Generality
The enlarged heart is a marked heart anomaly, examined by X-rays, by an increase in the size of the heart.
Its appearance may be due to different pathological conditions, which may not directly affect the heart. In fact, among the main causes, in addition to heart attack, cardiac arrhythmias, dilated cardiomyopathy, etc., hypertension, anemia and hemochromatosis also appear.
The most characteristic symptoms (even if not always present) of the enlarged heart consist of shortness of breath, edema of the legs, palpitations and alterations of the heart rhythm.
With the execution of various diagnostic tests, it is possible to establish the connotations of the enlarged heart and what it originated from.
Knowledge of the causes is fundamental for planning the right therapy.
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What is an enlarged heart?
Also known as cardiomegaly, the so-called enlarged heart represents a cardiac anomaly that can be found on X-rays, characterized by an increase in the volume or mass of the heart.
From the purely anatomical point of view, the size variations can be determined by a thickening of the heart muscle (ie the myocardium ) or a dilation of the atrial and / or ventricular cavities.
IS IT A SYMPTOM OR A DISEASE?
In medicine, the enlarged heart is considered a symptom and not a disease.
WHAT IS MYOGARD?
The myocardium is the heart muscle.
By alternating a phase of contraction with one of relaxation, the muscle fibers that compose it allow the heart to pump blood to the lungs (for blood oxygenation) and to the rest of the body (for the nourishment of the various organs and tissues of the body).
The myocardium has the extraordinary ability to generate the impulses for its own contraction, thanks to the atrial sinus node . The atrial sinus node, located at the level of the right atrium, is the source and the center of regulation of the heartbeat.
Causes
Cardiomegaly usually arises as a result of particular pathological conditions, which affect the heart and beyond. Furthermore, there are cases of idiopathic cardiomegaly (for which a real cause is not found) and others due to transitory situations, such as pregnancy .
HEART PROBLEMS AT THE BASE OF THE WHOLESALE HEART
The problems and heart diseases at the base of the enlarged heart work by making it more difficult to pump the heart or damage the myocardium. They consist of:
- Heart attack . It is a serious cardiac disorder, commonly called a heart attack, caused by interruption of blood flow to a more or less extensive part of the myocardium. Coronary heart disease, or coronary artery disease, is at the origin of most heart attack cases.
- Arrhythmias . They are alterations in heart rhythm. The latter, following an arrhythmia, can become too slow, too fast or irregular.
- Congenital defects of the heart . The term congenital indicates that the defect is present from birth.
- Heart valve defects . There are four heart valves that regulate blood flow between atria and ventricles and between ventricles and efferent vessels.
- Dilated cardiomyopathy . The term dilated cardiomyopathy identifies a disorder characterized by thickening of the walls of the heart, in particular those of the ventricles.
- Pulmonary hypertension due to heart disease . High blood pressure at the pulmonary artery, which leads blood from the heart to the lungs, can lead to an enlargement of the right ventricle and then of the right atrium.
- Pericardial effusion . The heart is wrapped in a membrane, the pericardium, containing a fluid, called the pericardial fluid. Excessive collection of pericardial fluid causes the so-called pericardial effusion phenomenon; one of the most serious consequences of pericardial effusion is cardiac tamponade .
- Amyloidosis in localized form . Amyloidosis includes a group of diseases characterized by the accumulation of abnormal protein material, also called amyloid material, in the tissues of the body. Amyloidosis affects the heart when the accumulation of amyloid material occurs in the heart compartment.
- Viral infections of the heart . They cause an inflammation of the myocardium ( myocarditis ).
OTHER CONDITIONS ON THE BASIS OF THE WHOLESALE HEART
The enlarged heart can also arise following one of the following pathological conditions:
- Hypertension . High blood pressure, hindering the normal pumping function of the heart, initially causes an enlargement of the left ventricle and then of the atrium above.
- Anemia . Anemia affects red blood cells and the hemoglobin they contain, whose deficiency leads to inadequate oxygenation of the body's tissues and organs. A chronic anemia causes the heart of the affected person to do more intense work. A more intense work can result in an abnormal dilation of the cardiac cavities (atria and ventricles).
- Thyroid disease . Hypothyroidism and hyperthyroidism can put too much stress on the heart, which dilates the heart cavities.
- Hemochromatosis . It is a disease, both hereditary and acquired, characterized by the abnormal accumulation of iron in the body's tissues. Other causes of enlarged heart:
- Pregnancy
- Alcohol abuse
- Use of drugs
- Renal failure . If the kidneys are sick, the heart struggles to pump blood into circulation and changes its normal anatomy.
