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Home / Heart Disease / Enlarged Heart – Explained By A Cardiologist
enlarged heart

Enlarged Heart – Explained By A Cardiologist

May 14, 2018 by Dr. Mustafa Ahmed 43 Comments

What is Enlarged Heart? Enlarged heart refers to enlargement of either the heart chamber size or the heart muscle size in a process known as hypertrophy. Often this enlarged heart occurs as a response to stresses faced within the heart and although initially may be a form of compensatory response it often ultimately turns out to be somewhat harmful. In this article we will review the various forms of enlarged heart, and discuss evaluation and treatment of these.

Why Does Enlarged Heart Happen?

Lets go through a bunch of scenarios here to help understand enlarged heart and the process of ventricular hypertrophy, remodeling, and why it happens.

High Blood pressure and Enlarged Heart – The heart usually pumps in to the body against the blood pressure in the body, and at a normal blood pressure level it is designed to handle this well. Now if that blood pressure is very elevated, the heart has to pump against this. This increases well stress on the wall of the heart muscle that is struggling to do its job at this point. The heart at this point needs to respond. If you go to the gym and lift weights, your muscles get bigger as a response to the weight and enlarge, its called hypertrophy. The heart enlarges in the same way; ultimately it’s about minimizing stress. The problem with the heart enlarging here however is that firstly it doesn’t always regress to normal size when the stress is minimized, and secondly it fundamentally alters the hearts architecture in a way that can lead to problems down the road such as problems relaxing and failure of the muscle itself.

concentric enlarged heart

concentric enlarged heart

Heart Attacks and Enlarged Heart – In a heart attack a certain part of the heart muscle may often die and become thinned out and form a scar. This increases stress on that area of the heart and forces the other areas of the heart to become more active to compensate. This redistribution of wall stress leads the heart to enlarge over time in a process called remodeling. Unfortunately unless this remodeling can be somewhat prevented the heart function will drop as a result and heart failure may ensue.

Genetically Enlarged Heart – Certain genetic conditions lead to the heart to grow to where it becomes a clearly enlarged heart, often in distinct patterns. The most classic example of this is hypertrophic cardiomyopathy, the kind that often leads to sudden death in athletes. The enlarged heart of hypertrophic cardiomyopathy involves disarray of the fibers that make up the heart muscle and can lead to lethal heart arrhythmias as well as obstructing blood flow out of the heart. In hypertrophic cardiomyopathy the heart is very thick. There is also a genetic component to an enlarged heart known as dilated cardiomyopathy. This is different in that the walls of the heart are thin and the heart chamber sizes enlarge while the heart pumping function can severely diminish.

Valve Disease and Enlarged Heart – Different heart valve diseases lead to different types of heart enlargement which although initially felt to be compensatory remodeling ultimately lead to heart failure if left untreated. In aortic stenosis, the valve through which blood has to go through to leave the heart becomes tight, increasing pressure and stress on the wall of the heart known as pressure overload. The heart becomes thick to compensate in a form of enlarged heart called concentric hypertrophy. The thick heart, although pumps well, does not relax well and that can lead to heart failure, and if not treated in time can lead to severely reduced heart function and weak muscle. In aortic regurgitation, that same valve is leaky and there is a different type of stress in addition known as volume overload. Aortic regurgitation is somewhat unique in that there is pressure and volume overload leading to both enlarged heart chambers and thick heart muscle.

aortic regurgitation animal valve

aortic regurgitation animal valve

In mitral regurgitation the mitral valve that separates the upper and lower chambers of the left heart is leaky. A classic cause for this leak is mitral valve prolapse. In mitral regurgitation the heart is placed under a volume overload stress and the heart enlarges by increased chamber size and often-thinner walls in a process known as eccentric hypertrophy. Unfortunately if the heart is to get too enlarged in mitral regurgitation even correction of the leak with surgery or interventional procedures such as the Mitraclip will not improve the heart function that will often be reduced after surgery. It’s critical therefore to understand and recognize the various forms of heart enlargement and patterns of change when managing heart disease.

