From the Guidelines
If an EKG shows possible left atrial enlargement, you should follow up with your healthcare provider for further evaluation, as this finding is associated with an increased risk of atrial fibrillation, stroke, and heart failure 1. Left atrial enlargement on an EKG is not a diagnosis itself but a finding that requires additional investigation to determine its cause and significance. Your doctor will likely recommend an echocardiogram (heart ultrasound) to confirm the enlargement and assess its severity, using maximal left atrial volume indexed to body surface area for quantification of left atrial size, as recommended by the European Task Force for Multimodality Imaging in Atrial Fibrillation 1. They may also order additional tests such as blood work, chest X-ray, or stress testing depending on your symptoms and medical history. Common causes of left atrial enlargement include:
- Hypertension
- Mitral valve disease
- Heart failure
- Atrial fibrillation Treatment will depend on the underlying cause and may include:
- Blood pressure medications like ACE inhibitors or ARBs
- Diuretics
- Rate-controlling medications such as beta-blockers
- Anticoagulants if atrial fibrillation is present, with warfarin being the recommended anticoagulant agent in patients judged to be at risk for thromboembolism 1 Lifestyle modifications including reducing sodium intake, regular exercise, weight management, and avoiding alcohol and tobacco are also important. Left atrial enlargement is concerning because it can increase the risk of atrial fibrillation, stroke, and heart failure, so prompt evaluation and management are essential even if you're not experiencing symptoms, and a generally aggressive strategy for maintaining sinus rhythm is warranted due to the association of AF with progressive heart failure and mortality, as well as stroke 1.
From the Research
Next Steps for Possible Left Atrial Enlargement on EKG
If an EKG shows possible left atrial enlargement, the following steps can be considered:
- Further diagnostic testing, such as echocardiography, to confirm the presence and severity of left atrial enlargement 2, 3, 4, 5, 6
- Evaluation of underlying conditions that may be contributing to left atrial enlargement, such as hypertension, valvular heart disease, or heart failure 2, 3, 4
- Assessment of cardiovascular risk factors and implementation of strategies to reduce risk, such as lifestyle modifications or medical therapy 2, 3, 4
Diagnostic Considerations
- EKG criteria for left atrial enlargement have been shown to have low sensitivity but high specificity 3, 5, 6
- Echocardiography is considered the gold standard for diagnosing left atrial enlargement 3, 4, 6
- The use of artificial intelligence-enabled ECG may improve the detection of left atrial enlargement 2