An enlarged heart (cardiomegaly or a bovine heart) is characterized by an increase in the size of the heart chamber or myocardium. A similar pathological process is known as hypertrophy. Often, heart enlargement is a reaction to the stresses that affect the heart muscle. Initially, hypertrophy may be one of the stages of a compensatory reaction, but in fact it turns out to be somewhat harmful.
Cardiomegaly does not belong to independent diseases, since it mainly develops against the background of other pathological conditions such as obesity, hypertension, coronary heart disease.
Diagnosis of an enlarged heart is not difficult. More questions usually arise during treatment. The use of drugs very rarely can significantly improve the condition. Most often, drugs should be taken until the end of life in order to avoid serious complications.
Video: Big heart disease (cardiomegaly)
Cardiomegaly - what is it?
Normally, the size of the heart is individual for each. They depend on the complexion of a person, gender, age. It is believed that the size of the organ is approximately equal to the size of a palm clenched into a fist. Nevertheless, there are limits that separate the norm from pathology. An enlarged heart is called cardiomegaly. It can be detected both during a physical examination, and thanks to instrumental diagnostics. In most cases, the ventricle of the heart is enlarged, mainly the left. Less commonly, cardiomegaly occurs due to the right departments. An increase in the organ appears due to hypertrophy of the muscle layer, as well as due to myocardial stretching (dilatation). This phenomenon rarely occurs in a short time. Cardiomegaly is usually preceded by a prolonged chronic illness.
Causes of heart enlargement
There are several ways to enlarge the heart, which are often the process of ventricular hypertrophy and myocardial remodeling.
- High blood pressure and an enlarged heart.
The heart, as a rule, during pumping blood through the body must overcome the pressure created by the vascular system. With a normal blood pressure, this does not present special difficulties for the myocardium. If the blood pressure is high, the heart experiences a certain load. This has a stressful effect on the myocardium, which is struggling to do its job at this point.
If a person goes to the gym and lifts weights there, his muscles become larger in response to the load. This process is called hypertrophy.
The heart grows in the same way, only the problem that has arisen is associated with several consequences. Firstly, myocardial hypertrophy does not always return to normal size. Secondly, the disease fundamentally changes the architecture of the heart in such a way that it can lead to problems in the future, for example, to excessive relaxation and disruption of the affected muscle.
- Concentric Enlarged Heart
Heart enlargement is quite strongly associated with heart attacks. In particular, with a myocardial infarction, a certain part of the heart muscle may die. The affected area is depleted and then a scar forms. This increases the load on the affected area of the heart, which causes other parts of the myocardium to activate to compensate for the violation.
Redistribution of stress exposure leads to the fact that the heart grows in size, which takes some time. A similar process is called remodeling. Unfortunately, if this remodeling cannot be prevented to some extent, cardiac function decreases as a result. In the future, heart failure may occur.
- Congenital expansion of the heart
A certain genetic predisposition leads to the fact that the size of the heart exceeds the established normal values. The most classic example of this is hypertrophic cardiomyopathy, which often contributes to sudden death in athletes.
An enlarged heart of hypertrophic cardiomyopathy is a random arrangement of fibers that make up the heart muscle. Pathology can lead to fatal cardiac arrhythmias, as well as obstruct blood circulation in the heart itself. With hypertrophic cardiomyopathy, the thickness of the myocardium increases.
There is also congenital expansion of the heart, known as dilated cardiomyopathy. With this pathology, the walls of the heart become thin, while the dimensions of the heart chamber increase, and the pumping function of the heart can greatly decrease.
- Valve Disease and Enlarged Heart
Various diseases of the valvular apparatus of the heart lead to an enlargement of the heart, which was initially considered compensatory remodeling, and ultimately directly leads to heart failure if the disease is not treated.
With aortic stenosis, the valve through which blood passes to enter the aorta becomes dense, which increases pressure and stress on the walls of the heart chambers, known as pressure overload. The heart becomes enlarged, which allows it to compensate for some time arising violations.