Right-Sided Enlarged Heart

We most commonly talk about left sided enlarged heart however it is important to identify right-sided heart enlargement also. The right side of the heart is not able to cope with large pressures in the same way the left side does, so in periods of stress it may enlarge and fail immediately. Examples of causes of acute right-sided heart enlargement include pulmonary embolism clot in the lungs or a right-sided heart attack. Other important causes include holes in the heart, leaky tricuspid valve, or increased pressures in the lung arteries known as pulmonary hypertension.

echocardiogram of pulmonary embolism

A large amount of clot is seen floating in the right side of the heart as it passes through on its way to the lung where is will result in a pulmonary embolism.

Enlarged Heart – Can It Return To Normal?

Below we will discuss some of the treatments for enlarged heart. Enlarged heart, depending on the cause may return to normal size if appropriate and timely treatment is given. In many cases it will not however, in which case the goal is prompt recognition and treatment to stabilize the situation and prevent further enlargement. Reversible causes include early stages of hypertensive heart caused by high blood pressure, early stages of significant valvular heart disease, early stages of a heart attack, and sudden onset weaknesses of the heart muscle known as cardiomyopathies that may include pregnancy related, stress related or viral. The right side of the heart has a remarkable ability to bounce back from acute strain and treatment of the underlying cause may often lead to resolution of the enlargement completely.

Treatment of Enlarged Heart

Treatment of enlarged heart depends on the underlying cause. Above we have talked about many of the causes, however there are many other causes which we do not exactly know the cause of. In enlarged heart of high blood pressure, meticulous blood pressure control is key and can certainly lead to regression of the enlargement to varying degrees. In a heart attack and other cardiomyopathies, the process of remodeling can be somewhat attenuated by taking medicines such as ACE-Inhibitors and beta-blockers that can lead to improvement of heart function and regression of enlargement. In valve disease, treatment at the appropriate time, prior the onset of full-fledged failure, can often lead to regression of heart enlargement. Important to recognize however is that not only can the appropriate treatment prevent or improve enlargement, it may save lives.

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Comments

  1. Bhupinder kumar says

    February 10, 2019 at 4:12 pm

    Which medicine, can a heart in normal size from enlarge heart?

    Reply
    • Dr. Mustafa Ahmed says

      February 14, 2019 at 5:32 am

      Several medicines can help depending on the underlying cause.

      you can follow our twitter at @MustafaAhmedMD

      Reply
      • Cecel ambida says

        December 14, 2021 at 10:45 am

        Sir im suffering from enlarge heart and my medication for life is sumapen, degoxin, aldactone, warfaren and lasix. However i stop my warfaren because for the reason that my mucus have blood so i stop it. And sometimes cant even buy my meducine due to financial matter. I realy wanted to get heal sir. Pls help me what should i do. Im suffering too much, cant even breath properly. Pls help me

        Reply
    • Narayana says

      January 3, 2021 at 9:32 am

      Heart.enlarge.treatment.give sum.suggestion

      Reply
    • Milan Ilic says

      April 15, 2021 at 4:21 pm

      Can a low resting heart rate of around 45-50bpm and a low blood pressure 90/60 together with an enlarged heart in a 42 year old female patient predict further complications and what course of action should you recommend? Many thanks

      Reply
  2. Sheila Costello says

    March 9, 2019 at 3:50 am

    My Father had large heart 1982 . His lungs was full of water. Is this a family history. I have high blood pressure and on blood thinner. This is Family history of large heart. I’m 67. female
    Hope to hear from you.

    Reply
  3. Edwina says

    March 21, 2019 at 11:04 am

    I have just been told i have an enlarged heart. My blood pressure is normal. I dont smoke. I am worried.

    Reply
    • Dr. Mustafa Ahmed says

      March 26, 2019 at 6:48 am

      Were you given any specifics of the enlargement?

      Please follow our Twitter at @MustafaAhmedMD

      Reply
      • Shirley Williams says

        March 12, 2020 at 4:29 pm

        i just found out my heart is a bit large ,what does it mean? im nearly 62 ,and i was hoping to live a few more years im still young lol .doctor recons its not serious hum .

        Reply
        • Dr. Mustafa Ahmed says

          April 12, 2020 at 9:47 pm

          Did they provide specifics?

          You can follow our twitter at @MustafaAhmedMD

          Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.

