Cardiomegaly is an enlargement of the heart, but it is not a disease in itself, but a symptom that is visible in imaging tests. Many conditions can lead to it, so it's worth finding out what ailments can make your heart too big. Is cardiomegaly treated?

Cardiomegalyis not a separate disease entity, and a symptom that may occur in the course of many diseases, not only of the cardiovascular system, it is often associated with heart failure, being its symptom or causing it . The incidence of cardiomegaly depends on age and so: under 30 years of age: about 8% of men and 5% of women have this condition, after the age of 70 it is 33% and 49% respectively. The diagnosis of cardiac enlargement does not require complex research. It is worth remembering that cardiomegaly carries many adverse effects, including very dangerous embolic changes (strokes) or rhyme disturbances that may cause cardiac arrest and death. For this reason, it is necessary to prevent diseases that cause cardiomegaly, and if they occur, appropriate treatment.

The size of the heart depends on many factors, e.g. age, sex, body composition, lifestyle, chest defects. The same size of this organ in two different people does not necessarily mean that both of them have the correct size, when assessing the heart one takes into account sex and body weight, it is important that this organ is proportional to our figure, and thus pumped efficiently blood depending on the demand for it.

The reason for the enlargement of the heart is forcing it to work excessively in relation to its capacity, i.e. overload. It is caused by over-exertion (some competitive athletes), when the muscle demand is disproportionate to the heart's ability to work, but also by many diseases, a common feature of many of them is the obstruction of blood flow through the blood vessels.

Heart overload causes two answers, whether it is volume overload or pressure overload. If the heart has to pump too much blood volume (volumetric overload), e.g. in a defect of the valves, when the blood flows back into the ventricles and the increased volume is pumped in the next contraction, it rather stretches its walls. If, on the other hand, the resistance that it has to overcome is increased, i.e. the generated pressure must be higher (overloadhypertension), e.g. due to high blood pressure, enlargement is the result of an increase in the heart muscle mass (so-called concentric hypertrophy).

Enlargement of the heart, contrary to what one might think, is not desirable and does not improve the efficiency of this organ. In the case of volume overload and stretching of the ventricles, their volume increases, but the structure of the muscle does not change, so the ratio of the volume of the chamber to the amount of muscle mass is disturbed. The increase in energy needed to pump out the right amount of blood is not satisfied and the heart becomes inefficient. Concentric hypertrophy (i.e. an increase in muscle mass) caused by pressure overload or congenital diseases is also unfavorable, in many cases muscle hypertrophy results from too weak heart function, which the body tries to compensate by increasing its mass. In this case, the deterioration in the quality of the heart's work has a different cause than in the case of volume overload. Here, the thick wall of the ventricle prevents full relaxation, the enlargement of the cavities, the blood returning to the heart has nowhere to flow, which reduces the amount of it reaching the arteries, even if the muscle efficiency is preserved.

Diseases that may result in cardiomegaly

The causes of cardiac enlargement are very diverse, they can be congenital and lifetime diseases, heart diseases, but also other organs.

The typical cardiac causes of cardiomegaly include:

  • heart failure
  • valvular insufficiency - this is when the heart pumps more blood as it returns to the ventricles during diastole,
  • stenosis of the valves, in this case more work is associated with overcoming additional resistance in the way of outflowing blood,
  • leakage defects, i.e. abnormal openings in the heart that cause blood to flow between the right and left parts of it and increase the amount of blood that flows through the heart,
  • hypertension,
  • hypertrophic cardiomyopathy, typical of this symptom. Cardiac enlargement is often its only symptom, it is associated with excessive development of the heart muscle and has many unfavorable consequences, e.g. ischemic heart disease may appear in its course. This is because the coronary vessels are too small to provide enough blood supply to accommodate the increased mass of the heart muscle. Hypertrophic cardiomyopathy is a genetic disease that occurs quite rarely, in about 0.2% of the population,
  • dilated cardiomyopathy, in this case the heart enlarges as a result of an increase in the volume of the heart cavities withoutgrowth of the heart muscle, which reduces heart function and reduces systolic function. There are many causes of this disease, e.g. genetic mutations, previous myocarditis, toxins (alcohol, chemotherapy), some of them remain unknown,
  • puerperal cardiomyopathy, which is a type of dilated cardiomyopathy,
  • pulmonary hypertension, i.e. an increase in pressure in the pulmonary artery (the vessel coming from the right ventricle),
  • myocarditis,
  • fluid in the pericardium, on a chest X-ray examination, the outline of the heart seems enlarged, but in reality such an image is formed by the accumulated fluid, stretching the pericardial sac, after removing the fluid, the image of the heart remains normal,

Non-cardiac causes of cardiomegaly include:

  • obesity and related hypertension,
  • lung diseases - asthma, COPD,
  • anemia,
  • thyroid disease - hypothyroidism and myxedema,
  • diseases of the pituitary gland - acromegaly,
  • hemochromatosis and other storage diseases, e.g. amyloidosis,
  • advanced renal failure,
  • diabetes,
  • connective tissue diseases,
  • competitive sports,

Cardiomegaly itself is a symptom, very often it remains undiscovered or accidentally revealed, but sometimes it can also cause some discomfort. They usually result from the disease causing the heart enlargement and they dominate. It is often accompanied by: shortness of breath, arrhythmias and a feeling of uneven heartbeat, swelling, chest pain, fainting, dizziness. All these symptoms may indicate the existence of life-threatening diseases, therefore a medical consultation is necessary in the event of their appearance.