A hypertrophied heart, although it contracts well, relaxes badly and can lead to heart failure. If the pathology is not treated in time, it can lead to a significant decrease in heart function and weakening of the myocardium.
With aortic regurgitation, the same valve passes blood back. In this case, another type of voltage develops, also known as volume overload. Aortic regurgitation is somewhat unique in that it combines pressure and volume overload, which directly leads to a stretching of the heart chamber, as well as an increase in the myocardium.
In mitral regurgitation, the mitral valve, which separates the upper and lower chambers of the left half of the heart, also “leaks”. A classic cause of this leak is mitral valve prolapse. With mitral regurgitation, the heart is under volumetric loading stress. The expansion of the organ occurs by increasing the size of the chamber and reducing its walls in a process known as eccentric hypertrophy. Unfortunately, if the heart enlarges too much with mitral regurgitation, even correction of the leak with surgery or endoscopic procedures such as Mitraclip is not able to improve cardiac function. After surgery, it will usually be reduced. Therefore, timely diagnosis of various forms of an enlarged heart and appropriate therapy of heart diseases is important.
- Right widened heart
Most often they talk about left-sided enlargement of the heart, however, it is also important to identify changes in the right half of the organ. This side of the heart is not able to cope with great pressure as intensively as the left side, therefore, under the influence of stress, it can increase rapidly and break off just as sharply.
Examples of causes of acute right-sided enlargement of the heart are as follows:
- Pulmonary embolism.
- Right-sided heart attack.
- Tricuspid valve insufficiency.
- High blood pressure in the arteries of the lungs, known as pulmonary hypertension.
Echocardiogram of a pulmonary embolism: a large clot is located on the right side of the heart, during its passage to the lungs, where a pulmonary embolism develops.
Enlarged heart: causes of pathology
Cardiomegaly can occur due to many reasons. It depends on the patient's age, hereditary predisposition, body weight and lifestyle. Sometimes an enlarged heart is considered a normal variant. In this case, cardiomegaly should be moderate. Such cases include constant physical activity, pregnancy, rarely adolescence. A significant increase in heart size in this category of people is also a pathology. The following causes of cardiomegaly are distinguished:
- Congenital malformations (CHD). They form during pregnancy, can be of various sizes. With large or combined defects, heart failure occurs quickly. In this case, cardiomegaly can manifest itself in the first months of a child's life. If the defects are minor, the enlargement of the heart occurs gradually, sometimes it does not occur at all.
- Inflammatory diseases. These include myo-, endo- and pericarditis. Most often, these pathologies occur in childhood and adolescence. Cardiomegaly is observed only in cases where the disease has become chronic. Also, dilated myopathy can be attributed to this group.
- Acquired heart defects. Formed in adulthood. Most often they are a consequence of rheumatism.
- Chronic cardiovascular disease. These include myocardial ischemia (heart attack, angina pectoris), arterial hypertension.
- Chronic lung disease. Among them - bronchial asthma, COPD.
- Pathologies of other organs and systems. An enlarged heart can be observed with severe anemia, renal and hepatic insufficiency, hyperthyroidism.
- Metabolic syndrome (obesity in combination with diabetes).
The mechanism of development of cardiomegaly
The pathogenesis of cardiomegaly depends on the cause. Most often, left ventricular hypertrophy occurs in people with metabolic syndrome, coronary artery disease, or arterial hypertension. With a small supply of oxygen, the heart muscle contracts more than usual, and gradually increases in size. About the same thing happens with hypertension. In this case, the heart does not have time to pump blood fast enough because of its high pressure, so the body needs more effort. The mechanism of development of cardiomegaly is different with stenosis and valve insufficiency. In the case of these pathologies, the blood does not completely enter the adjacent chamber or vessel (aorta, pulmonary artery) and causes stretching of one of the departments of the heart. With long-term defects, both the ventricle and the atrium increase. In some cases, hypertrophy of the entire organ may occur. Right ventricular failure occurs with pulmonary pathologies, liver diseases.
