Basics Of Cardiomegaly,Classifications,Sign and Symptoms,Causes, Treatment and Prevention

Basics Of Cardiomegaly

Introduction:

Also called an "enlarged heart," cardiomegaly is a condition where the heart becomes larger than normal for the patient's size.

Cardiomegaly needs to be carefully observed because, due to it, the patient may have the entire circulatory system impaired, since the heart cannot properly pump blood throughout the body. Over time, the patient suffering from cardiomegaly may develop heart failure.

Classification:

Cardiomegaly can be categorized according to the structure of the enlargement or according to the primary area of the heart that is enlarged.

There are also particular extra subtypes. For instance, the athletic heart syndrome is a non-pathological disease that is frequently observed in sports medicine and causes the human heart to grow and have a lower resting heart rate than usual.

By expanded place

Hypertrophy of the heart valves:-

left ventricular dilatation:

It is the most common diagnosis in patients with enlarged cardiac silhouette on chest X-ray . Radiologically, when the pulmonary vasculature is normal, volume overload cardiac lesions tend to have a greater degree of cardiomegaly than isolated pressure overload lesions. That is, in valvular regurgitation (with volume overload), we should expect dilation to be greater than in arterial hypertension or in isolated aortic stenosis (pressure overload) as long as the pulmonary flow (assessed in the radiological situation of vessels) is normal.

 In other patients, dilation of the ventricular diameters is accompanied by normal or even increased ventricular systolic function (hypercontractile state). This pattern occurs systematically in patients with volume overload. In heart patients, this situation basically occurs when valve insufficiencies develop (mitral and/or aortic). However, in patients without heart disease, it can occur if there is volume overload, such as renal failure with fluid overload.

left ventricular hypertrophy

Right ventricular dilatation:

 Right ventricular dilatation is very rare as an isolated finding. It almost always accompanies left ventricular dysfunction. In the initial stages, dilation of this cavity is very difficult to diagnose radiologically, since it is usually located forward and does not modify the right border of the heart. On the other hand, if the right ventricle is severely dilated, it can occupy almost the entire radiological left heart border, including the apex of the heart. The dilated right ventricle can displace the right atrium to the right, which will result in a clear increase in the transverse diameters of the heart. For all these reasons, radiological assessment of right ventricular dilatation is not very sensitive.

Right Ventricular Dilation

Dilatation of the atrial cavities:

The left atrium is represented on the posteroanterior view by a slightly concave segment at the left cardiac border. Its dilation can be suspected when this segment becomes straight or laterally convex. Another important sign is the elevation of the right main bronchus causing the carinal angle to be greater than 75º. However, there is non-vascular pathology that can simulate the dilatation of the left atrium. For example, a pericardial fibroma or cyst, a lymphoma, a thymoma, mediastinal or pleural neoplasms, etc. This difficult radiological evaluation classically required the use of the oblique projection, in which the retrocardiac space was totally obliterated and the normal curve of the left atrium, drawn by the esophagus filled with barium, it was enlarged and displaced backwards. For all these reasons, assessment of the left atrium is currently surpassed by echocardiographic assessment.

Left/ Right pulmonale

 The enlargement structure:

Cardiomegaly most frequently manifests as dilated cardiomyopathy. The heart's left or right ventricle's walls thinning and stretching with this ailment. An enlarged heart is the outcome.

The big, muscular left ventricle of the heart develops an unusually thick wall in the other kinds of cardiomegaly. Typically a hereditary condition, cardiomyopathy

Pattern of dilated cardiomyopathy:

• Increased end-systolic and end-diastolic diameters.
• Spherical geometry of the ventricle instead of ellipsoid.
• Decreased global systolic function (usually measured as ejection fraction.
• Normal or decreased parietal thickness (eg, in areas of eschar due to previous infarction).
• Variable contractile pattern depending on the etiology:
•  With ischemic heart disease: Normal segments and segments with decreased contraction.

Signs of cardiomegaly

 In many cases, cardiomegaly does not cause symptoms in the patient and is only diagnosed when an imaging test is performed that captures the chest, such as a simple x-ray.

However, some patients may experience some symptoms that serve as a sign of cardiomegaly. These are conditions like:

• shortness of breathe
• tiredness even when making small efforts;
• weakness;
• high blood pressure;
• palpitation;
• dizziness;
• fainting;
• decrease in the amount of urine passed per day.

