Enlarged Heart

An enlarged heart occurs when the heart becomes bigger than its usual size. This happens when the heart muscle is overworked – the muscle thickens or the chambers dilate.

An enlarged heart is not a disease by itself but is an indication of an underlying condition. As it progresses, the heart’s pumping efficiency starts to decline, which can lead to complications such as heart failure or stroke.

The underlying issues causing an enlarged heart may be classified as:

• Pathological: diseases affecting the heart muscle
• Physiological: other causes like thyroid diseases or high blood pressure

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In some people, an enlarged heart causes no symptoms for a number of years. Some may exhibit mild symptoms which do not change over the years while others may have progressively worsening symptoms.

When the heart is unable to pump blood well, signs of congestive heart failure present:

• Swelling in the feet, legs, or abdomen
• Shortness of breath – while active or lying flat
• Abnormal heart rhythm or palpitations
• Fatigue
• Dizziness
• Fluid retention

A person must seek emergency care if they experience any of the following symptoms, as these are associated with a heart attack:

• Severe shortness of breath
• Fainting
• Chest pain
• Discomfort or pain in the neck, jaw or back

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An enlarged heart is caused by conditions that damage heart muscle or cause it to pump harder than usual. Some of the predisposing factors causing an enlarged heart are as follows:

• High Blood Pressure: Also called hypertension, in this condition, the force of blood passing through the vessels is constantly very high.
• Coronary Heart Disease: in this condition, the arteries are narrowed due to the build-up of fatty deposits or plaques, resulting in less oxygen and blood reaching the heart.
• Thyroid disorder: An overactive thyroid gland (hyperthyroidism) and an underactive thyroid gland (hypothyroidism) can both cause an enlarged heart. The thyroid regulates the metabolism and a thyroid disorder can result in an irregular heartbeat, high blood pressure, and high blood cholesterol – all of which could cause enlargement of the heart.
• Heavy alcohol consumption or substance abuse: Alcohol and substance abuse is associated with a decline in heart health and blood vessels.
• Past heart attack: a heart attack weakens the heart muscle, which may then enlarge to meet the demands of pumping blood throughout the body.
• Sedentary lifestyle: Lack of physical activity and exercise is associated with lots of health conditions, including high blood pressure and coronary heart disease.
• Obesity: Excessive body fat increases the risk of high blood pressure, which can in turn cause an enlarged heart.
• Heart Valve Disease: Any defect in the valves of the heart might result in the blood flowing in the opposite direction, necessitating the heart to pump harder. Heart valve disease can be caused by connective tissue disease, as a side effect of some medications or radiation treatment for cancer, rheumatic fever, irregular heartbeat, heart defect or due to infections.
• Congenital heart disease: These are heart conditions present from birth which affect the structure of the heart.
• Family history: If immediate family members such as parents or siblings have an enlarged heart, the person is at increased risk of developing the same condition.
• Hemochromatosis: This is a disorder in which the body is unable to metabolise iron, leading to its build-up in various organs including the heart. This in turn causes the weakening of the heart muscle.
• Chronic anaemia: In case anaemia is not treated, it can lead to irregular or rapid heartbeat as the heart pumps more to compensate for lesser oxygen in the blood.
• Myocarditis: This is an infection of the heart, typically caused by a virus. This develops as a viral illness to start with and later presents with symptoms of congestive heart failure.
• Age: As people age, the arteries lose elasticity and start becoming stiff, causing high blood pressure.
• Idiopathic cardiomegaly: When the heart grows bigger in size and weak, the cause of which is unknown.
• Pregnancy: This is also called peripartum cardiomyopathy. During pregnancy, the heart pumps up to fifty per cent more blood. The heart often returns to its normal size post-delivery but the damage caused to the heart is irreversible.

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An enlarged heart can cause certain complications depending on its cause and the part of the heart that is affected. Some of the complications are:

• Blood clots: Enlarged heart increases the risk of developing blood clots in the lining of the heart. This can block the blood flow, cause a stroke or a heart attack, or lead to pulmonary embolism (the clot travels to the lungs).
• Heart murmur: In this condition, the valves of the heart do not close properly. As a result, blood flows backwards creating a swishing sound, which can be heard via a stethoscope. It is not necessarily harmful, however, heart murmurs need to be monitored to diagnose their severity.
• Heart failure: Enlarged left ventricle is a more severe type of enlarged heart, that causes the heart’s pumping efficiency to go down. Over a period of time, this can result in damage to the organs and the collection of fluid in the lungs.
• Cardiac arrest: At times, an enlarged heart can cause severe disruptions in the heart’s rhythm – either heart beats too slow or too fast. This can cause cardiac arrest and even sudden death.

