Cardiomegaly, the pathological enlargement of the heart muscle, is a serious disease that usually occurs as a result of an underlying disease and must also be treated accordingly. There are a variety of diseases in the course of which cardiomegaly occurs.
What is cardiomegaly?
Cardiomegaly, the pathological enlargement of the heart muscle, is a serious disease that usually occurs as a result of an underlying disease and must also be treated accordingly. The organ enlargement usually occurs as a result of another disease. However, too intense permanent physical stress (excessive sports workouts) can also lead to it (athlete’s heart). Other names for cardiomegaly are (acute) cardiac dilatation, cardiac hypertrophy and cor bovinum (ox heart). In cardiac dilatation, the heart’s internal chambers widen into the chest cavity. The term “cardiac hypertrophy” indicates overgrown heart muscle tissue: Due to various causes of disease, the heart muscle must pump more blood volume to supply all organs with sufficient oxygen. The exertion results in increased growth of the heart muscle tissue. Since the increased muscle mass in turn requires more oxygen, an even greater blood flow must be pumped. Since the body is often no longer able to do this, cardiac insufficiency (heart failure) occurs. If cardiomegaly remains within certain limits, it is asymptomatic and often goes undetected. In advanced cardiac enlargement, cardiac arrhythmias and heart failure may occur. Cardiac hypertrophy occurs in two forms: right ventricular hypertrophy (RVH, cor pulmonale) and left ventricular hypertrophy (LVH, affecting only the left ventricle).
Causes
Underlying disease causes of cardiomegaly may include: Valvular heart disease, hyperthyroidism, high-grade anemia, cardiomyopathy, pericarditis, hemochromatosis, cardiac amyloidosis, and diphtheria. In addition, cardiac muscle may increase due to excessive physiological stress (competitive sports, endurance sports). Cardiomyopathy is a congenital chronic heart muscle disease that results in weakened pumping function. It is often associated with an enlarged liver, progressive muscle weakness and breathing problems. Pericarditis is the medical term for inflammation of the pericardium. Patients with the rare hemochromatosis have too much iron in their blood. In cardiac amyloidosis, a rare immune disorder, the liver produces proteins that accumulate in the heart tissue and can no longer be broken down. Continued physical overload from exercise can also lead to cardiomegaly. The enlarged heart muscle can then no longer be supplied with sufficient oxygen. In other cases, the conduction system is disturbed. Younger athletes in particular are at increased risk of premature sudden cardiac death.
Diseases with this symptom
- Heart valve defect
- Cardiomyopathy
- Amyloidosis
- Hyperthyroidism
- Pericarditis
- Diphtheria
- Anemia, iron deficiency anemia
- Iron storage disease
- Dilated cardiomyopathy
Diagnosis and course
Cardiomegaly, if the patient does not experience symptoms, is often detected by chance on the X-ray (X-ray thorax in p.a. projection). Indicator for this disease is the cardiothoracic ratio (CTR). A CTR value greater than 0.5 indicates pathological cardiac enlargement. It relates the maximum transverse diameter of the cardiac silhouette to the maximum transverse internal diameter of the bony thorax. However, because the CTR value may be elevated by other conditions, the physician must perform other tests. On mobile X-ray machines, cardiomegaly is detected by the cardiac silhouette touching the left thoracic wall. In addition, the heart disease is diagnosed with the help of echocardiography: it shows up in the form of a widened cardiac apex. The course of cardiomegaly – if not recognized and treated in time – is progressive.Symptoms typical of myocardial insufficiency then occur: Shortness of breath at rest and on exertion, nocturnal episodes of shortness of breath, increased nocturnal urination, edema, especially of the shins and ankles, nausea, fatigue, abdominal pain, severe weight loss, muscle weakness, cardiac arrhythmias, limitations in brain performance, cardiac asthma, cough, pulmonary edema, enlarged liver and spleen, abdominal dropsy, and cold extremities.
Complications
Cardiomegaly, or enlargement of the heart, can be pathologic or physiologic. Typically, endurance athletes usually have an enlarged heart; this does not entail further complications. A pathologically enlarged heart, such as can occur due to valvular heart disease or high blood pressure, can develop into cardiac arrhythmias or even cardiac insufficiency (heart failure). Typical cardiac arrhythmias are, for example, atrial fibrillation or ventricular fibrillation. In atrial fibrillation, there is a high risk of thrombi forming that can break loose and clog vessels. If the blood clots form in the left atrium, they are washed out into the lungs, resulting in pulmonary embolism characterized by shortness of breath and shortness of breath. From the right atrium, the thrombi are usually washed out in the direction of the cerebral vessels, and a stroke can be the consequence here. The failure symptoms depend on the localization of the vascular occlusion. Other complications include heart failure, which cannot be cured and significantly reduces the patient’s life expectancy. Heart failure can quickly progress to shock symptoms with high heart rate and a sharp drop in blood pressure. Blood may also back up because the heart is no longer pumping adequately. Edema is the result. In addition, the risk of dying from sudden cardiac death is also increased.
