From the Guidelines
An enlarged heart, or cardiomegaly, requires prompt medical attention as it indicates underlying heart problems, and diagnosis typically involves a physical exam, chest X-ray, echocardiogram, electrocardiogram (ECG), cardiac MRI, and blood tests to determine the cause, with treatment focusing on addressing the underlying condition causing the enlargement, as recommended by the 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR guideline for the management of hypertrophic cardiomyopathy 1.
Diagnosis
Diagnosis of an enlarged heart involves various tests, including:
- Physical exam
- Chest X-ray
- Echocardiogram
- Electrocardiogram (ECG)
- Cardiac MRI
- Blood tests The clinical diagnosis of hypertrophic cardiomyopathy (HCM) can be established by imaging, typically with 2D echocardiography or cardiovascular magnetic resonance (CMR) showing a maximal end-diastolic wall thickness of ≥15 mm anywhere in the left ventricle, in the absence of another cause of hypertrophy in adults, as stated in the 2024 guideline 1.
Treatment
Treatment focuses on addressing the underlying condition causing the enlargement, and may include:
- Medications for heart failure, such as ACE inhibitors like lisinopril (10-40 mg daily), beta-blockers such as metoprolol (25-200 mg daily), diuretics like furosemide (20-80 mg daily), and aldosterone antagonists such as spironolactone (25-50 mg daily)
- Antihypertensives to maintain blood pressure below 130/80 mmHg for hypertension treatment
- Surgical repair or replacement for valve disorders
- Lifestyle modifications, including sodium restriction (less than 2,300 mg daily), regular moderate exercise (30 minutes most days), weight management, smoking cessation, and limiting alcohol consumption
- Implantable devices like pacemakers or defibrillators in severe cases, and heart transplantation in some patients, as recommended by the 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy 1.
Management
The 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR guideline for the management of hypertrophic cardiomyopathy recommends comprehensive 2D echocardiography to establish the diagnosis of HCM, determine hypertrophy pattern, presence of LV apical aneurysms, LV systolic and diastolic function, mitral valve function, and presence and severity of LVOTO, with routine follow-up of patients with HCM, including serial TTE every 1 to 2 years, to assess for changes in LV systolic and diastolic function, wall thickness, chamber size, LVOTO, and concomitant valvular disease 1.
From the Research
Diagnosis of Enlarged Heart
- Enlarged heart, also known as cardiomegaly, can be diagnosed using chest radiographs, which can identify important abnormalities in patients undergoing diagnostic evaluation for cardiovascular diseases 2.
- The clinical implications of cardiomegaly depend on the underlying clinical disorder, and its presence can have important clinical associations, including increased BNP levels and increased right heart pressures, in patients undergoing evaluation for pulmonary hypertension 2.
- Patients with cardiomegaly often have elevated BNP, BUN, and creatinine levels, as well as elevated right atrial pressures, right ventricular pressures, and pulmonary artery pressures, and reduced cardiac indices and reduced mixed venous oxygen saturations 2.
Treatment of Enlarged Heart
- The treatment of enlarged heart, or hypertensive heart disease (HHD), involves optimal antihypertensive therapy in the setting of therapeutic lifestyle changes, which is crucial in the prevention and control of HHD 3.
- Regression of left ventricular hypertrophy (LVH) is achievable and associated with improved prognosis, and prevention of myocardial remodeling before LVH establishes would further increase the benefits to cardiac function and prognosis 3.
- Antihypertensive agents, such as beta-blockers and ACE inhibitors, can be used to treat enlarged heart, and combining these agents into a single pill can provide effective blood pressure lowering and improved cardiovascular outcomes 4.
- Higher doses of ACE inhibitors and ARBs can reduce the risk of HF worsening and hospitalization compared to lower doses, but may increase the risk of adverse effects, such as hypotension, dizziness, and hyperkalemia 5.