An enlarged heart (cardiomegaly) is a sign that the heart is overworked. Heart enlargement can be pathological (related to significant heart disease) or physiological (related to exercise or other physical activity). An enlarged heart is an indication of an underlying condition. If it is associated with heart disease, physicians will typically attempt to treat the underlying disease at the same time as the enlarged heart.

An enlarged heart is often present during heart failure, when the heart cannot pump adequate blood to meet the needs of the body. Additionally, a small number of patients have an enlarged heart with no known cause. An enlarged heart may be accompanied by symptoms such as shortness of breath (dyspnea), dizziness, swelling (edema) or irregular heart beat (arrhythmia).

Cardiomegaly may be discovered on an x-ray during an examination for an unrelated condition. Physicians can confirm the diagnosis by conducting an echocardiogram (a test that uses sound waves to evaluate the heart’s anatomy and function).

Treatment for an enlarged heart can include medications (e.g., ACE inhibitors and beta blockers) to treat the condition itself, as well as treatment for any underlying conditions, such as high blood pressure or heart valve disorders. With proper treatment, the condition may be controlled or even reversed, although the underlying disease may be difficult to control.

An enlarged heart is a sign that the heart is overworked and is usually a symptom of an underlying disease or other factor that changes the way the heart functions. For example, a heart defect affecting the heart’s valves may mean that the heart is unable to pump oxygen-rich blood efficiently. Alternatively, in otherwise healthy people, long periods of intense exercise increases the demand for oxygen throughout the body, causing the heart to pump more blood. Either way, the heart has to work harder to satisfy the body’s demands.

Over time, this higher work level can cause the heart to enlarge as the chambers grow to allow more blood to be processed. Depending upon the nature of the enlargement, the heart can become stretched to its limit, like a taut rubber band. Among children and adolescents, an enlarged heart can lead to sudden cardiac death.

Medically, an enlarged heart is known as cardiomegaly or a hypertrophic heart. If just the left ventricle is enlarged, the condition is known as left ventricular hypertrophy. This can occur as a result of diseases or conditions that place extra stress on the left ventricle, which is the heart's main pumping chamber.

Hypertrophic cardiomyopathy is another condition in which the heart is enlarged. In this condition, there is an abnormal growth of muscle fibers on the heart, causing it to enlarge. This is generally considered a genetic disorder and can cause sudden cardiac death in seemingly healthy young individuals.

Heart enlargement can be pathological (related to significant heart disease) or physiological (related to exercise or other physical activity). Any sustained condition or activity that makes the heart work harder can enlarge it, including:

• Heart failure
  
  
• Coronary artery disease
  
  
• Valve disease
  
  
• High blood pressure (hypertension)
  
  
• Obesity
  
  
• Coronary artery spasm
  
  
• Cardiac ischemia
  
  
• Thyroid disease
  
  
• Severe anemia
  
  
• Excess iron or protein build-up in the body
  
  
• Excessive alcohol use
  
  
• Obstructive sleep apnea

Additionally, a small number of patients have an enlarged heart with no known cause (idiopathic).

Another condition, sometimes referred to as “athlete’s heart,” can occur in high-level athletes who engage in regular, sustained and often intense exercise. In most cases, this is not a medically significant or dangerous condition for them. Some studies, however, have shown that even among elite athletes, an enlarged heart may raise the risk for heart failure. Athletes at all levels are recommended to undergo regular physical exams to rule out hidden or underlying heart defects.

Symptoms of cardiovascular conditions that are associated with an enlarged heart include:

Many patients, especially those with high blood pressure can go for long periods of time without any symptoms.

Tests that may be used to diagnose an enlarged heart include:

Treatment for an enlarged heart may include medications, such as ACE inhibitors, to lighten the heart’s pumping load and keep it from further enlargement. Treatment should also be directed at the cause of the enlarged heart (e.g., high blood pressure, valvular heart disease). Medications such as diuretics may be prescribed for those with heart failure.

Prevention of the underlying diseases that could cause the heart to enlarge, and early diagnosis once it has developed, is crucial. This includes:

Proper management, such as controlling high blood pressure, treating valve disease and discontinuing alcohol consumption may reverse an enlarged heart.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients or parents may wish to ask their doctor the following questions about an enlarged heart:

1. Why do you suspect I have an enlarged heart?
   
   
2. Was this caused by another underlying disease or condition?
   
   
3. What tests will be used to confirm the diagnosis?
   
   
4. How severe is my condition?
   
   
5. What are my treatment options?
   
   
6. What are the risks associated with these treatments?
   
   
7. How long will it take for therapy to work, and is my condition reversible?
   
   
8. Without treatment, will my heart become more enlarged?
   
   
9. If I made the suggested lifestyle changes, will I be able to stop taking the medication?
   
   
10. Am I taking any medications  or supplements that can complicate my condition?
    
    
11. Can I still exercise and perform other physical activity?
    
    
12. What are the signs that I should seek immediate medical attention for my condition?
    
    
13. Are my children at higher risk for this condition?