Cardiomegaly: Causes and Treatments

The prefix “cardio” means heart and the suffix “megaly” means enlarged. Thus, cardiomegaly means enlarged heart.

There are many factors that can lead to an enlarged heart. Typically, it’s the result of coronary heart disease or high blood pressure.

Most patients suffering from an enlarged heart will require life-long treatment.

In this article, we’ll talk about the common causes of cardiomegaly, as well as the potential treatment options.

Dilated Cardiomyopathy – A Type of Cardiomegaly

The reason why the heart enlarges is because the heart muscle gets damaged in some way. Up to a point, the heart can still function normally.

But as the damage ensues, the heart’s ability to pump decreases. Dilated cardiomyopathy is a type of cardiomegaly.

Dilated Cardiomyopathy

It happens whenever the ventricles of the heart become thin. This causes the heart to enlarge.

There are other types in which the left ventricle of the heart becomes overly thick (high blood pressure is often a cause of this).

In some cases, the tendency to develop cardiomegaly can be inherited, which can increase your risk.

Bottom Line: Dilated cardiomyopathy is a type of enlarged heart that happens whenever the ventricles of the heart become too thin.

What Causes Cardiomegaly?


The most common cause of cardiomegaly is a blockage of the heart’s blood supply.

This is known as a myocardial infarction– or heart attack- and can lead to death if not quickly treated. Other possible causes include:

  • Abnormal heart valve
  • Viral infection of the heart
  • Pregnancy
  • Kidney disease
  • HIV infection

Alcohol and cocaine abuse, as well as genetic conditions can also be a cause. If the cause isn’t known, the doctors will call it idiopathic dilated cardiomyopathy. In this case, “idiopathic” means of unknown origins.

Bottom Line: Some common causes of an enlarged heart include heart attacks, abnormal heart valves, pregnancy, kidney disease, HIV infections, and viral infections of the heart.

Symptoms of an Enlarged Heart

Cardiomegaly can manifest itself in many ways. The most common symptoms include:

  • Shortness of breath
  • Swelling of legs
  • Weight gain
  • Fatigue
  • Skipped heartbeats

As the heart struggles to pump blood, you may begin to feel tired. You might even notice your heart skipping beats and have pain in your chest.

In some cases, patients don’t present any symptoms. It’s also possible to present these symptoms for years without anything changing.

The main symptom to watch out for is shortness of breath. If you’re experiencing this symptom daily, or if it’s increasing in intensity, then get to a hospital right away.

Bottom Line: As the heart becomes less efficient at pumping blood, you experience tiredness, weight gain, skipped heart beats, and shortness of breath.

Diagnosing Cardiomegaly

Cardiomegaly can be discovered in different ways. Usually, it’s discovered after a patient tells a doctor about their symptoms.

Other times, it’s discovered by accident. For example, the doctor might do an MRI of the chest for unrelated reasons and notice that the heart is abnormally large.

A common diagnostic procedure is the ultrasound. It’s also called an echocardiogram, and is a noninvasive way to look inside the body. It will measure the following qualities of the heart:

  • Pumping Efficiency
  • Size
  • Muscle Thickness

An ultrasound is typically good enough to give a doctor an idea of what’s going on. A doctor might also perform an X-ray of the chest for a more detailed look.

This information, combined with the information from your medical history and physical exam, will help them make a more accurate diagnosis.

A cardiac catheterization can be used to look for blockages within the coronary arteries (the arteries that supply heart tissue with blood).

cardiac catheterization

This is considered an invasive technique so doctors may reserve it only for when it’s needed.

Other common diagnostic procedures used to test for cardiomegaly include blood tests, MRIs, CT scans, and biopsies.

With the blood test, doctors are looking for things like HIV or thyroid disease. Biopsies are rarely done and reserved for extreme cases.

Bottom Line: There are an extensive list of diagnostic procedures used to diagnose an enlarged heart. The most common ones include x-rays, ultrasounds, CT scans, MRIs, and blood tests.

Treatment Options

How is an enlarged heart treated? In general, there are four types of treatment options: drugs, medical devices, surgeries, and lifestyle changes. We’ll talk about each one below.

Drug Treatments

Here are the most common drug treatments:

  • Diuretics: A diuretic reduces the concentration of sodium and water in the body. Thus, it helps lower blood pressure.
  • ACE Inhibitors: ACE stands for “Angiotensin-Converting Enzyme”. This drug will improve heart efficiency while reducing BP.
  • ARBs: ARB stands for “Angiotensin-Receptor Blocker”. This drug will have similar effects of an Ace inhibitor.
  • Beta Blockers: Cardiomegaly can be treated with the help of beta blockers, which improve heart function and lower blood pressure.

Medical Device Treatments

The main medical device treatments for cardiomegaly include:

  • Pacemaker: A pacemaker will help coordinate the beating of your heart to ensure that you don’t begin to experience serious arrhythmias.
  • ICDs: This is a small device that can be inserted within an enlarged heart to monitor its rhythm. Like a pacemaker, it can also deliver electric shocks.

Surgical Treatments

The main surgical treatments include:

  • Heart Valve Surgery: If cardiomegaly is due to problems with a heart valve, then heart valve surgery may be required.
  • Coronary Bypass Surgery: This surgery is required whenever the coronary arteries (the arteries that supply the heart with blood) become blocked.
  • Left Ventricular Assist Device: An LVAD is an implantable mechanical pump that will help a patient who is suffering from a weakened heart pump.
  • Heart Transplant: In the direst cases of enlarged heart, a patient will need to undergo a heart transplant.

Lifestyle Treatments

In certain cases, lifestyle treatments can help. They include:

  • Plant-Based Diet: Animal foods raise cholesterol and increase blood pressure, which are the two biggest risk factors for heart-related problems.
  • Exercise: Exercise is can be a great way to protect the heart against disease. In some cases, people with an enlarged heart won’t be allowed to exercise.
  • Stress Management: Stress causes an increase in blood pressure. For people with cardiomegaly, this can make their situation worse.
Bottom Line: The four primary treatment options for people with this heart condition include drugs, medical devices, surgery, and lifestyle intervention.

Potential Complications  

blood clot

A person with this heart condition will need to worry about blood clots. As the heart becomes less efficient at pumping blood, clots can form in the lining of the heart.

A clot can go on to become a pulmonary embolism, which can kill a person. Another potential complication is sudden cardiac arrest.

This happens whenever the heart stops beating completely, and results in sudden death.

As you can see, it’s in a patient’s best interest with cardiomegaly to get their condition treated as promptly as possible. Eventually, the heart will fail to pump altogether, resulting in death.

Bottom Line: Potential complications of a failing heart include blood clots (which can lead to pulmonary embolism) and sudden cardiac arrest (which can lead to sudden death).
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