Picture 1 – Cardiomegaly
Source – www.moondragon.org
For those who are inquisitive to know as to what is cardiomegaly, one may define cardiomegaly as a condition characterized by the enlargement of the heart that is caused by many an underlying causes or diseases. In fact, in case of cardiomegaly, the heart enlarges in a cardiothoracic ratio of over 0.50. The cardiothoracic ratio is the ratio of the size of the heart to the area within the rib cage. It basically affects the ability of the heart to pump in oxygenated blood to the entire body. And cardiomegaly in children is usually mild than those affecting adults.
The symptoms of cardiomegaly depend on the cause and the severity of the condition. In case of mild or moderate cardiomegaly, one may not exhibit any symptoms or even if one does, it may be of a very mild nature. However, cases of acute or chronic cardiomegaly may show severe signs.
Patients suffering from cardiomegaly usually suffer from pesky cough. But more chronic ones exhibit other serious symptoms.
Shortness of breath is the most common symptom of cardiomegaly. One may also suffer from highly fluctuating pulse rate, dizziness and other associated problems such as heart palpitations, arrhythmia, caused due to underlying heart problems. This shortness of breath causes one to faint quite often. Chest pain is also a severe symptom of cardiomegaly.
People suffering from cardiomegaly also exhibit edema, i.e., the swelling of the limbs. One may also suffer from tenderness in the upper right quadrant.
Fluids may also form and accumulate in the abdominal cavity in case of this condition. This condition is known as Ascites. Severe cardiomegaly may lead to cardiac arrest leading to death.
The causes of cardiomegaly depend on the underlying diseases and disorders that one may suffer from. It is mostly caused either due to dilation or due to ventricular hypertrophy. The etiology of cardiomegaly may be explained as under:-
When dilation is the cause of cardiomegaly, it is called as Dilated Cardiomegaly (DCM) or Congestive Cardiomyopathy. In this case, the heart becomes weak and enlarged and is unable to pump the oxygenated blood to the body. It is more common in men than in women. Cardiomegaly in children is a result of this problem.
Left Ventricular Hypertrophy
The thickening of the heart muscles in the left ventricle causes cardiomegaly. It is the result of airway blockage triggered by aerobic exercise. However, the cardiomegaly caused due to left ventricular hypertrophy is temporary in nature. The abbreviation for this cause is LVH.
Right Ventricular Hypertrophy
As against the previous one, this is a condition wherein the right ventricle of the heart is affected. The thickening of the right ventricular muscles decreases the circulation of the blood to the lungs. Due to this, the heart enlarges unnaturally.
Left Atrial Hypertrophy
Cardiomegaly may also be caused in case of the enlargement of the left atrial area of the heart. Along with cardiomegaly, it may also aggravate to cause irregular heartbeat and heart attack, stenosis, systemic hypertension.
High blood pressure is caused when the heart finds it difficult to pump blood to the entire body. This results due to the thickening of the heart muscles and leads to hypertensive cardiomegaly.
Valvular Heart Disease
Conditions and diseases such as connective tissue disorders, rheumatic fever, endocarditis, and other heart problems caused due to cancer related medications and therapies usually lead to valve related problems which make the circulation of blood difficult. Along similar lines, the leakage, the narrowing or the prolapse of the valves causes the heart to enlarge and thereby leads to other complications.
Disorders associated with the thyroid glands, like hyperthyroidism and hypothyroidism may be cited as one of the prime reasons for causing cardiomegaly.
The lack or the insufficient presence of Red Blood Cells (RBCs) in the blood may be highly responsible for causing cardiomegaly. This exerts pressure on the heart to beat at a fast pace so as to compensate for the loss of adequate oxygen to the tissues. But this has the unfortunate consequence of enlarging the heart and thereby giving rise to other problems associated with the same.
This is a condition that occurs due to the improper metabolism of iron in the body, which leads to the accumulation of excess amount of iron in the various body organs such as liver and the kidneys. This leads the heart muscles to weaken and causes an enlargement of the left ventricle of the heart.
Morquio Syndrome, also known as Mucopolysaccharidosis IV is a kind of rare dwarfism that has severe repercussions on the health of a person. It owes its name to complex polysaccharides, called mucopolysaccharides which in case of dwarfism cannot be properly processed and cause cardiomegaly.
The accumulation of amyloids, which are abnormal or excess proteins, in the heart leads to an enlargement of the same and puts forth hurdles before the normal functioning of the heart.
The other causes of cardiomegaly include side-effects of medications prescribed for dealing with other underlying diseases or disorders, toxication of blood due to alcoholism and drug abuse, infections and deficiency of nutrients. Among these, alcoholism and nutritional deficiency causes borderline cardiomegaly or globular cardiomegaly. Congenital heart disease may lead to cardiomegaly in infants or newborn.
