and improve heart function.
• Diuretics (salt pills or water pills) to lower the amount of sodium and water in your body.

Enlarged heart treatment may include procedures/surgery to:

• Implant a pacemaker to help your heart beat a steady rhythm.
• Place an implantable cardioverter defibrillator (ICD), a device that can shock your heart back into rhythm.
• Repair or replace a damaged heart valve.
• Coronary artery bypass surgery or stent placement.

Complications/side effects of the treatment

Any medication can cause side effects, but many of these get better or go away with time. Contact your healthcare provider if the medicine they prescribed for you is causing issues. They can replace it with a different drug.

Surgeries carry a risk of bleeding or infection, along with other risks that vary by procedure. If you’re concerned about these and other risks, talk to your provider about what safeguards are in place to protect you.

How can I prevent an enlarged heart?

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, such as:

• Eating a heart-healthy diet.
• Exercising for at least 30 minutes most days of the week.
• Managing your blood pressure and cholesterol.
• Maintaining a healthy weight.
• Stopping the use of tobacco products and avoiding recreational drugs.
• Sleeping eight hours each night.
• Drinking alcohol in moderation.

What is the outlook for people with an enlarged heart?

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

Enlarged heart complications

The health risks of an enlarged heart depend on the cause. They also depend on which part of your heart is enlarged.

Potential health complications from an enlarged heart can include:

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

Does cardiomegaly return after enlarged heart treatment?

Some people have an enlarged heart because of temporary factors, such as pregnancy or an infection. In these cases, your heart will return to its usual size after treatment.

Does cardiomegaly go away?

If a chronic (ongoing) condition is causing your enlarged heart, it usually won’t go away. You need to continue medication or other treatments to manage symptoms.

How do I take care of myself?

Follow your healthcare provider’s instructions for managing the condition that caused your cardiomegaly. This could mean making lifestyle changes, taking medicine or having a minimally invasive procedure.

When should I see my healthcare provider?

Keep going to your regular checkups with your provider so they can monitor your condition. Seeing them regularly allows them to check to be sure you aren’t developing worse symptoms or complications. If you develop symptoms like leg swelling, shortness of breath or chest pain, it could indicate cardiomegaly. In this case, you should see your healthcare provider right away.

When should I go to the ER?

Most of the time, an enlarged heart isn’t an emergency. Seek immediate medical attention if you experience:

• 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 my situation?
• How often do I need follow-up appointments with you?
• Do my family members need screening?

A note from Cleveland Clinic

Though an enlarged heart may not go away, most people are able to manage the condition well with the right treatment. Don’t be afraid to ask your healthcare provider questions about what’s causing your enlarged heart. Understanding what’s happening in your body is the first step in managing your condition. Be sure to keep taking medicines your provider prescribed for you and keep going to all scheduled appointments.