HEALTHNET

What is cardiac enlargement?

The heart may be enlarged when its muscles are thickened...

(Posted on 18 January 2007)

Q1. My mother had a check-up and was found to have enlarged heart. What is cardiac enlargement?

A1. The heart is a muscular pump about the size and shape of your clenched fist. Its size can be roughly estimated on physical examination of the chest by checking the position and quality of the heart's beating. A routine ECG examination, chest X-ray, or other imaging studies of the thorax can also measure the size of the heart.

The heart may be enlarged when its muscles are thickened. This often happens in untreated hypertension when it is forced to work under high pressure. Similarly, in chronic anemia, the circulatory system needs to work harder in order to supply enough oxygen and nutrients to the body.

When the heart can no longer pump away the blood filling its cavities, it would be distended with blood and appear enlarged. In heart failure, the heart's cavities are filled up with blood which cannot be pumped out effectively. Therefore an enlargement heart may be a failing heart.

An enlarged heart frequently signifies that something is seriously wrong in the circulatory system. Patients should seek professional advice. An underlying cause would be found in most cases, such as hypertension, coronary artery disease, or diseases of the heart valves.

Q2. What health problems are associated with cardiac enlargement?

A2. Before the heart fails, a patient may not experience any symptoms. But an enlarged heart is an overworked heart. If something is not done to release its workload, sooner or later it would fail as the patient ages. Symptoms such as shortness of breath on mild exertion, breathing problems at night, and ankle swellings caused by fluid retention would then appear and become increasingly disabling.

Cardiac enlargement isn't a condition in itself, but a symptom of an underlying disease. Hypertension is one of the most common causes of cardiac enlargement in the elderly. Coronary artery disease is another. Chronic inadequate blood supply caused by narrowed coronary arteries can weaken the heart muscles. These patients may not have any history of heart attacks.

Some patients may be born with abnormal heart valves, or their heart valves may be damaged by diseases. The diseased heart valve compromises the efficiency of the heart's pumping action.

"Hyperthyroidism", where too much thyroid hormone causes all systems in the body to run faster than normal, is not an uncommon cause for cardiac enlargement in women past middle age. Patients with chronic anemia would also have an enlarged heart because the heart needs to work harder.

"Cardiomyopathy" refers to a mixed category when common causes are excluded in patients with cardiac enlargement. Scientists are still not certain why some of these cases occur.

Q3. Is treatment for cardiac enlargement necessary?

A3. A patient with cardiac enlargement needs to undergo a thorough workup. When the underlying cause is satisfactorily dealt with, the heart size would return to normal. For example, patients with an overactive thyroid gland may only need simple medications to control the level of thyroid hormone. Those with a diseased heart valve may recover after surgical replacement.

Unfortunately it is only possible to cure the underlying disease causing heart enlargement in a minority of patients. Most patients would still therefore require long-term medications.

Doctors may prescribe drugs to relieve the workload of the heart, or to augment its pumping force. People with hypertension would need a regime of diet, exercise and drugs to control blood pressure. Very often a tighter target is desirable when the heart is enlarged. Many patients with cardiac enlargement are also suffering from fluid overload. They would benefit from drugs that help the body eliminate the excess fluid in the urine, together with dietary restriction of salt and fluid intake.

In addition, all patients should:

Stop smoking.
Stop drinking alcohol.
Exercise regularly.
Maintain a healthy weight.
Control high blood cholesterol and diabetes.

Source: Quality HealthCare