          Reply
        • David Ayoub says

          March 26, 2021 at 2:18 pm

          Hi Doctor, I have been told I have borderline enlarged heart. Nurse explained it’s from high blood pressure but my blood pressure has been good since I take high blood pressure medication. She insisted that I not worry and just need to make sure my blood pressure remains good. I just wanted to get your opinion. I worry a lot. Thank you.

          Reply
          • Dr. Mustafa Ahmed says

            April 25, 2021 at 12:15 pm

            How was that diagnosed?

            You can follow our twitter at @MustafaAhmedMD

            Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.

      • Teresa mcclain says

        March 14, 2020 at 6:34 pm

        My mom has a enlarged heart. She has had 1 heartattack .But several stents put in. She had her heart attack back in the 90s. She is 80 years old in very bad health

        Reply
    • KL says

      June 19, 2019 at 10:29 pm

      I was diagnosed with borderline prominence of heart size with no significant abnormality. I was told to lose 40lbs due to me being overweight. My blood work came back remarkable no cholesterol issues, diabetes or high blood pressure. Can that diagnoses be reversed?

      Reply
    • D MM says

      July 4, 2019 at 12:54 pm

      Don’t be worried I am 46 yrs old and I am awaiting my test
      From the Cardiologist my answer to you,is stay positive keep talking to your doctor read up more about your problem and spend as much time with loved ones,relax go out and enjoy life it’s stress & worrying makes us sicker tell your self from today I am going to embrace life and b grateful for all that I have and just move on with your life
      .go to farms,go to the beach,swimming pool,and the park anywhere that is relaxing now I am learning to have fun,you have this life live in the present it’s all you have.

      Reply
  4. Tommy says

    March 30, 2019 at 1:12 am

    Hello, my father has an enlarged heart. He has high blood pressure and his were also filled with liquids. As a result of liquid in his lungs, his right leg is swollen and has an inflated stomach, for a lack of a better description. Is there anyway for him to decrease his heart through surgery, since his doctor recommended?

    Reply
    • Dr. Mustafa Ahmed says

      April 7, 2019 at 6:25 am

      Depends on the cause. Have any investigations been done?

      follow our twitter at @MustafaAhmedMD

      Reply
      • Cecel ambida says

        December 14, 2021 at 10:48 am

        Sir im just 32 years old but im suffering enlarge heart. Pls help me

        Reply
  5. Rene says

    May 14, 2019 at 7:06 pm

    My stepfather has just been told his heart is quite enlarged. He has had 2 or 3 strokes in the last 3-5 years due to not taking his blood pressure medicine. Recently his legs have been very swollen and weeping a bit. My mom took him to the Dr and he was told by the internist he has an enlarged heart from the X ray. Next she is taking him to a cardiologist. I’m not sure what to expect and am worried.

    Reply
    • Rene' says

      May 14, 2019 at 8:32 pm

      Cardiologist told him he has Grade 1 Diastolic Disfunction. I’ll have to find out what that means.

      Reply
    • Dr. Mustafa Ahmed says

      May 20, 2019 at 3:09 am

      The signs and symptoms may suggest heart failure, maybe from long standing high blood pressure or other reasons. Don’t worry, the important thing is that this is being looked in to. They will likely start with an echocardiogram to evaluate the structure and function of the heart, and address risk factors for heart disease. There may also be some form of stress testing involved to evaluate the blood supply to the heart.

      You can follow our twitter at @MustafaAhmedMD

      Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.

      Reply
  6. Robert Dawkins says

    May 17, 2019 at 5:03 pm

    I was told that I had a slightly in large heart after a echocardiogram. I was told just to continue to take my blood pressure medication which I have only been on approximately three weeks. Originally my blood pressure was moderately high. So is there anything else that I need to do other than diet and exercise? They were very vague.

    Reply
    • Dr. Mustafa Ahmed says

      May 19, 2019 at 5:33 am

      It depends on the type and pattern of enlargement. In many cases blood pressure is felt to be the driving cause and so that is the focus of treatment however all around risk factor modification is advised which can be summarized as attention to risk factors and lifestyle in general.

      You can follow our twitter at @MustafaAhmedMD

      Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.

