Heart Enlargement (Dilated Congestive Cardiomyopathy, Hypertrophic Cardiomyopathy)

An enlarged heart is the most common manifestation of heart muscle disease, or cardiomyopathy. Even so, there are only about 50,000 new cases in the United States annually. Any abnormality of the heart muscle can cause cardiac enlargement, because the heart increases in size to compensate for the muscle weakness. If the expanded muscle is also abnormal, it further reduces the heart's ability to pump blood. Although the entire heart can be affected, the left ventricle, the main pumping chamber, usually becomes the most enlarged part.

If allowed to progress, the enlargement will eventually cause heart failure, in which the weakened muscle pumps ineffectively. Because blood then flows more slowly through the heart, clots tend to form; they can lead to pulmonary embolism, a stroke, a heart attack, or another circulatory blockage. The underlying cause of an enlarged heart often cannot be identified, but possibilities include a heart attack, high blood pressure, heart valve disease, a sustained fast heartbeat, alcoholism, radiation therapy, anti-cancer drugs, inflammation of the heart muscle, infection, malnutrition, complications of pregnancy, and genetic, metabolic, or neurological disorders.

Diagnostic Studies and Procedures

A chest X-ray will usually detect an enlarged heart and the accompanying fluid-filled lungs. Echocardiography, an examination using ultrasound, provides a more detailed image of the heart's chambers and how well they are functioning. Various scanning techniques can measure stroke volume; the amount of blood that is pumped with each heartbeat, and cardiac output: a per minute measurement. An MRI study may be ordered to obtain a three-dimensional picture of the heart. If the diagnosis is still in doubt, an imaging study called cardiac catheterization may be necessary. During this examination, which involves threading a long, thin, flexible tube through a blood vessel and into the heart, a small sample of heart muscle may be collected for laboratory analysis.

Medical Treatments

Treatment depends on the stage and nature of the enlargement. Sometimes discovering the underlying cause, such as lowering high blood pressure, can halt further heart expansion. In many cases, however, treatment focuses on relieving the symptoms of heart failure. A doctor may prescribe digitalis and other medications to strengthen the heartbeat and increase the efficiency of the heart's pumping action. Diuretics can reduce fluid retention and lessen lung congestion. Steroids may be necessary if the heart muscle is inflamed. If drug therapy does not succeed in controlling heart failure and the enlargement progresses, a heart transplant may be considered.

Alternative Therapies

Although the role of alternative therapies in treating an enlarged heart is limited, some can be useful adjuncts to medical treatment.

Herbal Medicine. Hawthorn berries are thought to strengthen the heart, lower blood pressure, and dilate blood vessels, thereby increasing blood flow. Available in capsule form, hawthorn is also a mild diuretic. Anyone with heart disease should check with a doctor before taking hawthorn, however, because it may interact with other medications. Herbalists also contend that garlic, consumed raw, cooked, or in capsule form, strengthens the heart muscle.

Nutrition Therapy. A low-salt diet is recommended to help prevent retention of fluid. Thiamine supplements may also be advocated if alcoholism is responsible for the enlargement.

Self-Treatment

Self treatment alone cannot manage an enlarged heart, but lifestyle can play an important role in alleviating symptoms and perhaps halting progression of the disorder. Total elimination of alcohol is imperative. Alcohol is toxic to heart muscle cells, so even small amounts can worsen the condition. If you smoke, now is the time to quit. And avoid secondhand smoke, which is also detrimental to the heart.

Consult a nutritionist or doctor before making any major dietary changes. Losing excess weight and keeping it off reduces the heart's workload and can help relieve symptoms. However, crash diets can be dangerous for anyone with heart disease, because the body metabolizes its own muscle tissue, including the heart, when calories are overly restricted. Learn to pace yourself. Regular exercise can help improve endurance, but it must be adapted to the limitations of an impaired heart. A doctor, in consultation with an exercise physiologist, can work out an appropriate regimen. Avoid becoming overly tired; if necessary, take frequent rest breaks while working or doing exercises. Simple measures, such as propping the head and back with extra pillows, may help reduce lung congestion.

Other Causes of an Enlarged Heart

Athletes sometimes develop an enlarged heart because of the extra demands that intense exercise workouts place on their heart muscle. However, this type of enlargement usually does not cause problems.