Symptoms and Complications
The enlarged heart can be asymptomatic, that is, free of symptoms and obvious signs, or cause of shortness of breath, alterations of the heart rhythm ( arrhythmias ), swelling (or edema ) to the legs, palpitations, sense of fatigue and weight gain
WHEN TO REFER TO THE DOCTOR?
An early diagnosis of an enlarged heart makes its treatment easier. Therefore, at the first signs of a possible heart problem, it is advisable to request a cardiological consultation, in order to identify the nature of the disorder.
COMPLICATIONS
The appearance of complications due to cardiomegaly depends on the underlying causes of the enlargement (for example a pregnancy is a transient and less dangerous situation than a heart attack) and on the anatomic part of the heart involved.
The most common complications are:
- Heart failure . Heart failure is a very serious pathological condition that affects the left ventricle. The latter undergoes a dilation which tends to strongly weaken the pumping action of the heart.
- Formation of blood clots . An enlarged heart due to serious heart problems can lead to the formation of blood clots inside it. Blood clots can block circulating blood in the heart or neighboring vessels, causing a heart attack or stroke. If the clots form in the right half of the heart they can move into the lungs, giving rise to the so-called pulmonary embolism .
- Heart valve disorders (or valvulopathies) . Two of the four heart valves, the mitral valve and the tricuspid valve, can deform (in some cases it is an additional malformation) and cause the blood to flow incorrectly. This causes the appearance of so-called heart murmurs .
- Cardiac arrest or sudden cardiac death . When the heart is enlarged, the signs for cardiac contraction can undergo an alteration, giving rise to an arrhythmia. If the arrhythmia is severe (for example, a ventricular fibrillation ), the individual who suffers from it may suffer cardiac arrest.
Diagnosis
The diagnosis of an enlarged heart requires an accurate physical examination, aimed at the observation of signs and symptoms, accompanied by the execution of other tests, such as chest X-rays, electrocardiograms, echocardiography, exercise tests, CT scans, nuclear magnetic resonance, blood tests and cardiac biopsy by catheterization.
The investigations must be scrupulous, as, in order to best treat the enlarged heart, it is necessary to know in depth the causes and characteristics of the anomaly.
EXAMINATION OBJECTIVE
During the physical examination, the doctor analyzes the patient's signs and clinical history .
The typical manifestations of a heart disease (ie chest pain, shortness of breath, fainting, arrhythmia, palpitations, heart murmurs, etc.) and the favoring situations, such as a hypertension, a family history of enlarged heart, are very important indications. a congenital heart abnormality etc.
Physical examination is important, but not sufficient, especially if the affected individual has a form of asymptomatic cardiomegaly.
CHEST OF RADIOGRAPHY, CT and NUCLEAR MAGNETIC RESONANCE
Chest X-rays (or chest X -rays ), CT scans (or computerized axial tomography ) and nuclear magnetic resonance (or NMR ) are imaging diagnostic tests that show the shape and size of the heart, proving to be very useful because they bring in evidence the changes in the volume of the heart.
NB: the chest X-ray and the CT scan, unlike the MRI, expose the patient to a minimum share of harmful ionizing radiation.
ELECTROCARDIOGRAM
The electrocardiogram ( ECG ) measures the electrical activity of the heart through the application, on the chest and on the limbs, of some electrodes. From the recording of how the signal for cardiac contraction is conducted, the cardiologist is able to detect the presence of arrhythmias or damage due to a previous heart attack.
The ECG is a fairly simple exam, it does not require any special preparation, it is not invasive and gives an idea of what may be the origin of the enlarged heart.
ECHOCARDIOGRAM
The echocardiogram is an ultrasound examination that shows, in detail, the anatomy of the heart. It allows the identification of valvular defects, congenital heart defects, myocardial malformations (including dilations of the cardiac cavities and thickening of the walls) and the difficulty of pumping blood.
Echocardiogram, like ECG, is a simple and non-invasive exam.
EFFORT TEST
The exercise test is an evaluation of how an individual's heart works during a physical activity.
It provides that, during a very simple exercise test such as walking on a treadmill or pedaling on an exercise bike, some vital parameters are measured, such as heart rate, blood pressure and breathing.
BLOOD ANALYSIS
Blood tests can measure the levels of certain substances, which, if above the norm, could explain why the heart has become enlarged.
CARDIAC BIOPSY THROUGH CATHETERISM
Cardiac biopsy by catheterization takes place with a catheter which, inserted into an artery of the body and carried to the heart, allows the collection of a small piece of tissue.
It is an invasive and risk-free exam, however it offers the possibility of analyzing abnormal heart tissue in the laboratory.
