What health problems are associated with cardiac enlargement?

With the exception of exercise-induced enlargement, all forms of cardiac enlargement are abnormal and associated with further problems, including heart failure, irregular heart rhythms , and an increased risk of angina and heart attack. Heart failure results because thickened or dilated heart muscle cannot function effectively as a pump. The diseased muscle cells in both types of enlargement are also capable of causing irregular heart rhythms that can lead to passing-out or sudden death. Because the processes which cause hypertrophy typically do not increase the amount of heart blood vessels to match the thickened heart muscle, the consequences of decreased blood flow to the heart, angina and heart attack, are more common. All of this contributes to an increased risk of death and decreased quality of life for most of those with cardiac enlargement. Treatments are available to help most of these problems.

What are the symptoms of cardiac enlargement?

Some people can have varying degrees of cardiac enlargement and have no symptoms. Once dilation or hypertrophy begins to place undue demands on heart function, however, symptoms do result. These can include:

• Shortness of breath
• Chest pressure or pain
• Palpitations (a sense that the heart is beating rapidly or forcefully or “skipping beats”)
• Swelling of the feet, ankles, or legs
• Dizziness or lightheadedness
• Loss of consciousness

In milder forms of cardiac enlargement, the symptoms may occur only with exercise or exertion. In more severe forms, they can occur at any time, even while resting. Other heart and lung problems and other diseases can cause these symptoms as well, so they are not specific to cardiac enlargement.

How is cardiac enlargement diagnosed?

Cardiac enlargement can sometimes be diagnosed based on a physical examination by a physician or other health care provider. A patient’s symptoms or family medical history, high blood pressure, characteristic heart murmur, forceful heart beat, swelling of the legs, or the sound of fluid in the lungs can be clues to the diagnosis. A chest x-ray can show an enlarged heart size or fluid in the lungs and an ECG will often show increased waveforms, indicating LVH or RVH. In fact, it has been suggested that ECG be used to screen young athletes for hypertrophic cardiomyopathy. Unfortunately, cost issues are likely to prevent this from being done on a large-scale basis.