And cardiomegaly with cephalization of the vessels may aggravate to cause severe cardiomegaly. Cardiomegaly may also occur on a temporary basis in case of pregnancy. Besides these causes, rigorous physical exercise may also contribute to enlargement of the heart which is problematic for a normal person but common among athletes.
The diagnosis of cardiomegaly must be done properly for the significance of the organ involved in this condition.
The first method is to physically examine the symptoms of the problem. It also entails one to get one’s blood tested for the presence of excess iron or other substances such as foreign elements which may trigger heart problems.
But for the purpose of realism and the proper detection of the problem, the doctors advise patients to have a cardiomegaly x-ray done. An x-ray of the chest helps one to detect any kind of enlargement of the heart.
For confirming the cause of the condition, one has to undergo an electrocardiogram, which records the electrical activities and impulses of the heart and detects arrhythmia, and other causes of heart disease.
Similarly, an echocardiogram produces an image of the heart to detect an enlargement and helps in providing clue for the same which may actually be triggered by cephalization of the vessels, irregular pumping of the heart, cardiac arrest and even congenital heart ailments.
CT scan or MRI
A cardiac CT scan helps in gathering images of the heart, lungs and the chest and helps in detecting cardiomegaly. When a CT scan proves not much efficient, one may have to go for a cardiac MRI, which may provide a better diagnosis of the ailment.
Cardiac Catheterization & Biopsy
The insertion of a catheter into the groin may help in providing a biopsy of the heart. This test helps in analysing the pressure by which blood flows inside the chambers of the heart. It detects any kind of arterial blockage which may have triggered cardiomegaly.
Also known as an exercise test, it gives an idea of the condition of the heart during any kind of strenuous physical activity. It records the rhythm of the heart, blood pressure and pulse rate so as to detect any kind of cardiac problem.
In short, the diagnosis of cardiomegaly or for that matter any disease or disorder helps one to directly observe changes, record and analyse cardiomegaly pathophysiology.
The objective in the treatment of cardiomegaly is to correct the underlying cause and it depends on whether one suffers from mild or slight cardiomegaly or severe cardiomegaly. The treatment for cardiomegaly includes medications and surgeries.
Diuretics are the first choice of doctors for treating cardiomegaly. Diuretics such as spironolactone (Aldactone), furosemide (Lasix) help in reducing the amount of sodium and water in the body, thereby lowering the arterial pressure within the heart that may be a cause for cardiomegaly.
Angiotensin-converting enzyme inhibitors such as ramipril (Altace), lisinopril (Zestril), captopril (Capotein), and enalapril (vasotec) help in reducing the blood pressure and improving the pumping capacity of the heart.
For those who cannot bear the side-effects of ACE Inhibitors, Angiotensin Receptor Blockers like valsartan (Diovan), and losartan (Cozaar) are prescribed.
Blockers such as metoprolol (Lopressor) and carvedilol (Coreg) improve the function of the heart and aids in lowering the blood pressure.
This drug helps in improving the function of the heart to pump in and out more blood and lessens the probability of getting hospitalized.
Warfarin (Coumadin) is an anticoagulant that reduces the clotting of blood, thereby preventing stroke and cardiac arrest.
Medical Devices & Surgeries
The treatment of cardiomegaly may also include the implantation of a pacemaker which helps the contraction between the ventricles of the heart. This is done in cases wherein cardiomegaly is caused due to dilation.
Another device which may be implanted is Left Ventricular Assist Device (LVAD), which assists in improving the hearts capability to pump blood.
Cardiomegaly caused due to arrhythmia may be dealt with a surgery for an Implantable Cardioverter Defibrillator (ICD) that may be placed within the chest which deals with high pulse rate by giving electric shocks to the heart.
One suffering from valve problems may have to undergo a heart valve surgery in which case the removal of a narrow valve is substituted with a valve from a human, or an animal or an artificial valve. It is also undertaken in case of valve regurgitation.
When a person suffers from cardiomegaly caused due to atrial fibrillation, one has to undergo a surgery that shall regulate heart rhythm and cause stability in the pace of heart beat.
When all these procedures and treatment fail, one may have to undergo a heart transplant. This is the last resort for the treatment of cardiomegaly.
However, the treatment of cardiomegaly must be accompanied with various preventive measures and lifestyle changes such as controlling diabetes and blood pressure, reducing or even giving up smoking and the consumption of alcohol. It must also be corroborated with a low-salt diet and sufficient amount of sleep and physical exercise. The prognosis of cardiomegaly also depends on the underlying cause of cardiomegaly. All these measures if undertaken and followed in a sincere way may help one to avert the dangers associated with cardiomegaly.