Enlarged heart - can it return to normal?
An enlarged heart, depending on the cause, may return to normal size if timely treatment has been performed. In many cases, however, this does not happen, and in this case, the goal of therapy is to quickly determine the cause and conduct treatment to stabilize the situation and prevent the further development of cardiomegaly.
Reversible causes include:
- Early stages of hypertension caused by high blood pressure.
- The early stages of significant congestive heart disease.
- The early stages of a heart attack and sudden weakness of the heart muscle, known as cardiomyopathies, can be associated with pregnancy, severe stress, or a viral infection.
The right side of the heart has a remarkable ability to recover from acute stress, so treatment of the underlying cause can contribute to complete recovery.
Video: Cardiomegaly, stretching of all cavities of the heart, rhythm disturbance DCMP
Symptoms with an enlarged heart
Symptoms of an enlarged heart can be expressed to varying degrees. With left ventricular hypertrophy, patients complain of shortness of breath. Attacks of lack of air occur during exercise, weight lifting, fast and long walking. With severe cardiomegaly, shortness of breath can also be at rest. In addition, some patients have edema syndrome. Most often, fluid accumulates on the lower third of the legs in the evening. If ischemia is the cause of heart failure, patients are concerned about pain in the heart region. Also, the clinical picture depends on the cause of cardiomegaly. With pulmonary pathologies, coughing, suffocation is added to the listed symptoms. Hepatic insufficiency is characterized by massive edema (ascites, anasarca), swelling of the cervical veins. Elderly people with an enlarged heart often have hypertension.
Treatment and recovery
Therapy of cardiomegaly will depend on the condition of the heart and associated diseases. Medical manipulation or surgery may be required if the disease is not controlled by drugs and lifestyle changes.
Medications can help reduce the severity of symptoms and in some cases help eliminate the causes, for example:
- Lower blood pressure.
- Prevent blood clots.
- Reduce the risk of heart attack or other complications.
- They increase the strength and effectiveness of heart contractions.
The doctor may recommend surgery or surgery if the above indications are available. Depending on this can be performed:
- Coronary artery bypass surgery - this operation improves blood circulation, eliminates chest pain and prevents the development of a heart attack with the help of sewn arteries or veins taken from other parts of the body. Such anastomosis allows you to bypass narrowed coronary arteries.
- Implantation of an auxiliary device to stimulate the work of the ventricles - with this device, the weak heart muscle contracts more efficiently.
- Heart Valve Surgery — An operation can be performed to reconstruct or replace with an artificial valve taken from a cow, pig, or human, or made from piece materials.
- A heart transplant operation is an extreme method for resolving issues with a sick heart, which cannot be restored by any means possible today.
The length of stay in the hospital depends on the surgical procedure.
- After coronary artery bypass grafting, the patient spends one to two days in the intensive care unit and another three to five days in another department before he can return home. Full recovery may take 6-12 weeks. Precisely, when a patient is allowed to be physically active again, including returning to work or resuming sexual activity, only a doctor can.
- Recovery after implantation of a ventricular stimulator depends on the general condition of the patient before surgery. Typically, the patient spends one to two days in the intensive care unit and another three to five days in another department before he can return home. Sometimes you have to gradually move home from the hospital, which involves staying at home throughout the day, but returning to the hospital in the evening. The doctor, as a rule, reports on the acceptable level of activity, which can be followed by participation, until the recovery process is completely over.
- After heart valve surgery, you usually have to spend one to two days in the intensive care unit and another three to five days in another department before you are allowed to return home. Full recovery may take 6-12 weeks. The doctor basically tells when the patient will be able to be physically active again.
