Enlarged heart

To diagnose an enlarged heart, a health care provider will usually do a physical exam and ask questions about your symptoms and medical history.

Tests that may be done to help diagnose an enlarged heart (cardiomyopathy) and its cause include:

• Blood tests. Blood tests may help confirm or rule out conditions that can cause heart enlargement. If an enlarged heart occurs with chest pain or other signs of a heart attack, blood tests may be done to check the levels of substances in the blood caused by heart muscle damage.
• Chest X-ray. A chest X-ray can help show the condition of the lungs and heart. If the heart is enlarged on an X-ray, other tests will usually be needed to determine whether the enlargement is real and to find the cause.
• Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the test results. An electrocardiogram (ECG) can show if the heart is beating too fast or too slow. A health care provider can look at signal patterns for signs of a thickened heart muscle (hypertrophy).
• Echocardiogram. This noninvasive test uses sound waves to create images of the heart's size, structure and motion. An echocardiogram shows blood flow through the heart chambers and helps determine how well the heart is working.
• Exercise tests or stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. Exercise tests help reveal how the heart responds to physical activity. If you're unable to exercise, you might be given medications that mimic the effect of exercise on your heart.

• Cardiac computed tomography (CT) scan or Magnetic resonance imaging (MRI). During a cardiac CT scan, you usually lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.

  In a cardiac MRI, you typically lie on a table inside a long tubelike machine that uses a magnetic field and radio waves to produce signals that create images of your heart.

• Cardiac catheterization. A health care provider threads a thin tube (catheter) through a blood vessel in the arm or groin to an artery in the heart and injects dye through the catheter. This makes the heart arteries show up more clearly on an X-ray. During a cardiac catheterization, pressure within the chambers of the heart can be measured to see how forcefully blood pumps through the heart. Sometimes a small piece of heart tissue is removed for examination (biopsy).

Treatment of an enlarged heart (cardiomegaly) depends on what is causing the heart problem.

Medications

If cardiomyopathy or another type of heart condition is the cause of an enlarged heart, a health care provider may recommend medications, including:

• Diuretics. These drugs reduce the amount of sodium and water in the body, which can help lower blood pressure.
• Other blood pressure drugs. Beta blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) may be used to lower blood pressure and improve heart function.
• Blood thinners. Blood-thinning medications (anticoagulants) may be given to reduce the risk of blood clots that could cause a heart attack or stroke.
• Heart rhythm drugs. Also called anti-arrhythmics, these medications help control the heartbeat.

Surgery or other procedures

If medications aren't enough to treat an enlarged heart, medical devices and surgery may be needed.

Surgery or other procedures to treat an enlarged heart may include:

• Pacemaker. A pacemaker is a small device that's usually implanted near the collarbone. One or more electrode-tipped wires run from the pacemaker through the blood vessels to the inner heart. If the heart rate is too slow or if it stops, the pacemaker sends out electrical impulses that stimulate the heart to beat at a steady rate.
• Implantable cardioverter-defibrillator (ICD). If the enlarged heart is causing serious heart rhythm problems (arrhythmias) or you're at risk of sudden death, a surgeon may implant an implantable cardioverter-defibrillator (ICD). An ICD is a battery-powered unit that's placed under the skin near the collarbone — similar to a pacemaker. One or more electrode-tipped wires from the ICD run through veins to the heart. The ICD continuously monitors the heart rhythm. If the ICD detects an irregular heartbeat, it sends out low- or high-energy shocks to reset the heart rhythm.
• Heart valve surgery. If an enlarged heart is caused by heart valve disease, surgery may be needed to repair or replace the affected valve.
• Coronary bypass surgery. If an enlarged heart is due to a blockage in the coronary arteries, this open-heart surgery may be done to reroute blood flow around a clogged artery.
• Left ventricular assist device (LVAD). If you have heart failure, your health care provider may recommend this implantable mechanical pump to help your heart pump. You may have an left ventricular assist device (LVAD) implanted while you wait for a heart transplant or, if you're not a candidate for heart transplant, as a long-term treatment for heart failure.
• Heart transplant. A heart transplant is the final treatment option for an enlarged heart that can't be treated in any other way. Because of the shortage of donor hearts, even people who are critically ill may have a long wait before having a heart transplant.

If you have an enlarged heart or any type of heart disease, your health care provider will likely recommend following a heart-healthy lifestyle. Such a lifestyle typically includes:

• Reducing or avoiding salt
• Limiting saturated and trans fats
• Eating plenty of vegetables, fruits and whole grain foods
• Avoiding or limiting alcohol and caffeine
• Exercising regularly and managing weight
• Controlling heart disease risk factors, including diabetes, high cholesterol and high blood pressure

If you think you may have an enlarged heart or are worried about your heart disease risk because of your family history, make an appointment with your health care provider. You may be referred to doctor trained in heart diseases (cardiologist).

Here's some information to help you prepare for your appointment.

What you can do

• Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet or fast before tests.
• Write down your symptoms,, including ones that may seem unrelated to an enlarged heart or heart disease.
• Write down key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements you're taking, including doses.
• Take a family member or friend along, if possible. Someone who goes with you may remember something you missed or forgot.
• Write down questions to ask your health care provider.

Making a list of questions will help you make the most of your time with your health care provider. For an enlarged heart or heart disease, some basic questions to ask your health care provider include:

• What is likely causing my symptoms or condition?
• What are other possible causes for my symptoms or condition?
• What tests do I need?
• What's the best treatment?
• What foods should I eat or avoid?
• What's an appropriate level of physical activity?
• Are there restrictions I should follow?
• How often should I be screened for heart disease? For example, how often do I need a cholesterol test?
• I have other health conditions. How can I best manage them together?
• Should I see a specialist?
• Should my children be screened for this condition?
• Is there a generic alternative to the medicine you're prescribing?
• Are there brochures or other printed materials I can take? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask you questions, including:

• When did your symptoms begin?
• Do you always have symptoms or do they come and go?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, makes your symptoms worse?
• What is your typical diet?
• Do you drink alcohol? How much?
• Do you smoke?
• How often do you exercise?
• Have you been diagnosed with other health conditions?
• Do you have a family history of heart disease?