When should you see a doctor?
Cardiomegaly always requires treatment. Usually, it cannot even be detected by the patient himself, but is usually detected as a result of heart problems in an examination. Since cardiomegaly does not occur without a background, it must always be treated. It is the consequence of other heart-weakening causes and would be accompanied by cardiac death if left untreated. If the diagnosis is made by the family physician, he will advise to see a resident cardiologist and issue an appropriate referral. Quick action by the medical professional is essential in making the diagnosis, as the disease is already considered advanced when cardiomegaly is present. This information is given to the patient during a consultation and therapy session. It is the patient’s own responsibility to have the causes treated. Which treatment is advisable or necessary for affected persons cannot be explained in this context, these always refer to the cause and can vary from medication to surgery.
Treatment and therapy
Cardiomegaly is generally treated as follows: Determination of body mass index (BMI) and examination of body composition leads the patient either to follow a reduction diet under medical supervision or, in the case of underweight, to participate in an underweight program. He receives antihypertensive medication and must undergo regular medical check-ups. To prevent further heart damage, he will be vaccinated against pneumococcus and influenza. He must change his diet according to the underlying disease (increased amount of vegetables and fruits, lots of fiber, a fish dish twice a week to provide omega-3 and omega-6 fatty acids) and may still take an appropriate dietary supplement. Beta-receptor blockers and cardiac glycosides prescribed by the doctor improve his heart function and reduce heart rate. Draining agents rid the bloodstream of excess fluid. Cardiomegaly patients with aortic valve stenosis receive a new mechanical or biological aortic valve through surgery. They also need to take antihypertensive medications. In the case of cardiac dilatation caused by long-term alcohol abuse, rehab must be performed. In pericarditis, the underlying viral or bacterial infection or autoimmune disease is treated appropriately.In the case of hemochromatosis, monthly phlebotomies help; in the case of cardiac amyloidase, heart transplantation is required. Congenital heart defects such as foramen ovale can also only be eliminated surgically. If the patient has an isolated right-sided enlargement of the heart, the causative COPD (chronic obstructive pulmonary disease) and pulmonary fibrosis are treated. Cardiac arrhythmias necessitate the insertion of a pacemaker.
Outlook and prognosis
In general, cardiomegaly is a serious symptom that can lead to death if not treated. Because it is caused by an underlying disease in every case, the underlying disease is treated first and foremost. In most cases, the patient’s quality of life is extremely limited by cardiomegaly. It is no longer possible to perform physical activities and sports without further ado. Thus, shortness of breath often occurs, and in many people this can lead to a panic attack. The shortness of breath also leads to dizziness and sometimes vomiting. Often, those affected also suffer from fatigue that cannot be compensated by sleep. Likewise, abdominal pain and underweight occur. Liver and spleen may enlarge, causing pain. In the worst case, the development of cardiac insufficiency can lead to death. Treatment is usually causal and is always aimed at the underlying disease. This is usually treated with the help of medication or by surgery. If necessary, the patient is then dependent on a pacemaker. Life expectancy is not limited if treatment is initiated early and leads to success. If the heart enlargement is due to the abuse of alcohol, the damage usually cannot be reversed.
Prevention
To prevent cardiomegaly, it is recommended to practice a healthy lifestyle and exercise only moderately. Regular examinations by a specialist help to detect the heart disease at an early stage and initiate the appropriate treatments. In addition, patients should make sure that they regularly take the medications necessary for their underlying disease and undergo the prescribed therapies.
Here’s what you can do yourself
In most cases, a healthy lifestyle will help with cardiomegaly. The patient should eat a healthy diet and exercise. This includes drinking plenty of fluids. Also, giving up alcohol and other drugs has a positive effect on cardiomegaly and can prevent it and limit its symptoms. Likewise, smoking should be given up. In any case, the affected person must be careful to take all prescribed medications, so that there is no subsequent damage. Stressful situations, hectic movements and discussions should be avoided, as they can cause hypertension. It is also not recommended to perform heavy physical activities. In this case, it may be necessary to change jobs. To calm down, valerian can be taken either as a tea or in the form of tablets. Likewise, lemon balm tea has a positive effect on the heart. Visits to the sauna can generally strengthen the cardiovascular system and prevent further problems and complaints with the heart. Those affected by cardiomegaly should pay attention to a low temperature. Nuts also help against cardiomegaly. As a rule, especially hazelnuts and walnuts are very healthy, because they are rich in omega 3 and 6 fatty acids. In any case, the patient should still consult a cardiologist to avoid unexpected complications.
