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Cardiomegaly: Treatment & Diagnosis

Cardiomegaly or "enlarged heart" isn't a distinct clinical condition—it's a sign of an underlying heart problem. Treatment for cardiomegaly varies depending on the condition that causes it. A doctor can usually diagnose an enlarged heart with simple imaging tests or an electrocardiogram (EKG/ECG), though determining the underlying cause may be more complicated.

How to diagnose cardiomegaly

Cardiomegaly may not cause symptoms, especially when it's mild or in the beginning stages, and you may not get a diagnosis of cardiomegaly on its own. It's more likely that your doctor will check for an enlarged heart if you come in with symptoms of another heart disease, such as heart palpitations or swelling due to an inefficient pumping from your heart.

Sometimes, a doctor may detect a heart murmur during a routine check and decide to look for other heart complications. It's also possible to see an enlarged heart on imaging tests taken for another reason. For instance, an enlarged heart may show up on a chest X-ray taken after a traumatic accident. For patients with high blood pressure or heart muscle defects, evidence of an enlarged heart can be seen on an EKG.

If your doctor suspects you have a heart condition associated with cardiomegaly—or if you have direct symptoms of an enlarged heart—they will order tests to evaluate your heart. These tests may include imaging that helps the care team understand what condition you're dealing with, what stage it's in, and how to treat it.

How to detect an enlarged heart

The most common way to diagnose cardiomegaly is with an echocardiogram, a simple ultrasound test for heart function. It's a painless imaging procedure that uses the same technology as the ultrasound used to look at developing babies. Medical staff will touch an ultrasound wand to your chest, allowing them to see whether the heart has grown abnormally large. Echocardiograms are also used to diagnose many other heart conditions, so the echo can help them understand what may be causing your enlarged heart.

Your doctor will look for the underlying heart condition causing your cardiomegaly, so they may do other tests, including:

  • X-ray: A chest X-ray can show the heart and lungs.
  • CT scan: This technology uses multiple X-ray images to create a three-dimensional image of the heart. They can even show blood flow through the heart, which can help diagnose conditions like mitral valve stenosis.
  • MRI: Strong magnets can create a highly detailed image of the heart.
  • Electrocardiogram (EKG/ECG): This test assesses the heart's activity using electrodes stuck to the skin.
  • Genetic testing: Some heart conditions that cause cardiomegaly are genetic. Your doctor may want to check for these genetic diseases.
  • Heart catheterization: In some cases a stress test may point to a need to look at the coronary arteries and to measure pressures within the heart that can rise due to conditions causing cardiomegaly.

Can an EKG detect an enlarged heart?

An EKG doesn't provide an image like many tests to diagnose cardiomegaly. Instead, it measures the heart's activity and shows it as electrical waves. If the waves are abnormally large in amplitude, it may indicate an enlarged heart, especially from an underlying heart muscle defect or effects of high blood pressure.

What cardiac condition shows cardiomegaly on a chest X-ray?

Cardiomegaly is a sign of many cardiac conditions. If you have an enlarged heart, it will appear abnormally large on a chest X-ray, regardless of what condition is causing the heart to be enlarged.

Cardiomegaly treatment

Cardiomegaly treatment guidelines depend on the condition causing the heart to enlarge. Your doctor won't treat the cardiomegaly directly. Instead, they'll identify and treat the underlying condition causing your enlarged heart.

For example, if cardiomegaly is the result of mitral or aortic valve regurgitation, you may need a mitral or aortic valve repair. When cardiomegaly results from coronary artery disease, you may need a stent or bypass surgery. The range of possible treatments includes treatments for most serious heart conditions.

Your doctor may prescribe several different kinds of medication for cardiomegaly, depending on the condition causing it:

  • Antiarrhythmics: Drugs to help your heart maintain a normal rhythm.
  • ACE inhibitors and ARBs: Medicines that lower your blood pressure.
  • Beta-blockers: Drugs that improve heart function and control blood pressure.
  • Blood thinners: Anti-clotting medicines that can help prevent blockages in the cardiovascular system.
  • Diuretics: These medications manage the amount of water or salt in your body.
  • Comorbidity-focused treatments: Treatments for primary health conditions like diabetes or obesity.

If medication isn't sufficient to treat your enlarged heart, you may need a surgical treatment or catheter procedure:

  • Pacemaker: A surgically implanted device that manages irregular heartbeat
  • Internal defibrillator: An implantable device that shocks your heart back to normal function during cardiac arrest.
  • Heart valve surgery: Repair or replace a defective heart valve that's stressing the heart too much.
  • Bypass surgery or stenting: Operations to improve or restore correct blood flow to the heart.
  • Transplant: An operation to replace your heart with a compatible donor heart.
  • Left ventricular assist devices: A specialized heart pump to replace or support the weak pumping by the heart.

Heart conditions are serious, and you should get proper medical care for an enlarged heart. However, many lifestyle factors can ease the load on your heart and help it perform at its best:

  • Diet: Eating a heart-healthy diet can help. Limit your intake of alcohol, caffeine, salt, fat, and sugar. Eat plenty of fresh fruits and vegetables and focus on lean proteins.
  • Exercise: Physical activity is good for the heart. Check with your doctor about any restrictions or exercises to avoid due to your heart condition.
  • Manage related conditions: Control your blood pressure and cholesterol and manage any other conditions, such as diabetes, that put you at risk for heart problems.
  • Obesity management: Medications, exercise, and dietary changes can often help reduce weight and reverse the enlargement of the heart associated with this condition.

FAQs about cardiomegaly treatment

An enlarged heart isn't a specific condition. It's a sign of other heart problems, and there's no "one size fits all" treatment. Your care team will determine the best diagnosis and treatment for your enlarged heart based on the underlying cause.

It can be. Lots of conditions cause cardiomegaly, and some of them have a genetic component. Even when the cause is genetic, it's not healthy. If your heart is enlarged, get medical attention to determine the cause and get treatment. Sometimes congenital heart disease causes cardiomegaly. 

In general, yes. Depending on what's causing your cardiomegaly, you may have some restrictions on how you can exercise, but most people with an enlarged heart can still train and perform physical activity. For some individuals with heart muscle defects leading to cardiomegaly, extreme or competitive sports may be prohibited.

The most common causes of cardiomegaly are coronary artery disease and high blood pressure.

An enlarged heart isn't always an immediate medical emergency, but it is a sign that something is wrong. Don't panic but do speak to your doctor to determine the condition triggering your cardiomegaly and get treatment.

A proper diagnosis and targeted treatment can reduce the enlarged heart toward normal size. In cases where cardiomegaly is caused by a temporary condition, such as pregnancy or infection, an enlarged heart may return to normal once the trigger has passed. However, it's more typical for your heart to stay enlarged, especially if you don't resolve the underlying problem.