- After a heart transplant, you need to spend several days in the intensive care unit and several weeks in another department before being allowed to return home. After discharge, you must be in close proximity to the hospital for the first six weeks in order to maintain the necessary visits and laboratory tests. When the opportunity arises, the doctor reports an acceptable level of physical activity, which can be maintained until a complete recovery of the body occurs.
Before leaving the hospital, the doctor or nurse will provide a follow-up plan, which is likely to include examinations and laboratory tests. It is important that medical examinations are conducted daily to reduce the risk of additional blockage of the arteries:
Recommendations useful for implementation:
- A diet low in fat, cholesterol, and salt should be practiced.
- Every day you need to perform exercises from exercise therapy.
- It is important to avoid the use of tobacco products and alcohol.
It is necessary to minimize stress.
- If there are risk factors such as high blood pressure and others, you should take medications prescribed by your doctor daily.
If the enlarged heart was not diagnosed in time and was not treated at an early stage of development, complications can occur, including:
- Thrombosis. Blood clots can weaken the heart and affect its ability to pump blood throughout the body. Если от тромба отрываются кусочки, тогда подобные эмболы распространяются с кровотоком и могут заблокировать кровеносный сосуд в любом участке тела. Остановка сердца или внезапная смерть, инсульт и легочная эмболия - все эти заболевания как раз связаны с тромбоэмболией.
- Heart failure. As the left ventricle increases, the risk of heart failure increases. With its development, the ventricles cease to contract normally and pump blood efficiently.
- Valve failure. Blood can flow in the opposite direction if the valves (most often the mitral and tricuspid) do not close tightly. The result is a characteristic sound called heart murmur. Although this may not be harmful, the doctor should regularly monitor the patient's condition.
How to diagnose cardiomegaly?
There is insufficient history to detect cardiomegaly. For this, it is necessary to palpate and percussion of the organ. When the heart is tapped, it becomes clear to the doctor whether its size corresponds to the norm or goes beyond its borders. In addition, an X-ray examination of the chest is performed. With cardiomegaly, the outline of the organ in the images is increased. To determine in which departments hypertrophy is observed, an ECG is performed. Thanks to this study, one can also find out about the cause of the disease (ischemia, lung pathology). Echocardiography (ultrasound of the heart) is considered the most accurate for diagnosis. It allows you to determine the thickness of the myocardium in each chamber, the size of the cavities, the presence of dilatation.
- Heart enlargement, or “bovine heart,” is a serious illness that, without treatment, is complicated by heart failure.
- The occurrence of an enlarged heart is most often associated with other diseases such as genetic disorders, hypertension, heart defects.
- Treatment of an enlarged heart is carried out according to the indications. In some cases, a drug exposure is sufficient, but there is a need for surgical intervention.
- After the operation, a recovery period should pass, which, depending on the severity of the disease, can be two or more weeks.
- Cardiomegaly is dangerous for its complications, as in severe cases, sudden death, valve insufficiency, etc. can occur.
Video: Hypertrophic cardiomyopathy. Big heart disease
2. "What Is an Enlarged Heart (Cardiomegaly)?". WebMD. 2019-01-30.
Enlarged Heart Treatment
When this symptom is identified, patients ask themselves what to do if the heart is enlarged. Treatment should be started only after a full examination and clarification of the reasons. If necessary, bronchodilator, antihypertensive, diuretic drugs are prescribed. In some cases, a combination of these agents is necessary. Regardless of the reason, it is important to take medications that affect the suppression of heart failure. These include the preparations "Coronal", "Propronalol", "Captopril", etc. In case of severe heart defects, surgical treatment is necessary. It is also prescribed for persistent ischemia and acute circulatory failure.
The diagnosis of “big heart” or “cardiomegaly” is often made, in Russia there are about 9.5 million people with this syndrome. This is due to the rapid spread of cardiovascular diseases and pathologies of the heart muscle.
At risk are, first of all, older people who have a history of related ailments.
If the heart is enlarged, there is a high probability of a long-term illness, which as a result will lead to chronic organ failure. The left ventricle is more often deformed, less often - the right. The reason is hypertrophy of the muscle walls or dilatation (resizing chambers).