Cardiomegaly: risk factors and prevention

The risk of heart enlargement is directly related to the risk of diseases that cause it, our lifestyle and treatment of conditions that may cause it is essential if we want to protect ourselves against this ailment. Therefore, it is necessary: ​​regular blood pressure control, especially in people with hypertension, treatment of ischemic heart disease, treatment of thyroid and lung diseases, control of diabetes and cholesterol levels. Equally important is a he althy lifestyle implemented by simple measures such as: quitting smoking and avoiding passive smoking, avoiding alcohol consumption, and physical activity. Unfortunately, there are diseases that we have no control over, they are mainly congenital diseases, such as: hypertrophic cardiomyopathy found in relatives, congenital heart defects - valve defects,abnormal connections of the heart cavities. In these cases, it is important to know about the existence of these diseases in the family, and in the event of disturbing symptoms, see a doctor and inform him about the existence of such diseases in relatives.

Cardiomegaly: possible complications

Cardiomegaly, although it is a symptom, can also have some consequences on its own, so it is important to prevent and treat the underlying diseases so that complications will not occur or will be significantly delayed. Possible consequences include: heart failure (this disease can be a cause, but also a consequence of an enlarged heart), peripheral embolism, i.e. the formation of clots in enlarged heart cavities, which then go to the brain, causing a stroke or coronary vessels causing a heart attack. The most dangerous complication is sudden cardiac arrest and death, it happens because sometimes cardiomegaly causes serious arrhythmias, when the heart beats too fast or too slowly, making contractions ineffective.

The diagnosis of cardiomegaly does not require complicated tests

The basic examination that allows to determine the enlargement of the heart figure is the chest X-ray, here the so-called cardiopulmonary index is assessed, i.e. the ratio of the width of the heart to the entire transverse dimension of the chest. If this index exceeds 0.5, i.e. the outline of the heart is greater than half of the chest size, it is estimated to be enlarged. This condition can also be found or suspected on the basis of other tests: certain features of the ECG record are characteristic of cardiomegaly - mainly high bends in precordial leads, confirmation facilitates the calculation of the so-called Sokolov index. Similarly, the features of ischemia visible on the ECG or conduction disturbances in the ventricle may be diagnostic and lead to the suspicion of enlargement of the heart. Another important examination is echocardiography, i.e. the so-called echo of the heart, it allows not only to accurately assess the enlargement, to find out which part of the heart it affects, but also to diagnose many causes of this condition. Another advantage of echocardiography is the ability to objectively examine and monitor the severity of the disease. Another test - a stress test assesses the work of the heart during exercise and diagnoses possible ischemia accompanying the enlargement of the heart. Among the imaging tests, computed tomography and magnetic resonance imaging are also used, the latter of these tests is rarely used, but very accurate, thanks to it, similarly thanks to echocardiography, it is possible to diagnose some causes of cardiomegaly. In certainIn cases, a heart biopsy is used, most often it is performed through the groin and the femoral vein located there, then the samples are sent for histopathological examination. However, a biopsy is a final choice test when it is difficult to diagnose the cause of an enlarged heart. Genetic tests are performed when hypertrophic cardiomyopathy and other hereditary diseases are suspected. A significant enlargement of the heart's silhouette in a radiograph is sometimes called " cor bovinum ".

Cardiomegaly: treatment

The most important goal of cardiomegaly diagnostics is to find out its cause. It is necessary primarily for proper treatment, because there is no specific treatment for cardiomegaly, and the therapeutic process is aimed at combating its causes. There are many medications available for pharmacological treatment, e.g. diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, B-adrenergic blockers, and many others. They are used in various diseases of the cardiovascular system, they improve the functioning of the cardiovascular system in various ways, stop the progression of diseases and eventually heal them. These preparations can be used in the case of arterial hypertension, heart failure, ischemic heart disease or myocarditis.

Similar treatments are used in hypertrophic cardiomyopathy, but here the treatment is only aimed at slowing the progression of the disease and reducing the severity of its symptoms, as there is no way to cure the cause of the disease.

Surgical intervention is sometimes necessary, in the case of hypertrophic cardiomyopathy, procedures such as mictomy, i.e. excision of part of the interventricular septum, alcohol ablation of the septum (performed percutaneously), both of these procedures are aimed at reducing the thickness of the interventricular septum and improving the function left ventricle.

In the case of valve defects (stenosis or regurgitation) and abnormal connections of the heart cavities, the primary treatment method is cardiosurgical or endovascular, usually the decision to intervene is made if the defect causes troublesome symptoms or worsens.

Sometimes heart diseases causing cardiomegaly cannot be cured with pharmacological and surgical interventions, then the only option is heart transplantation. Other therapeutic options are used in the case of cardiomegaly of non-cardiovascular origin, then pharmacological treatment includes, depending on the cause, diabetes, diseases of the connective tissue, thyroid gland, pituitary gland, and lungs. Unfortunately, diseases of the thyroid gland or pituitary glandsometimes require surgical intervention.

Category:

Cardiology