Pathophysiology: An enlarged heart (cardiomegaly) isn't a disease, but rather a symptom of another condition. The term "cardiomegaly" most commonly refers to an enlarged heart seen on a chest X-ray. Other tests are then needed to diagnose the condition causing your enlarged heart. You may develop an enlarged heart temporarily because of a stress on your body, such as pregnancy, or because of a medical condition, such as the weakening of the heart muscle, coronary artery disease, heart valve problems or abnormal heart rhythms. In some people, an enlarged heart causes no signs or symptoms. Others may have these signs and symptoms: • Shortness of breath • Abnormal heart rhythm (arrhythmia) • Swelling (edema) Statistics: The estimated prevalence of dilated cardiomyopathy is 1:2500. This condition is among the most common causes of heart failure. The incidence of dilated cardiomyopathy discovered at autopsy is estimated to be 4.5 cases per 100,000 populations per year, whereas the clinical incidence is 2.45 cases per 100,000 population per year. Dilated cardiomyopathy may manifest clinically at a wide range of ages, but this condition most commonly occurs in the third or fourth decade of life. Treatment: If cardiomyopathy or another type of heart condition is to blame for your enlarged heart, your doctor may recommend medications. These may include: • Diuretics to lower the amount of sodium and water in your body, which can help lower the pressure in your arteries and heart • Angiotensin-converting enzyme (ACE) inhibitors to lower your blood pressure and improve your heart's pumping capability • Angiotensin receptor blockers (ARBs) to provide the benefits of ACE inhibitors for those who can't take ACE inhibitors • Beta blockers to lower blood pressure and improve heart function • Digoxin to help improve the pumping function of your heart and lessen the need for hospitalization for heart failure • Anticoagulants to reduce the risk of blood clots that could cause a heart attack or stroke • Anti-arrhythmics to keep your heart beating with a normal rhythm Medical procedures and surgeries If medications aren't enough to treat your enlarged heart, medical procedures or surgery may be necessary. • Medical devices to regulate your heartbeat: For a certain type of enlarged heart (dilated cardiomyopathy), a pacemaker that coordinates the contractions between the left and right ventricle may be necessary. In people who may be at risk of serious arrhythmias, drug therapy or an implantable cardioverter-defibrillator (ICD) may be an option. ICDs are small devices — about the size of a pager — implanted in your chest to continuously monitor your heart rhythm and deliver electrical shocks when needed to control abnormal, rapid heartbeats.
The devices can also work as pacemakers. If the main cause of your enlarged heart is atrial fibrillation, then you may need procedures to return your heart to regular rhythm or to keep your heart from beating too quickly. • Heart valve surgery: If your enlarged heart is caused by a problem with one of your heart valves, you may have surgery to remove the valve and replace it with either an artificial valve or a tissue valve from a pig, cow or deceased human donor. If blood leaks backward through your valve (valve regurgitation), the leaky valve may be surgically repaired or replaced. • Coronary bypass surgery: If your enlarged heart is related to coronary artery disease, your doctor may recommend coronary artery bypass surgery. • Left ventricular assist device (LVAD): If you have heart failure, you may need this implantable mechanical pump to help your weakened heart pump. You may have an LVAD implanted while you wait for a heart transplant or, if you're not a heart transplant candidate, as a long-term treatment for heart failure. • Heart transplant: If medications can't control your symptoms, a heart transplant may be a final option. Because of the shortage of donor hearts, even people who are critically ill may have a long wait before having a heart transplant.