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What causes an enlarged heart?

Updated on August 18, 2014

An enlarged heart is medically referred to as cardiomegaly. It is not a condition by itself, but a symptom of some other underlying health problem.

Cardiomegaly usually ascribes to an enlarged heart detected in a chest x-ray, before other diagnostic procedures are carried out to find out the causative factors. An enlarged heart may occur temporarily due to underlying disorders like coronary artery disease, cardiac muscle weakening, irregular heart rhythms, or problems of the heart valve, or due to some stress on the body like during pregnancy.

It may not be possible to completely prevent the occurrence of an enlarged heart, but it is generally curable. Treatment focuses on remedying the pre-existing disease via medicines, surgery, or other medical methods.

Symptoms accompanying an enlarged heart

Some patients may not experience any symptoms of an enlarged heart. Some of the common signs and symptoms are listed below:

  • Dizziness
  • Breathlessness
  • Arrhythmia or irregular cardiac rhythms
  • Coughing
  • Edema or swelling
  • Pain in chest

It is vital to seek immediate medical care in case of severe pain in chest, fainting, or excessive breathlessness as it may indicate a heart attack.

Causes of an enlarged heart

An enlarged heart is usually caused due to underlying diseases which damage the heart muscle or cause it to pump harder. The heart may occasionally experience weakening and enlargement due to reasons unknown.

Some disorders known to have links with an enlarged heart are listed below:

  • Disease of the heart valve: The correct flow of blood in the heart is directed by its 4 valves. Varied conditions like cardiac defects, rheumatic fever, infectious endocarditis and other infections, use of certain medicines, connective tissue diseases, radiation therapy for cancer, etc. can damage the cardiac valves resulting in an enlarged heart.
  • Hypertension: High blood pressure can cause the heart to work harder to supply blood to the rest of the body, thereby thickening and enlarging the muscles.
  • Cardiomyopathy/Heart muscle disease: It refers to stiffness and hardening of the cardiac muscle. The initial stages may be asymptomatic, but in the later stages the heart can get enlarged so as to supply more blood to the body. A family history of cardiomyopathy increases the vulnerability of a person to developing an enlarged heart.
  • Congenital heart defects: Several types of cardiac defects present from birth can affect the supply of blood and make the heart pump harder, thereby causing an enlarged heart.
  • Cardiac arrest: In addition to other cardiac damage, it can also result in an enlarged heart.
  • Arrhythmia: People with abnormal heart beat may suffer from inefficient cardiac function, making the heart pump harder, thereby enlarging it.
  • Anemia: It is a condition characterized by low count of red blood cells and insufficient supply of oxygen to the body’s tissues. The lack of oxygen in blood can cause the heart to pump harder. Untreated cases of anemia can cause rapid or abnormal heart rhythms. Chronic anemia-induced heart enlargement is quite rare.
  • Pulmonary hypertension: High blood pressure occurring in the artery that connects the lungs and the heart can make the heart work harder to continue efficient movement of blood between the two organs. This can eventually cause enlargement of the right part of the heart.
  • Thyroid anomalies: Hyperthyroidism as well as hypothyroidism can result in varied cardiac abnormalities such as an enlarged heart.
  • Amyloidosis and other rare conditions affecting heart function: Amyloidosis is a disorder wherein anomalous proteins flow in the bloodstream which then accumulate in the heart. Excessive buildup of amyloid in the heart can cause an enlarged heart.
  • Hemochromatosis/Elevated iron levels: Hemochromatosis refers to a disorder characterized by an inability of the body to effectively metabolize iron, leading to iron deposits in varied organs such as the heart. This can weaken the heart muscle and cause the left ventricle to enlarge.
  • Coronary artery disease:It refers to blocked arteries in the heart that arise due to presence of fatty plaques in them. This restricts the free and easy flow of blood through the cardiac vessels; it may also occasionally cause a part of the heart muscle to stop functioning completely. This makes the heart pump harder and subsequently undergo enlargement.

Treatment of an enlarged heart

Treatment of an enlarged heart is aimed at finding out the underlying cause, and then taking relevant medical steps to manage the symptoms, correct the causative factors, and prevent any relapse.

  • If an enlarged heart is caused due to cardiomyopathy or other heart conditions, then the doctor may prescribe medications such as ACE inhibitors to enhance cardiac pumping and decrease blood pressure; diuretics to reduce water and sodium content in the body and thus help lower arterial and cardiac pressure;angiotensin receptor blockers; digoxin; beta blockers; and anticoagulants to lower the chances of blood clot formation.
  • If an enlarged heart cannot be corrected with medicines, then doctors may opt for the use ofdifferent medical devices to control the heartbeat, such as pacemakers, ICDs, LVADs, etc., or different surgical procedures like coronary bypass surgery, heart valve surgery, or a heart transplant.


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