The term “cardiomegaly” most commonly refers to an enlarged heart seen on chest X-ray before other tests are performed to diagnose the specific condition causing your cardiomegaly. You may develop an enlarged heart temporarily because of a stress on your body, such as pregnancy, or because of a medical condition, such as the weakening of the heart muscle, coronary artery disease, heart valve problems or abnormal heart rhythms.
While having an enlarged heart may not always be preventable, it’s usually treatable.
In some people, an enlarged heart causes no signs or symptoms. Others may have these signs and symptoms:
Shortness of breath
Abnormal heart rhythm (arrhythmia)
Seek emergency medical care if you have any of these signs and symptoms, which may mean you’re having a heart attack:
Severe shortness of breath
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 enlarges and becomes weak for unknown reasons (idiopathic). Conditions associated with an enlarged heart include:
1. High blood pressure. Having high blood pressure can make it so that your heart has to pump harder to deliver blood to the rest of your body, enlarging and thickening the muscle.
2. Heart valve disease. Four valves within your heart keep blood flowing in the right direction. If the valves are damaged by such conditions as rheumatic fever, a heart defect, infections (infectious endocarditis), connective tissue disorders, certain medications or radiation treatments for cancer, your heart may enlarge.
3. Disease of the heart muscle (cardiomyopathy). Cardiomyopathy is the thickening and stiffening of heart muscle. In early stages of cardiomyopathy, you may have no symptoms. As the condition worsens, your heart may enlarge to try to pump more blood to your body.
4. Heart attack. Damage done during a heart attack may cause an enlarged heart.
5. A heart condition you’re born with (congenital heart defect). Many types of congenital heart defects may lead to an enlarged heart, as defects can affect blood flow through the heart, forcing it to pump harder.
6. Abnormal heartbeat (arrhythmia). If you have an arrhythmia, your heart may not pump blood as effectively as it would if your heart rhythm were normal. The extra work your heart has to do to pump blood to your body may cause it to enlarge.
7. High blood pressure in the artery connecting your heart and lungs (pulmonary hypertension). If you have 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.
8. 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. Left 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 when you’re anemic. Rarely, your heart can enlarge if you have anemia for a long time and you don’t seek treatment.
9. Thyroid disorders. Both an underactive thyroid gland (hypothyroidism) and an overactive thyroid gland (hyperthyroidism) can lead to heart problems, including an enlarged heart.
10. 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 muscle. This can cause an enlarged left ventricle due to weakening of the heart muscle.
11. 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. If amyloid builds up in your heart, it can cause it to enlarge.
Treatments and drugs
Treatments for enlarged heart focus on correcting the underlying cause.
If cardiomyopathy or another type of heart condition is to blame for your enlarged heart, your doctor may recommend medications. These may include:
1. Diuretics to lower the amount of sodium and water in your body, which can help lower the pressure in your arteries and heart, such as furosemide (Lasix), or other diuretics, such as spironolactone (Aldactone), which can help prevent further scarring of your heart tissue
2. Angiotensin-converting enzyme (ACE) inhibitors to lower your blood pressure and improve your heart’s pumping capability, such as enalapril (Vasotec), lisinopril (Zestril), ramipril (Altace) or captopril (Capoten) Angiotensin receptor blockers (ARBs), such as losartan (Cozaar) and valsartan (Diovan), for those who can’t take ACE inhibitors
3. Beta blockers to lower blood pressure and improve heart function, such as carvedilol (Coreg) and metoprolol (Lopressor)
4. Digoxin, which can help improve the pumping function of your heart and lessen the need for hospitalization for heart failure
5. Anticoagulants, such as warfarin (Coumadin), to reduce the risk of blood clots that could cause a heart attack or stroke
Medical procedures and surgeries
If medications aren’t enough to treat your enlarged heart, medical procedures or surgery may be necessary.
6. Medical devices to regulate your heartbeat. For people who have a certain type of enlarged heart (dilated cardiomyopathy), a special pacemaker that coordinates the contractions between the left and right ventricle (biventricular pacing) may be necessary. In people who may be at risk of serious arrhythmias, drug therapy or an implantable cardioverter-defibrillator (ICD) may be an option. ICDs are small devices — about the size of a pager — implanted in your chest to continuously monitor your heart rhythm and deliver electrical shocks when needed to control abnormal, rapid heartbeats. The devices can also work as pacemakers. If the main cause of your enlarged heart is due to atrial fibrillation, then you may need procedures to return your heart to regular rhythm or to keep your heart from beating too quickly.
7. Heart valve surgery. If your enlarged heart is caused by a problem with one of your heart valves, you may have surgery to remove the narrow valve and replace it with either an artificial valve or a tissue valve from a pig, cow or human-cadaver donor. If you have valve regurgitation, in which blood leaks backward through your valve, the leaky valve may be surgically repaired or replaced.
8. Coronary bypass surgery. If your enlarged heart is related to coronary artery disease, your doctor may recommend coronary artery bypass surgery.
9. Left ventricular assist device (LVAD). If you have heart failure, you may need this implantable mechanical pump to help your weakened heart pump. You may have an LVAD implanted while you wait for a heart transplant or as a long-term treatment if you have heart failure and you’re not a good candidate for a heart transplant.
10. Heart transplant. If medications can’t control your symptoms, a heart transplant may be a final option. Because of the shortage of donor hearts, even people who are critically ill may have a long wait before having a heart transplant.
Lifestyle and home remedies
While you can’t cure your enlarged heart with home remedies, there are some things you can do to improve your condition. Your doctor may recommend adopting the following lifestyle changes:
1. Quit smoking.
2. Lose excess weight.
3. Eat a low-salt diet.
4. Control diabetes.
5. Monitor your own blood pressure.
6. Get modest exercise, after discussing with your doctor the most appropriate program of physical activity.
7. Eliminate or reduce the amount of alcohol you drink.
8. Try to sleep eight hours each night.
In most cases you can’t prevent your heart from enlarging. Let your doctor know if you have a family history of conditions that can cause an enlarged heart, such as cardiomyopathy. If cardiomyopathy or other heart conditions are diagnosed early, treatments may prevent the disease from worsening.
You can help reduce your chance of developing heart failure by avoiding some of the conditions that can contribute to a weak heart, including the abuse of alcohol or cocaine, or not getting enough vitamins and minerals. Controlling high blood pressure with diet, exercise and possibly medications also prevents many people who have an enlarged heart from developing heart failure later in life.
Controlling risk factors for coronary artery disease — tobacco use, high blood pressure, high cholesterol and diabetes — helps to reduce your risk of an enlarged heart and heart failure by reducing your risk of heart attack.