      Reply
  7. Kathryn says

    May 20, 2019 at 3:34 pm

    I have been told my chest x-ray has said I have enlarged hear muscle .What does this mean ,please

    Reply
    • Dr. Mustafa Ahmed says

      July 5, 2019 at 3:31 am

      It means you may have findings on the x-ray that may suggest an enlarged heart however that is not conclusive, further tests such as an echocardiogram would be needed to see if this was truly the case.

      You can follow our twitter at @MustafaAhmedMD

      Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.

      Reply
    • Jeff says

      December 5, 2020 at 4:33 pm

      Ok hello I need help I’ve Been having anxiety for the past 1 year,and I’ve just been told by my cardiologist that I’ve a large heart but it’s not causing any obstruction and it’s working perfectly fine But he said I need to do an MRI scan to be sure,what does this means pls.this has definitely increase my anxiety I am freaking out

      Reply
  8. Dan says

    June 2, 2019 at 12:56 pm

    Hi Mustafa, excellent article was very easy to read and informative, I am writing as I have had a heart problem for around 2years since I was 28yo that was brought on by a bad reaction to a recreational drug which I believe caused a heart attack, and have been looking for answers since, it is primarily a very heavy heartbeat which has severely affected my sleep as well as causing fatigue and chest pains.
    My tests haven’t yet shown any conclusive evidence of visible damage though I have done some reading into possible causes and narrowed it down to the following possibilities.
    Aortic Valve Regurgitation?
    Mitral Valve Regurgitation
    Prolapse or Flail from Ruptured Chordae?
    Myocardial Rupture, Laceration of Ventricles or Atria or of Interatrial or Interventricular Septum or Papillary Muscles?
    Venticular Hypertrophy?
    I know this is a long list of possible causes though I am wondering from your experience what kinds of damage even if minor could cause these type of symptoms?

    Reply
  9. KL says

    June 19, 2019 at 10:25 pm

    I was diagnosed with borderline prominence of heart size with no significant abnormality. I was told to lose 40lbs due to me being overweight. My blood work came back remarkable no cholesterol issues, diabetes or high blood pressure. Can that diagnoses be reversed?

    Reply
  10. Pratik Patel says

    June 30, 2019 at 7:07 pm

    My 2.5 years old daughter diagnosed with dilated cardiomyopathy having 25-30% LVEF. Please tell me if she can be normal as before or not? What’s your observation in such cases.

    Reply
  11. Mohammad hassan kashif says

    October 18, 2019 at 12:58 pm

    Assalam o alikum..
    My baby is dcmp patient when he was only of four months..
    His EF figure only varied from 21 to 29 %
    N marked LV dilatation and dysfunction and Mild MR and TR..
    Symptoms are controlled but medicine still are not reaponding as it should be ..
    He is now of 8 months..
    How much critical this is for him??
    Is it threatening to his life ???
    Is it possible that all these abnormalities goes away as they came suddenly due to viral infection..?

    Reply
  12. Nicole Peers says

    November 4, 2019 at 6:01 pm

    I was diagnosed with an mildly enlarged heart. No high blood pressure, no high cholesterol, no diabetes. lungs filled with fluid and legs would swell easily when standing. They left it at that and told me to quit smoking, exercise and lose weight…I did.

    Things are stable, my lungs feel great, and my edema is non existent.

    I still have high inflammation markers tho. Now I need to look at my broken teeth and collapsing root canals. This was suggested by an endocrinologist as a pathway to toxic bacteria to enter my body…I dont have thousands of dollars to treat this dental issue and even though it is causing medical complications, I am on the hook to either find the money or it will compromise my health.

    Reply
  13. mark hull says

    January 23, 2020 at 2:35 pm

    I have been diagnosed with moderate mitral valve prolapse, and enlarged heart. cardiologist says that the mitral valve can not close completely due to heart enlargement. Apparently heart enlarged, but valve flaps did not. A surgical procedure can reduce valve opening so valve can close fully. I wonder if an alternative is to reverse the enlargement.
    I am finding contradictory info about the heart such as: “The heart is a muscle and when worked harder can become enlarged, just like other muscles.” Other information states that exercise is great for the heart. How come exercise which makes the heart work harder does not enlarge the heart? Can reducing work load of heart using high blood pressure meds, and little to no excercise cause the heart muscle to decrease in size?
    A curious thing in my case is that the other heart valves are normal and operating very well.I wonder what could cause only one valve to be having problems? I do have a history of high blood pressure, which has been controlled for several years with lisonipril. I also have had high cholesterol 14 years ago, but it has been controlled with diet changes for past 14 years.

