Heart disease - enlarged heart

The heart is a muscular pump about the size of a clenched fist. An enlarged heart is not a condition in itself but a sign of an underlying problem that is making the heart work harder than normal. Older people are at greater risk of having an enlarged heart. The medical name for an enlarged heart is cardiomegaly.

Symptoms of an enlarged heart#

In some cases an enlarged heart causes no symptoms. When symptoms do occur, it is often because the heart can no longer pump blood effectively, leading to a condition known as congestive heart failure. Symptoms may include:

• breathing problems and shortness of breath
• fluid retention
• dizziness
• an irregular heartbeat (arrhythmia)
• heart palpitations

Causes of an enlarged heart#

An enlarged heart can have many underlying causes, including:

• Coronary artery disease. Fatty deposits, or plaques, build up inside one or more of the heart’s arteries. This gradual narrowing, called atherosclerosis, reduces the oxygen supply that fuels the heart muscle.
• High blood pressure (hypertension). When blood is pumped with more force than usual through the arteries, it puts extra strain on the heart. Causes of high blood pressure include obesity and a sedentary lifestyle.
• Idiopathic dilated cardiomyopathy. A disease of the heart muscle with no known cause. An enlarged or dilated heart is one of the most common types of cardiomyopathy. The most common symptoms are shortness of breath and swelling of the ankles; rarer symptoms include dizziness and chest pain.
• Myocarditis. An infection of the heart, usually caused by a virus. A person may have a viral illness first and later develop symptoms of congestive heart failure.
• Heart valve disease. For example, a faulty mitral valve may allow blood to flow backwards, so the affected chamber has to contract with more force than usual.
• A previous heart attack. A weakened heart muscle may enlarge to keep up with the demands of pumping blood around the body.
• Thyroid disease. The thyroid gland regulates many of the body’s metabolic functions. Left untreated, a thyroid condition can lead to high blood pressure, raised blood cholesterol, an irregular heartbeat and enlargement of the heart.
• Obesity. Carrying too much body fat is a risk factor for high blood pressure, which in turn can cause the heart to enlarge.
• Lack of exercise. A sedentary lifestyle is a known risk factor for many conditions, including coronary heart disease and high blood pressure.
• Reduced blood flow to the heart (cardiac ischaemia). This can cause heart pain (angina).
• Older age. As we get older, our arteries lose some of their elasticity. This stiffening of the blood vessels causes high blood pressure, which is a risk factor for an enlarged heart.

Diagnosis of an enlarged heart#

An enlarged heart is diagnosed using a number of tests, which may include:

• a medical history and physical examination
• a chest x-ray, which shows the overall shape and size of the heart and lungs
• an echocardiogram, in which sound waves create a moving picture of the heart so the doctor can watch its chambers contract and relax
• a Doppler study, which shows blood flow through the heart valves and checks whether they are working normally
• an electrocardiogram, which measures the heart’s electrical activity and can assess the heart rhythm and look for evidence of an old heart attack or reduced blood flow

Treatment of an enlarged heart#

Treatment depends on the underlying cause but may include:

• addressing the underlying problem, for example through diet, stopping smoking and exercise, medication to control high blood pressure, or surgery to replace a faulty heart valve
• medication to stop the heart from enlarging further
• regular cardiovascular exercise
• adopting a low-fat diet and making dietary changes to lower blood cholesterol
• frequent medical check-ups to make sure the treatments are working

Key points#

• Older people are at greater risk of having an enlarged heart.
• In some cases an enlarged heart causes no symptoms.
• When symptoms do occur, they may include fluid retention and shortness of breath.
• An enlarged or dilated heart is one of the most common types of cardiomyopathy.
• The most common symptoms of cardiomyopathy are shortness of breath and swelling of the ankles.

Where to get help#