This phenomenon is also characteristic of athletes experiencing regular physical activity. But in this case, the muscle does not lose elasticity, the dimensions change due to the intensity of blood pumping.
Such a diagnosis in sports practice means that treatment and observation in cardiology are necessary, weakening of the training regimen.
The syndrome has various appearances. Most often, it occurs in men aged 80-84 years.
- Pathologies of the cardiovascular system, including congenital heart failure.
- Chronic infectious and inflammatory processes in the tissues of the heart muscle (for example, pericarditis or rheumatism).
In athletes, the syndrome may not be detected for a long time, since it does not have bright independent symptoms. The diagnosis in 80% of cases is established by examination associated with other complaints.
Causes and symptoms
In more than 50% of cases, cardiomegaly is caused by hypertrophy of ventricular tissue, mainly on the one hand.
If both the left and right ventricles have thickened walls, the heart significantly increases in size. This phenomenon is more difficult to diagnose.
If both atria are dilated and the heart does not have the ability to function fully, surgery may be necessary.
The syndrome is caused not only by heart disease, but also by other physiological conditions. The load on this organ may be associated with the labor regime, improper lifestyle or a special condition of the body.
- Long-term use of antibiotics.
- Alcohol addiction.
- High performance sports mode.
- Diabetes mellitus and concomitant hypertension.
- Congenital or acquired heart disease.
- Asthma and obstructive pulmonary disease.
- Pathology of the liver, kidneys.
- Anemia 2 and 3 degrees.
- Hormonal cardiomyopathy.
- Coronary heart disease.
- Myocardial infarction.
These diseases do not always entail a diagnosis of the heart muscle, so this syndrome takes a chronic form and finds itself at an unexpected moment, often on fluorography.
Pathology does not have certain symptoms and is characterized by manifestations of the underlying disease. Most often, there is a sign of fatigue and lack of strength.
The pathology is indicated by:
- Shortness of breath with slight physical activity.
- Swelling, especially the ankles of the legs and hands.
- Heaviness in hypochondrium on inhalation on the right.
- Throbbing headache.
- Pain in the hypochondrium on the left.
- Pressure is above normal.
- Noise and ringing in the ears.
- Deaf cough without sputum.
- Weakness, fatigue.
- Ripples before the eyes.
Important! In 35% of cases, cases of asymptomatic cardiomegaly are diagnosed. Only a regular medical examination will be able to timely identify the problem, which after 55 years needs to be done once every 6 months.
Pathology in children
An enlarged heart is found in children while still in the womb. The disease is serious, but in many cases does not lead to death.
A phenomenon occurs due to an adverse effect on a woman during the formation of the cardiovascular system in the embryo.
This process begins at 3-6 weeks of pregnancy, when the mother often still does not know about her condition and does not limit herself to anything. Complete heart formation occurs in up to 12 weeks.
Causes of intrauterine cardiomegaly:
- X-ray and radioactive radiation.
- Infectious and viral diseases of a woman in the first trimester of pregnancy.
- Reception of antiepileptic, psychotropic drugs.
- Severe violation of diet (starvation, diet).
- Improper lifestyle (alcohol or drug use, smoking).
- Maternal inherited gene.
With such risks, diseases of the system of the heart and blood vessels of the fetus are formed. Most often, a defect occurs in the form of congenital heart failure (ANS), Epstein's disease.
With the development of anomalies in a child in half of the cases, its moderate course is observed. If there are concomitant chromosomal abnormalities, gene diseases, or hormonal causes, the prognosis of treatment is uncertain.
Symptoms of cardiomegaly in a child may occur in the first months of life or be absent altogether if the defect is minor. The prognosis of treatment in a newborn is favorable if there are no other cardiac pathologies.
If necessary, the newborn is saved by surgery. Modern medicine is able to provide perinatal and cardiological centers with the necessary equipment, so the baby is operated on already in the first week from birth.