Treatment
As anticipated, in order to cure the enlarged heart (or at least reduce the symptoms), it is necessary to know the causes.
Therefore, therapy depends on what is at the origin of the cardiac anomaly.
The therapeutic treatments currently available are pharmacological (for less severe cases) and medical-surgical (in the most serious cases).
PHARMACOLOGICAL THERAPY
Drug therapy is suitable for less severe cases of enlarged heart. It consists of the administration of one or more of the following drugs:
- Diuretics . By increasing daily diuresis, they promote the elimination of sodium present in the body and the lowering of blood pressure. They are particularly indicated in cases of enlarged heart due to hypertension and / or characterized by edema.
- ACE inhibitors (or angiotensin converting enzyme inhibitors) . They are used in cases of enlarged heart sustained by hypertension, as they are effective in lowering blood pressure. The most widely used ACE inhibitors are captopril, enalapril and lisinopril.
- Angiotensin receptor blockers (or sartans) . They have the same effects as ACE inhibitors, therefore they act against hypertension which is the basis of the enlarged heart.
- Digoxin . It is an ideal drug to increase the force of contraction of the myocardium and consequently improve the pump function of the heart. Digoxin is administered when the blood supply to tissues and organs is insufficient.
- Anticoagulants . As you can guess from the name, they are drugs that act against blood clotting. They are administered to dissolve or prevent the formation of blood clots. The presence of the latter, in fact, can cause a stroke or a heart attack.
- Beta-blockers . They are class II antiarrhythmic drugs, which are used to lower blood pressure (hypertension) and to slow down the heart rate, when it is high and beyond normal levels. One of the most widely used beta-blockers is metoprolol.
- Antiarrhythmics of other classes . In addition to beta-blockers (class II), there are sodium channel blockers (class I), potassium channel blockers (class III) and calcium channel blockers (class IV). Each class has slightly different characteristics, but in general they all have the goal of keeping the heart rate stable.
MEDICAL-SURGICAL THERAPY
If drug therapy is ineffective, or if the patient's condition with an enlarged heart worsens, a more marked and invasive medical-surgical intervention is required.
The possible treatments, in these cases, consist in the installation of a pacemaker or an implantable cardioverter defibrillator (ICD), in the valvular surgery, in the coronary bypass, in the insertion of a ventricular assistance device and, finally, in the heart transplant .
Installation of a pacemaker or implantable cardioverter defibrillator (ICD) . The pacemaker and the ICD are two small devices that, connected to the heart by different leads, monitor and maintain the contraction and the cardiac rhythm.
Figure: an implantable cardioverter defibrillator, or ICD
A pacemaker and an ICD last an average of 7/8 years, after which they must be replaced.
Valvular surgery . If at the origin of the enlarged heart there is an imperfection of the heart valves, it may be necessary to have surgery. Valvular surgery involves replacing the defective valve with a mechanical or biological valve.
Coronary bypass . Coronary bypass surgery is required when the coronary arteries of the heart present a partial or complete obstruction, which prevents the blood from properly oxygenating the myocardium. Its purpose is to "build" an artificial bridge (called a bypass), which bypasses the obstacle located at the level of the coronary arteries.
Insertion of a ventricular assist device . The ventricular assist device (VAD) is a mechanical implantable pump that replaces the heart when it is unable to perform its normal function. It is usually a temporary remedy, waiting for a "new" heart to be transplanted. The insertion of the VAD is particularly indicated in cases in which a severe heart failure has been added to the enlarged heart.
Heart transplant . Patients in the worst conditions may need a "new" heart from a compatible donor. Heart transplantation is a very complicated operation, which even when it is successful could lead to several complications, including rejection.
SOME USEFUL TIPS
In the case of an enlarged heart, it is essential to adopt a healthy lifestyle, ie not smoking, losing excess weight, limiting the salt taken with the diet, controlling blood glucose levels, maintaining blood pressure at normal levels, and exercising in accordance with prescribed by your doctor, moderate your alcohol intake, do not use drugs and, finally, sleep 7-8 hours per night.
Prevention
To prevent the enlarged heart, the best thing to do is to keep the factors that favor its appearance under control.
Therefore, it is good practice:
- List of the main risk factors of the enlarged heart:
- Hypertension
- Family history of an enlarged heart or dilated cardiomyopathy
- coronary
- Congenital heart diseases
- Heart valve dysfunctions
- Heart attack
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- Undergo periodic cardiological checks, if you belong to a family in which certain heart conditions occur, such as dilated cardiomyopathy. Only in this way, in fact, is it possible to identify (and cure) the enlarged heart at the beginning.
