ENLARGED HEART (CARDIOMEGALY)

Symptoms depend on the cause, although in some cases there are no symptoms. Common signs and symptoms include:

• Edema (fluid retention) with weight gain
• Arrhythmia
• Palpitations
• Tiredness
• Fatigue
• Shortness of breath
• Chest pain

DIAGNOSIS

The doctor will ask you about your medical history and perform a physical exam. He will order routine blood tests and suggest one or more diagnostic tests. These include:

• Chest x-ray will let the doctor see if your heart is enlarged and whether there is fluid buildup in your lungs.
• Blood tests. Your doctor may order blood tests to check the levels of certain substances in your blood that may point to a heart problem. Blood tests can also help your doctor rule out other conditions that may cause your symptoms.
• Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack.
• Echocardiogram. An echocardiogram uses sound waves to produce images of your heart. With this test, the four chambers of the heart can be evaluated.
• Stress test. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. This test provides information about how well your heart works during physical activity.
• Coronary angiography uses dye and special x rays to show the inside of your coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization. A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels. This helps your doctor assess the heart’s valves, as well as extract a biopsy sample of the heart tissue for laboratory analysis.

TREATMENT

Medications

Medications for patients with cardiomegaly include:

• ACE Inhibitors (captopril, enalapril)
• Angiotensin Receptor Blockers (candesartan, losartan, valsartan)
• Beta blockers (bisoprolol, metoprolol, carvedilol)
• Diuretics (furosemide, chlorothiazide)
• Anticoagulants (warfarin, heparin)
• Digoxin
• Anti-arrhythmics

Devices and surgical procedures

• Implantable Cardioverter-Defibrillator (ICD) are indicated for patients with severe heart failure or serious arrhythmias (irregular heartbeats). These devices are surgically placed and deliver pacing, or an electric countershock, to the heart when a life-threatening abnormal rhythm is detected.
• Left ventricular assist device (LVAD) is a battery-operated, mechanical pump-type device that’s surgically implanted. It helps maintain the pumping ability of a heart that can’t effectively work on its own
• Heart valve surgery is done to to remove the defective valve and replace it with either an artificial valve or a tissue valve from a pig, cow or deceased human donor.
• Coronary bypass surgery may be performed if your enlarged heart is related to coronary artery disease.
• Heart transplantation is often the last resort for patients with severe, progressive heart failure that can’t be helped by medications and dietary and lifestyle changes.