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When a person presents with symptoms of an enlarged heart, the doctor carries out a physical examination, including checking for arrhythmia and heart murmurs. The patient’s medical history is also taken. This is followed by investigations, such as:

• Stress test: this involves the patient walking on a treadmill or riding a stationary bike to understand the functioning of the heart during exercise.
• Chest X-Ray: this depicts the overall size and shape of the heart and lungs.
• Blood tests: to check for thyroid condition or viral infections
• Ultrasound: Also called an echocardiogram, this utilises sound waves to create an image of the heart. It is used for identifying blockages in the coronary arteries, and congenital heart diseases and monitoring the heart’s pumping efficiency.
• ECG: electrocardiogram is used to observe the electrical activity in the heart and is used for diagnosing arrhythmia and blood flow to the heart.
• CT Scan: This presents detailed images of the heart and surrounding structures and is used to identify valve defects or inflammations.
• MRI Scan: Through magnetic and radio waves, signals are generated to produce detailed images of the heart. This is used to check for a variety of heart conditions.
• Biopsy: In rare cases, the doctor may require a small sample of the heart to be tested. For this, a catheter is inserted in the groin and threaded through the lumen to the heart.

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Treatment of enlarged hearts focuses on correcting the underlying conditions. Some of the medications that may be prescribed are:

• Beta-blockers to improve heart function and control the blood pressure
• Antiarrhythmics to regulate the heart beating
• Diuretics, also called water pills, for decreasing sodium and water in the body. They increase water excretion from the body, which helps lower the pressure in the arteries and heart. Diuretics also help reduce swelling in the body.
• Angiotensin-converting enzyme (ACE) inhibitors or Angiotensin II receptor blockers (ARBs) to treat high blood pressure
• Anticoagulants for lowering the risk of blood clots, preventing a stroke or heart attack

In case medications are found insufficient to treat the underlying condition, medical procedures or surgery are used for curing:

• Pacemaker / ICD: A pacemaker helps regulate the heartbeat by generating electrical impulses to coordinate the contractions in the heart. An implantable cardioverter-defibrillator (ICD) is a medical device implanted in the chest to regularly monitor heartbeats and prevent arrhythmia. ICDs can also work as pacemakers.
• Left Ventricular Assist Device (LVAD): Left ventricle is the largest chamber of the heart and is responsible for pumping the blood from the heart to the rest of the body. When the heart has become too weak, an LVAD device is implanted before a heart transplant.
• Heart Angioplasty and Stent placement: Angioplasty involves using a balloon to widen the artery while the stent is inserted to avoid the artery getting closed. This procedure is undertaken to open clogged arteries.
• Heart Bypass Surgery: This surgery is used to improve blood flow to the heart by unblocking coronary arteries or repairing damaged coronary arteries using grafting healthy blood vessels to bypass the damaged portion. This helps prevent heart failure.
• Heart valve surgery: In case the enlarged heart is due to issues with the heart valves or where the heart valve is affected because of an enlarged heart, surgery is carried out to repair or replace the damaged valve.
• Heart Transplant: If medications and medical procedures are unable to address the symptoms definitively, a heart transplant remains the last option.

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An enlarged heart can be managed and the severity of its symptoms lessened by following certain lifestyle changes, such as:

• Quitting smoking, avoiding tobacco and illicit drugs
• Limited intake of alcohol and caffeine
• Controlling diabetes
• Losing excess body fat
• Eating a healthy, balanced diet
• Reducing salt and foods filled with saturated and trans fats from the diet
• Keeping a track of blood pressure and cholesterol levels
• Moderate exercise, with consultation from doctors on safe exercises
• Reducing stress by practising mindfulness techniques
• Ensuring regular sleep of approximately eight hours

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There are various heart-related conditions that can cause an enlarged heart. An early diagnosis helps increase the chances of full recovery and prevents the underlying condition from getting worse. With lifestyle changes, a person can manage the symptoms of an enlarged heart.

In case the enlarged heart is temporarily caused due to pregnancy or an infection, it will return back to its normal size post-pregnancy and post-treatment respectively. However, in the case of chronic conditions, medications and other treatments would be necessary to manage the symptoms.

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