CARDIOMEGALY: SYMPTOMS, CLASSIFICATION, CAUSES AND TREATMENT - MEDICINE - 2025

The cardiomegaly is the abnormal growth of the heart. It is not considered a pathology as such, but rather the clinical manifestation of some local or generalized disease. Depending on the entity that causes it, cardiomegaly can be temporary or permanent and mild or severe.

The enlargement of the heart does not always produce symptoms in patients. Some are even unaware of their illness and are only diagnosed accidentally. Others do have significant clinical signs, which are associated with irreversible heart damage.

The diseases that produce cardiomegaly are very varied. Most of these are concentrated in the cardiovascular sphere, but some other systemic or infectious can also cause cardiomegaly. As expected, treatment will depend on the cause and can be solely through medication, or even interventionist.

Symptoms

Mild or transient cardiomegaly does not always present significant symptoms. The clinical manifestations usually appear when the heart has reached a very large size and its functional capacity is severely compromised.

Abnormal heart rhythm

Palpitations or irregular heartbeat are the first alterations caused by cardiomegaly. Elongation of muscle fibers and the cardiac nerve network may be the cause. The patient reports feeling the heart "uncontrolled" or with beats that occasionally change rhythm.

Chest pain

It is not very intense but it is annoying. Its etiology is associated with small ischemic events due to the inability of the heart to irrigate its own blood vessels.

It often occurs after an effort of variable intensity, but when it occurs at rest it is a sign of severe heart damage.

Shortness of breath

It is a typical symptom of heart failure associated with cardiomegaly. Like pain, it occurs after some physical activity.

It is common to find the patient panting, doubled over, with one hand on his chest and stating that he cannot get air. Dyspnea at rest is common in very ill patients.

Cough

It is also directly related to heart failure. The improper handling of the fluids that enter the heart causes them to leak and enter the lungs, irritating them and causing coughing. In very serious cases it can be accompanied by reddish expectorations due to the presence of blood.

Edema

The increase in volume or edema is another consequence of the mishandling of fluids by the enlarged heart. Cardiac dysfunction causes slowed venous return and plasma leakage through vascular walls. It starts with swelling of the ankles and can progress to the abdomen.

Fatigue

Beyond shortness of breath, fatigue is a daily symptom in patients with cardiomegaly. Inadequate irrigation of the tissues involved in movement appears to be the cause. It is accompanied by occasional pain in the legs and claudication.

Classification

There are two basic classifications for cardiomegaly. The first is a radiological classification, in which the size of the heart is related to the rest of the structures observed in a chest film. The second is based on the characteristics of the walls of the heart and its symptoms.

Radiological classification

It is calculated with the following formula, using the measurements in centimeters that appear in the previous image:

Cardiothoracic index (CI) = A + B / C

Normal values ​​will always be below 0.5 centimeter.

Grade I

It includes any CI value above 0.5 but less than 0.6 centimeters. It is usually an occasional radiological finding.

Grade II

Includes any CI value above 0.6 and less than 0.7 centimeters in adults. There may be symptoms of mild heart failure.

Grade III

Values ​​above 0.7 centimeters, but without the heart touching the rib wall.

Grade IV

Any size of the heart over 0.7 centimeters, but with the condition that the cardiac silhouette makes contact with the rib wall.

Pathological classification

It is based on the thickness of the heart walls, although it depends primarily on the cause, the time of evolution and the patient's symptoms. The echocardiogram is essential for "in vivo" diagnosis as well as the electrocardiogram.

Hypertrophic cardiomegaly

As its name indicates, in this type of cardiomegaly the walls of the heart are thicker than normal, compromising the internal size of the cardiac chambers and their function.

Dilated cardiomegaly

In this case the walls of the heart are abnormally thin. When the heart muscle can no longer handle the normal pressures and volumes, it stretches and thus increases the size of its chambers. It usually occurs in chronic diseases.

Causes

Although most of the causes of cardiomegaly are in the cardiovascular sphere itself, there are many diseases that can cause it, including the following:

Arterial hypertension

As the pressure in the arteries increases, the heart must work harder to pump blood. This causes it, like any muscle that makes repeated effort, to enlarge. Initially it presents with hypertrophic cardiomegaly, but as the heart becomes chronic it ends up giving way and dilating.

Valvular disease

When any of the four valves of the heart fails, it does not carry out good blood flow management and can end up enlarging.

Valves can be damaged from birth due to congenital heart disease or as a result of infections, heart attacks, rheumatic fever, some drugs, or radiation therapy for cancer.

Pericarditis and pericardial effusion

When the sac that surrounds the heart (pericardium) becomes inflamed or filled with fluid, it does not allow it to contract normally and, when overexerted, it hypertrophies.

Anemia and hemoglobinopathies

The decrease in hemoglobin or its defects cause an increase in the cardiac work and, therefore, its abnormal growth.

Infections

Chagas disease or American trypanosomiasis is a parasitic infection caused by Trypanosoma cruzi. This parasite travels in certain insects such as bed bugs or warblers, which when biting humans inoculate the trypanosome and it lodges in the cells of the heart, damaging them over time and causing irreversible cardiomegaly.

Other causes of cardiomegaly are thyroid disorders, connective tissue diseases, hemochromatosis and some diseases considered rare.

Treatment

Although it is true that cardiomegaly is not a disease as such, there are common treatments for its relief while managing the cause that triggers it.

Medicines

Antihypertensives are the most common. Diuretics, calcium antagonists, beta-blockers, digoxin, anticoagulants, and antiarrhythmics may also be indicated.

Medical devices

The pacemaker, technological equipment that provides an adequate rhythm to the heartbeat, is installed in patients whose heart no longer works as it should because of cardiomegaly.

Surgery

Indicated to repair physical damage to the heart, such as some congenital abnormality, valvular heart disease, coronary bypass and even heart transplantation.

References

1. Leonard, Jayne (2018). What to know about cardiomegaly. Recovered from: medicalnewstoday.com
2. Myo Clinic staff (2017). Enlarged Heart. Recovered from: mayoclinic.org
3. Wikipedia (last edition 2018). Cardiomegaly. Recovered from: en.wikipedia.org
4. Conrad Stöppler, Melissa (2016). Enlarged Heart: Symptoms & Signs. Recovered from: medicinenet.com
5. World Health Organization (2018). Chagas disease (American trypanosomiasis). Recovered from: who.int
6. Bin Chon, Sung et al. (2011). Calculation of the Cardiothoracic Ratio from Portable Anteroposterior Chest Radiography. Journal of Korean Medical Science, 26 (11), 1446-1453.
7. Lunardo, Emily (2017). Enlarged heart (cardiomegaly): Causes, symptoms, diagnosis and treatment. Recovered from: belmarrahealth.com