Jie Yang, MD
Jie Yang, MD, is a cardiologist with Kaiser Permanente in Oakland, California. MyDoctor.KaiserPermanente.org/ncal/providers/jieyang
Hearing that your heart is enlarged can be terrifying…but it doesn’t have to be. Many people with enlarged hearts can stabilize their health through medication, lifestyle changes and sometimes surgery, says cardiologist Jie Yang, MD. Understanding this condition will help you and your doctor decide on an appropriate treatment plan.
Sometimes called cardiomegaly, enlarged heart doesn’t refer to one specific condition. It’s a somewhat loose umbrella term that describes what’s happening to the heart rather than describing a particular disease. In that sense, it’s a bit like the phrase “skin rash”—your skin can develop a rash for multiple reasons, and the term merely describes the state of your skin when some underlying condition, from poison ivy to measles, causes it to break out.
Several conditions can cause your heart to appear enlarged on medical tests, including high blood pressure (hypertension), a genetic mutation, abnormal protein deposits in the heart muscle (cardiac amyloidosis) and atrial fibrillation (an erratic heartbeat in the heart’s upper chambers). These conditions also are all causes of congestive heart failure (CHF). In fact, CHF is so closely linked to enlarged heart that when people use the term “enlarged heart,” they’re usually referring to CHF.
Your heart has four chambers, or hollow spaces, two at the top and two at the bottom. The top two chambers are known as the right atrium and left atrium. The bottom two are the right ventricle and left ventricle.
Usually when we speak of enlarged heart or CHF, we’re talking about the enlargement and weakening of the left and/or right ventricle.
The heart’s atria also can become enlarged due to high blood pressure or certain arrhythmias (abnormal electrical conduction of the heart causing irregular heart rhythms) such as atrial fibrillation, but atrial enlargement is not commonly referred to as enlarged heart. And sometimes, the heart muscle, especially the septum—the wall between the heart’s chambers—thickens. This condition, called hypertrophic cardiomyopathy, usually is genetic and shows up during the teen years, although it also may be due to hypertension, aging or protein deposits. Doctors don’t usually refer to hypertrophic cardiomyopathy as enlarged heart, although occasionally patients use the term in that way.
CHF, which patients commonly refer to as “enlarged heart,” occurs when one or both ventricles become enlarged. The ventricles pump blood to the rest of the body, so when their function is decreased, blood flow to organs and tissues throughout the body is restricted. This often leaves patients feeling tired and weak. Because the heart is having difficulty pumping, blood can back up and cause accumulation of fluid in the lungs, abdomen and legs. CHF and enlarged heart symptoms include stomach cramps and/or pain…shortness of breath…fatigue…swelling in the legs and feet (edema)…and difficulty sleeping when lying flat (patients may require several pillows to prop themselves in bed at night to breathe better).
CHF has other serious long-term repercussions. Poor circulation can cause damage to organs, especially the kidneys, leading to renal injury, and patients with CHF are at increased risk for arrhythmias, even dangerous arrhythmias that lead to sudden death.
CHF is only rarely caused by a genetic mutation. Other rare causes include tachyarrhythmias (rapid heart rate), thyroid dysfunction, viruses, disease in or damage to a heart valve, substance abuse and alcoholism.
But the most common cause of CHF is coronary artery disease (CAD), the medical term for blocked blood vessels leading to the heart. Blood vessels carry oxygen and nutrients to the heart’s cells, so if these vessels are blocked, the heart muscle weakens over time.
Hypertension is another frequent cause of CHF. High blood pressure forces the heart to work harder, thickening and enlarging the left ventricle.
Doctors usually begin suspecting CHF when patients report their symptoms. Commonly, an enlarged heart shows up on a chest x-ray or is suspected when an EKG appears abnormal. It usually is confirmed with an ultrasound of the heart (also known as an echocardiogram).
Note: EKG and an ECG are the same thing. Both are abbreviations for “electrocardiogram” although EKG refers to the German spelling, “elektrokardiogramm.” An EKG measures electrical impulses to see if there are problems with the heart’s rhythm.
Beware: Chest x-rays taken on portable x-ray machines can artificially enlarge the image of the heart. If your heart image was taken using a portable x-ray, another test is warranted, such as echocardiogram.
If your doctor tells you that you have CHF, take it seriously. There are treatments to help you live with the condition, but it rarely resolves without intervention.
Today, several types of medicine are prescribed for CHF to strengthen the heart, all with good track records for safety and efficacy. Physicians apply goal-directed medical therapy (GDMT), wherein they start a patient with one drug at a time, gradually increasing its dosage to the target dose while monitoring the patient’s response before starting the next drug. These four drug types are the cornerstone of medical therapy to help the heart recover…
Beta-blockers: This class of drugs usually is used to lower blood pressure and suppress arrhythmias. Beta-blockers, most commonly metoprolol or carvedilol, cause the heart to beat more slowly and with less force.
Angiotensin drugs: Medications such as angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) relax the blood vessels. Neprilysin inhibitors help maintain fluid and sodium levels.
SGLT2 inhibitors: These drugs, including empagliflozin and dapagliflozin, previously were prescribed for diabetes but were found to improve outcomes for people with CHF.
Mineralocorticoid receptor antagonists (MRA): The drugs spironolactone and eplerenone appear to offer several benefits, including lowering blood pressure, reducing heart stiffness and preventing arrhythmias.
When patients have symptoms of fluid buildup, doctors usually also prescribe diuretics such as furosemide to help relieve the excess fluid.
Depending upon the cause of CHF, surgery may be required. Example: If the CHF is caused by coronary artery disease in multiple blood vessels of the heart, a coronary artery bypass graft (CABG) may be necessary. Once blood flow to the heart muscle is established, the heart eventually may revert back to normal size. In cases in which the CHF is caused by valve disease, surgeons may operate to repair or replace the valves.
For most people with CHF, exercise is both beneficial and safe, but check with your doctor. Start small and slow, by simply walking for a few minutes and then gradually increasing your distance or intensity. Don’t overexert yourself.
CHF patients generally are told to decrease their salt intake, especially when they have significant fluid accumulation. In severe cases, doctors may recommend limiting fluid intake to eight cups or less per day to help you maintain proper sodium levels and keep from overburdening your system.
Follow a heart-healthy eating pattern such as the Mediterranean diet. There are well-established general heart benefits to cutting back on highly processed foods, salt, added sugars and animal fats…and eating more fruits, vegetables, fish and whole grains.
While any diagnosis of CHF or enlarged heart should be taken seriously, many patients are able to return to their normal lives while taking medications to support their hearts. The heart can recover its normal function when properly treated with medications, surgery and lifestyle changes as needed.
