Author: Vanessa Mora
Editor: Nelly Sadat
Overview
Cardiomegaly is present worldwide, with a prevalence of 15 million people (Amin & Siddiqui, 2020).
This condition results in heart enlargement and often occurs as a symptom of acquired cardiomyopathies or other pathological processes (Amin & Siddiqui, 2020). The condition occurs when the transverse diameter of the cardiac silhouette is equal to or exceeds 50% of the transverse diameter of the chest on computed tomography or chest radiograph (Amin & Siddiqui, 2020).
Dilated cardiomyopathy is the main type of heart enlargement, where the heart ventricles become thin and stretched, however, heart enlargement may also be caused by hypertrophy; where the ventricles thicken (Amin & Siddiqui, 2020). An enlarged heart may not pump blood efficiently which may lead to heart failure, or further cardiovascular diseases and other symptoms (Amin & Siddiqui, 2020).
What causes Cardiomegaly?
Several conditions that may contribute to cardiomegaly are:
- Acromegaly,
- Alcohol and drug abuse,
- Amyloidosis,
- Anemia,
- Arrhythmia,
- Coronary artery disease,
- Intense Exercise,
- Heart attack,
- Heart valve anomalies,
- Hypertension,
- Hemochromatosis,
- Hypothyroidism,
- Kidney disease,
- Obstructive sleep apnea,
- Pregnancy,
- Pulmonary diseases,
- Sarcoidosis,
- Stress,
- Thyroid disorders,
- Viral infections (i.e. HIV or Chaga disease), or
- Vitamin B1 deficiency (Amin & Siddiqui, 2020)
Symptoms
Patients with cardiomegaly are asymptomatic (Amin & Siddiqui, 2020). When the condition is more severe, symptoms in symptomatic patients may include the following:
- Anorexia,
- Arrhythmia,
- Chest Pain,
- Dizziness,
- Early satiety,
- Fainting,
- Fatigue,
- Nausea and Vomiting,
- Orthopnea,
- Paroxysmal nocturnal dyspnea,
- Shortness of breath on exertion or at rest,
- Swelling of the lower legs, hands, and abdomen, or
- Weight Gain (Amin & Siddiqui, 2020).
Risk Factors
Cardiomegaly may result in the heart having to pump blood harder than usual or when the heart muscle is damaged (Amin & Siddiqui, 2020).
Risk factors include:
- Family history of cardiomyopathy
- High blood pressure: May damage the arteries by making them more narrow, resulting in decreased blood flow and oxygen to the heart (CDC, 2020).
- High cholesterol levels: Excess cholesterol in the heart walls build up and eventually leads to narrowing and arterial lumen blockage, affecting the amount of blood being pumped (Soliman, 2018).
- Obesity: Being overweight may lead to hypertrophy and thickening of the heart muscle, affecting the ability to pump blood efficiently. Obesity is also associated with high blood pressure, diabetes, and kidney disease which may lead to cardiomegaly (Ebong et al., 2014).
- Stress: Emotional or physical stress such as grief, fear, extreme anger, and surprise causes adrenaline release resulting in a rapid heartbeat and may cause muscle weakness leading to stress cardiomyopathy. Stress may also be associated with high blood pressure and increased cholesterol levels (Ramaraj, 2007).
- Being an athlete: Intense exercise such as weight lifting, bodybuilding and wrestling may lead to thickening of muscle, which includes heart muscle and may be the result of morphological, functional, and electrical remodeling of the heart. (Carbone et al.,2017).
- Diabetes: Diabetes may be associated with risk factors such as obesity, high blood pressure, and high levels of cholesterol which may result in cardiomyopathy ( Boudina & Abel, 2010).
- Alcohol/ drug use: Substance abuse may weaken and deteriorate heart muscle, affecting the ability to pump blood efficiently (American Heart Association,2020).
How does my doctor know I have Cardiomegaly?
Diagnosis of cardiomegaly is commonly performed through physical imaging techniques which provide information regarding the size and function of the patient’s heart (Alghamdi et al., 2020). Physicians may also confirm the diagnosis by assessing the patient’s symptoms (Alghamdi et al., 2020). The following tests may be performed in order to measure for clinical features such as abnormal heart activity: Chest X-ray (Alghamdi et al., 2020), Echocardiogram, Electrocardiogram, Cardiac MRI, (Amin & Siddiqui, 2020), and/or a Stress test (Ramaraj, 2007).
Blood tests and Genetic screening may be necessary in order to measure pathological features such as abnormal blood levels or genetic inheritance (Amin & Siddiqui, 2020; Xu et al., 2018).
Treatment
Treatment of cardiomegaly is advertently associated with the treatment of heart failure, where standard heart failure treatment guidelines may apply (Amin & Siddiqui, 2020). Spironolactone, angiotensin-converting enzyme inhibitors (ACEIs), and β-blockers are treatment options that have been shown to reduce heart failure symptoms and mortality (Amin & Siddiqui, 2020). Patients with cardiomyopathy and symptoms of heart failure are managed with diuretics and salt restriction (Amin & Siddiqui, 2020).
For patients with moderate to severe symptoms, they are also treated with aldosterone and Digoxin (Amin & Siddiqui, 2020). Patients with associated risk factors listed above may benefit from modification such as no smoking, limiting alcohol intake, weight loss through exercise, and consuming a healthy diet. As well as, treating any underlying risk conditions such as hypertension, diabetes, sleep apnea, arrhythmias, anemia, and thyroid disorders (Amin & Siddiqui, 2020).
References
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Alghamdi, S. S., Abdelaziz, I., Albadri, M., Alyanbaawi, S., Aljondi, R., & A. Tajaldeen (2020). Study of cardiomegaly using chest x-ray. Journal of Radiation Research and Applied Sciences, 13(1): 460-467.
Amin H, & W.J. Siddiqui (2020). Cardiomegaly. Treasure Island (FL): StatPearls Publishing.
Ashley E.A., & J. Niebauer. Cardiology Explained. London: Remedica; 2004. Chapter 7, Heart failure.
Boudina, S., & E. D. Abel. (2010). Diabetic cardiomyopathy, causes and effects. Reviews in endocrine & metabolic disorders, 11(1): 31–39.
Carbone, A., D’Andrea, A., Riegler, L., Scarafile, R., Pezzullo, E., Martone, F., America, R., Liccardo, B., Galderisi, M., Bossone, E., & R. Calabrò. (2017). Cardiac damage in athlete’s heart: when the “supernormal” heart fails!. World journal of cardiology, 9(6): 470–480.
CDC. (2020). High Blood Pressure Symptoms and Causes.
Ebong, I. A., Goff, D. C., Jr, Rodriguez, C. J., Chen, H., & A. G. Bertoni. (2014). Mechanisms of heart failure in obesity. Obesity research & clinical practice, 8(6): e540–e548.
Herman L.L., Padala S.A., Annamaraju P., et al. (2020). Angiotensin converting enzyme inhibitors (ACEI). Treasure Island (FL): StatPearls Publishing.
Ramaraj R. (2007). Stress cardiomyopathy: aetiology and management. Postgraduate medical journal, 83(982): 543–546.
Soliman G. A. (2018). Dietary cholesterol and the lack of evidence in cardiovascular disease. Nutrients, 10(6): 780.
Xu, H., Ii, G. D., Shetty, A., Parihar, A., Dave, T., Robinson, S., & S. Liggett. (2018). A genome-wide association study of idiopathic dilated cardiomyopathy in african americans. Journal of Personalized Medicine, 8(1): 11.