Causes of cardiomegaly

Cardiomegaly has a variety of causes and is often connected to other medical conditions that may or may not involve the heart. The following conditions are linked to an enlarged heart:

• Born with a heart problem (congenital heart defect). The heart muscle may enlarge and become weak as a result of issues with its composition and operation.
• Heart attack-related damage. It may be more difficult for the heart to pump enough blood to the body as a result of scarring and other structural cardiac abnormalities. The stress may cause cardiac enlargement and ultimately heart failure.
• Heart muscle conditions (cardiomyopathy). The heart can become hard or thick due to cardiomyopathy. The heart may have a tougher time pumping blood as a result.
• An accumulation of fluid in the sac around the heart (pericardial effusion). On a chest X-ray, an enlarged heart may be visible due to a buildup of fluid in the sac that houses the heart.
• Heart valve illness. The heart has four valves that help to maintain proper blood flow. The heart chambers may enlarge due to blood flow obstruction brought on by disease or damage to any of the valves.
• Elevated blood pressure (hypertension). The heart may have to work harder to pump blood to the rest of the body if you have high blood pressure. The cardiac muscle may enlarge and weaken as a result of the tension.
• Lungs' arteries have high blood pressure (pulmonary hypertension). To transfer blood from the lungs to the heart, the heart must exert more effort. The right side of the heart may become thicker or enlarge as a result of the stress.
• Low level of red blood cells (anemia). In anaemia, the body doesn't have enough healthy red blood cells to transport enough oxygen to the tissues. To compensate for the blood's deficiency in oxygen, the heart must pump more blood.
• Thyroid conditions. Heart issues, such as an enlarged heart, can result from both an underactive thyroid gland (hypothyroidism) and an overactive thyroid gland (hyperthyroidism).
• The body contains too much iron (hemochromatosis). The heart is one organ where iron can accumulate. The lower left heart chamber may enlarge as a result of this.
• Abnormal protein buildup in the heart (cardiac amyloidosis). Amyloid, a protein, builds up in the blood in this uncommon disease and sticks to human organs including the heart. Heart wall thickening brought on by amyloid protein deposits is irreversible. To pump blood, the heart must work harder.
• Aerobic activity In certain athletes, regular and sustained activity causes the heart to expand. Typically, this kind of enlarged heart is not regarded as a sickness and does not require medical attention.
• A heart-shaped mass. On a chest X-ray, some people's extra body fat that surrounds the heart may be visible. There is no need for treatment unless there are comorbid heart diseases.

Risk elements:

Cardiomyopathy is a condition in which the heart becomes enlarged.

• A history of heart muscle illness in the family (cardiomyopathy). Cardiomyopathy can run in families in some cases. If a parent or sibling has ever had a thick, stiff, or enlarged heart, mention this to your healthcare professional.
• Elevated blood pressure. Having a blood pressure reading higher than 140/90 millimetres of mercury qualifies as this.
• Heart conditions. Heart enlargement may be caused by any heart condition, including congenital heart abnormalities and heart valve dysfunction. To control heart disease, it's crucial to have a healthy lifestyle and get frequent checkups.

Complications:

Problems the likelihood of complications from an enlarged heart is influenced by the afflicted heart region and the underlying reason. An enlarged heart may cause complications such as:

• Cardiac arrest If the left ventricle, the bottom chamber of the heart, enlarges, cardiac failure may result. Heart failure occurs when the heart is unable to adequately pump blood throughout the body.
• Clots of blood. The lining of the heart may develop blood clots. The lungs might be affected by a blood clot that develops on the right side of the heart (pulmonary embolism). You may experience a heart attack or stroke if a clot restricts blood flow.
• Heart valve leak (regurgitation). The mitral and tricuspid heart valves may not close as a result of cardiac enlargement, allowing blood to seep backward. A heart murmur is a sound caused by the blood flow interruption. Heart murmurs should be checked by a medical professional even if they're not always dangerous.
• Sudden death and cardiac arrest. The heart may beat too quickly or too slowly as a result of an enlarged heart. Arrhythmia, or an abnormal heartbeat, can cause sudden death, cardiac arrest, or fainting.

Prevention:

If anyone in your family has or has ever had cardiomyopathy or any other medical disorders that resulted in an enlarged heart, let your healthcare professional know. Early detection and effective treatment of the underlying illness may stop the enlargement of the heart from getting worse.

A heart-healthy lifestyle can aid in the management or prevention of various illnesses that might result in an enlarged heart. Prevent an enlarged heart by doing the following actions:

• Diabetes, excessive cholesterol, and blood pressure should all be managed.
• Follow the directions on any prescription medication.
• Consume a healthy, balanced diet.
• Exercise frequently.
• Limit your alcohol intake.
• Avoid smoking.
• Don't utilise illicit substances.

How is cardiomegaly treated?

Cardiomegaly needs to be monitored because it is one of the main causes of myocardial infarction, in addition to being able to lead the patient to heart failure and sudden death.

Treatment of cardiomegaly can be done with the use of medications, such as diuretics, to support the heart. It may also involve treating the condition causing the cardiomegaly, if it can be identified.

Finally, if it is not possible to reverse the condition with the use of medication, this patient may undergo heart surgical procedures and even a transplant, depending on the severity of their case