Cardiac Enlargement: A Patient Guide

Cardiovascular or coronary artery disease (CVD or CAD) can cause dilated cardiomyopathy and can severely complicate either form of cardiac enlargement and should be aggressively treated. Treatment for CVD/CAD  and its risk factors – smoking, high dietary and blood cholesterol levels, diabetes, high blood pressure, being overweight and sedentary – includes the use of medications, lifestyle changes, angioplasty with or without coronary artery stenting, or bypass surgery.

In situations of either dilation or hypertrophy, heart failure can be treated with medications like beta blockers (to relax the heart), ACE inhibitors or the newer angiotensin receptor blockers (to decrease the pressure against which the heart has to pump), diuretics (to ease breathing and help decrease excess fluid in the lungs and body), and digoxin and other medications (“inotropes”) which improve the heart’s pumping strength. In severe cases, salt and fluid intake may be controlled.

Based on a number of factors, the chance of irregular heart rhythms can be reduced by using a variety of medications. For patients at highest risk, an implantable cardioverter-defibrillator can be life saving. For slow or blocked heart rhythms, a pacemaker may be needed.

Due to the risk of blood clot formation in a weak, dilated heart, blood thinners like warfarin (brand name Coumadin) are recommended for those with very poor heart function or those who have already had an episode of clotting.

Cardiac rehabilitation in the form of a structured exercise program can help reduce symptoms and improve exercise tolerance for those with cardiac enlargement.

For some of those with hypertrophic cardiomyopathy, where the thickened heart muscle blocks blood flow from the ventricle, there are procedures to reduce sections of heart muscle and improve heart function. One of these, a septal myomectomy, requires open heart surgery. A non-invasive option, called an alcohol septal ablation, involves a procedure and catheter similar to an angiogram. Instead of using contrast dye, however, alcohol is injected. This causes muscle cells in the thickened septum to die, reducing blood flow blockage. Heart transplantation is a last-resort option for selected patients with either type of cardiac enlargement and severely decreased heart function.

When should I seek treatment for cardiac enlargement?

If you have any symptoms of heart disease, either with exertion or at rest, you should see a doctor promptly. Symptoms include:

• Shortness of breath
• Chest pressure or pain
• Palpitations
• Swelling of the feet, ankles, or legs
• Dizziness or lightheadedness
• Loss of consciousness

These may indicate cardiac enlargement or may be due to other heart or lung problems or other conditions that may require treatment.

You should also seek treatment if a family member has hypertrophic cardiomyopathy. In this situation, a physical exam and a screening ECG are usually performed. This may be followed by an echocardiogram, if abnormalities are found or if suspicion continues.

Where can I learn more about cardiac enlargement?

The following organizations offer additional information about cardiac enlargement:

The Cardiomyopathy Association is a private charitable organization based in the United Kingdom which provides educational information and networking for those with cardiac enlargement and their families. Their Web site, address, and phone number can be found at www.cardiomyopathy.org.

The National Heart Lung and Blood Institute of the National Institutes of Health has information on its Web site.

The American Hearth Association has information on the topic on its Web site.