    Reply
  14. Anil Singh says

    February 29, 2020 at 12:50 pm

    Dear sir, My brother was suffered from heart decease and doctor suggested for stent due to blockage in LAD after 15 days of stent ECG was performed and ECG reported Right ventricle hypertrophy but doctor said it is OK . please suggest me what to do in this case

    Thanks & Regards
    Anil Singh

    Reply
  15. Judith says

    March 4, 2020 at 7:42 pm

    I’m really concerned… my boyfriend received his result after having done a mri for his heart, and the result said that he has a enlarged heart. I need to know if the test maybe wrong. He is really healthy. Under BMI fat, Yoga, plant-based etc….
    I pray that the result is wrong.

    Reply
    • Jeff says

      December 5, 2020 at 4:40 pm

      Hello Judith can you give me your email I need to speak with you regarding this pls

      Reply
  16. Nayan says

    November 11, 2020 at 2:50 pm

    Hello Dr.

    Hope you are doing well

    My mother was coughing at night. Took her to hospital. Checked xray CT scan and Eco with ECG

    Enlarged heart with fluid in lungs. She is now under medications

    Still coughing is a major problem
    Coughing 80% night and 20% thorough out the day

    Please suggest also send your WhatsApp number so I can send details

    Regards

    Nayan

    Reply
  17. andrea reyes says

    November 19, 2020 at 4:53 pm

    my husband chest xray result says he has LEFT VENTRICULAR FORM CARDIOMEGALY and THORACIC DEXTROSCOLIOSIS…..he always shortened his breathing…but with tje help of maintenance medicine hes doing good….my question is about the xray result…the DEXTROSCOLIOSIS is this the effect of heart enlargement? your answer is very much appreciated ? thank you doctors in adv. godbless keep safe everyone??☺️?

    Reply
  18. Zeyneb sutan says

    December 6, 2020 at 1:28 pm

    My little brother is suffering by heart enlargment of right ventricle(fibro elasticity) he is 13

    Reply
  19. ROSALINDA ELAWADY says

    January 9, 2021 at 4:38 am

    HI GOOD MORNING!!! I HAVE A PROBLEMA W/HEART THE DOC SAID.I HAVE HEART ENLARDMENT..PLS. TELL ME THE BEST REMEDY SO THAT MY WILL RETAIN back to normal.. I DONT SMOKE. NO ALCOHOL. AND I AM 72 NOW. THANKS FOR THE ADVICE!!

    Reply
  20. Joseph Cavano says

    November 22, 2021 at 12:38 pm

    I am a 78 year old man being treated by an excellent cardiologist. My latest Echo showed a heart enlargement. I believe it had gone from 3.1 to 3.4. At any rate it was still in the normal range.
    Can you give me a general idea of how serious this is and what I should do the keep it from getting worse and when I should contact my cardiologist before my next yearly appointment.
    A jogger for 46 years, I wonder if jogging is still recommended or at least acceptable.
    Thanks so much.My older brother practiced medicine for many years.

    Reply
  21. Althea says

    January 19, 2022 at 7:58 pm

    When do you consider cardiac muscle hypertrophy physiological, as opposed to pathologic, in a patient with hypertension and some edema and easy fatigability?

    Reply
    • Dr. Mustafa Ahmed says

      February 6, 2022 at 11:41 pm

      Depends on the pattern of remodeling as per tests such as echo or MRI in combination with the history.

      You can follow our twitter at @MustafaAhmedMD

      Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.

      Reply
  22. Jon says

    September 13, 2022 at 8:43 pm

    In Dec my Dr said my RV is dilated, same size as LV. He said come check back in a year! I saw a second Dr at 6 months bc I am sick thinking about it, and am getting lotsa PVCs. Second Dr didnt look at anything and said: You already have a Dr, listen to him.
    I am a fit looking 46yo with 5 and 6yo children. I need help before my heart is destroyed or dead 🙁
    Thank you.

    Reply

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