Forecasts with timely diagnosis and treatment are favorable.
In children from 1 year old, large heart sizes are caused by congenital (not established at the time) or acquired malformation.
Signs of ailment in a child:
- Fast fatiguability.
- Bad dream.
- Chronic nervous tension with outbursts of aggression.
- Frequent mood swings.
Symptoms and treatment of a child of primary or school age are the same as in an adult patient. The chance to do without surgery is high.
Diagnosis and treatment
Diagnosis of the syndrome requires a study of the patient's history. Chronic diseases, the causes of recent hospitalizations, medical extracts, test data, etc. are being studied. Including, the appointment of a hardware examination on special equipment is underway.
- Listening and heart rate monitoring.
- Blood test for biochemistry.
- Biopsy study.
- Chest x-ray. It is on x-rays that the boundaries of the expansion of the contours of the organ are clearly visible.
- ECHO KG, because the examination is noticeable when the heart muscle has signs of necrosis or ischemic pathology.
- Computed tomography or MRI will show an increase in organ volume.
- It is necessary to study the hormonal background, the mode of work, attitude to sport and the general condition of the body, because often a harmful lifestyle affects the course of the disease.
- Diuretic drugs to remove fluid stagnation.
- Antithrombotic drugs that affect blood coagulation, acting against the formation of plaques and blood clots in blood vessels.
- “Heart” pills (captopril, for example).
- Valve prosthetics, if there is a pathology.
- Installation of a pacemaker.
- Antihypertensive drugs for hypertension.
- Hormonal drugs.
Surgical intervention is prescribed in emergency cases when severe consequences are predicted, in particular, the diagnosis of a bull’s heart. To correct the situation, a transplant is needed, the operation is expensive and requires a donor organ.
In the complex of treatment, a cardiologist prescribes compliance with the correct diet, labor and rest. Together with drug treatment, this tactic gives a high result.
- Minimize salt and sugar in your diet.
- Exclude fatty, fried and spicy.
- Stop smoking and alcohol.
- Walk 30 minutes a day.
- Measure blood pressure regularly.
- Perform special gymnastics.
Only timely diagnosis increases the chances of effective treatment. Methods for detecting the syndrome are offered by every budget clinic. This makes it possible to carry out the necessary examinations free of charge and at any time.
The symptom of a large heart does not go away completely, but if treatment is started on time, as a result, the organ begins to decrease in size. This is due to the extinction of the activity of the underlying disease. With improper therapy or lack of treatment, the risk of complications is high.
- Myocardial infarction.
- Rupture of large vessels.
- Defects of the vascular trunks.
- Insufficient cerebral blood flow.
- Atherosclerosis, etc.
Pulmonary thromboembolism is on the 3rd place in the number of deaths. Most often, the diagnosis occurs in patients if the heart is enlarged across (stretching across the organ due to stagnation of blood).
The result can be a fatal outcome - cardiac arrest or the termination of the full functioning of blood vessels, etc.
An organ that is rapidly growing will take on a critical size, and only the operation can save it. But its cost and difficulties in finding an organ for transplantation hinder the timely rescue of the patient.
According to statistics, the likelihood of the syndrome increasing at the age of 55 years. An elderly person has a higher risk, because it directly depends on the course of diseases of the cardiovascular system.
It is necessary to undergo a routine examination at least 1 time per year: UAC, radiography, cardiogram, etc. In case of suspicious symptoms, you need to see a doctor, because procrastination threatens with a dangerous outcome.
Enlarged heart: the effects of the disease
Unfortunately, heart failure rarely goes away completely, as it is a chronic progressive disease. With inadequate therapy or its absence, the consequences can be serious. In the case of severe cardiomegaly, the patient constantly does not have enough air, as a result of which all organs suffer. Also, the disease can lead to myocardial infarction, stroke, thromboembolism of the heart or pulmonary vessels.