The patient with cardiomegaly may sometimes be asymptomatic for a variable period of time. Depending of the underlying disease and severity of compromise of cardiac function, the presentation may include:

• Dyspnea on exertion and on supine position
• Dizziness
• Syncope
• Palpitations
• Arrhythmia
• Fluid retention (pedal edema)

Other symptoms depending on the causative disease may have been present from before, like chest pain in cardiac ischemic disease, systemic symptoms in thyroid dysfunction or renal disease, etc.

• Pain

  Nor again is there anyone who loves or pursues or desires to obtain pain of itself, because it is pain, but because occasionally circumstances occur in which toil and pain can procure him some great pleasure. [medunion.wordpress.com]

  Chest Pain Chest pain is a common complaint by a patient in the ER. [medicinenet.com]

  A 64-year-old woman presented eight days following pericardiectomy with a 2-day history of progressive dyspnea and new crushing chest pain. Chest x-ray revealed development of interval "cardiomegaly." [ncbi.nlm.nih.gov]

  […] coughing. [3] [4] Chest pain is often a secondary symptom caused by arrhythmia; however, coughing and chest pain deserve special attention because if present, you could be close to a heart attack. [wikihow.com]

• Congestive Heart Failure

  Some of these can also help the heart pump more effectively. In very few people with cardiomegaly and severe congestive heart failure, a heart transplant may be recommended. [webmd.com]

  Samples were 30 patients with congestive heart failure hospitalized in Irina F and Cardio Vascular Brain Center Prof. Dr. R. D. Kandou Hospital in Manado. [ejournal.unsrat.ac.id]

  The causes of cardiomegaly were cardiomyopathy (two patients), congestive heart failure due to fluid overload, congenital mitral insufficiency, and idiopathic hypertrophic subaortic stenosis. [ncbi.nlm.nih.gov]

• Swelling

  A physical exam: You may have swelling. An enlarged heart can also produce abnormal sounds when a doctor listens with a stethoscope. Chest X-ray: Dilated cardiomyopathy increases the heart’s size on a chest X-ray film. [webmd.com]

• Anemia

  The causes of FC were cardiac causes 49.5%, Bart's hemoglobinopathies 28%, and non-Bart's anemia 15%. Ascites, pericardial effusion, and hydrops were more prevalent in fetuses with anemia than those with cardiac abnormalities. [ncbi.nlm.nih.gov]

  There are several types of anemia such as iron deficiency anemia (the most common type), sickle cell anemia, vitamin B12 anemia, pernicious anemia, and aplastic anemia. [medicinenet.com]

  Also find spoken pronunciation of Anemia in hindi and in English language. Tags for the entry "Anemia" What Anemia means in hindi, Anemia meaning in hindi, Anemia definition, examples and pronunciation of Anemia in hindi language. [shabdkosh.com]

• Amyloidosis

  GR is a nuclear transcription factor that leads to myocardial hypertrophy, and cumulative prednisolone doses may promote marked cardiomegaly and severe cardiac amyloidosis. [ncbi.nlm.nih.gov]

  Amyloidosis Amyloidosis is a group of diseases resulting from abnormal deposition of certain proteins (amyloids) in various bodily areas. [medicinenet.com]

  These conditions are known as amyloidosis and hemochromatosis, respectively. 1 Patients with conditions such as Alzheimer’s disease or have been in dialysis treatments for a long time are affected by amyloidosis. [healthmaza.com]

  Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI) Cardiac catheterization and biopsy may be rarely required in tumors or amyloidosis. Treatment depends on the underlying cause. [symptoma.com]

  There are many causes for cardiomegaly symptom to develop, like: CAD anemia arrhythmia heart attack amyloidosis hypertension Fabry disease rheumatic fever Pompe disease aplastic anemia cardiomyopathy hemochromatosis aortic valve stenosis Kawasaki syndrome [healthblurbs.com]

• Dyspnea

  We report an adult male who presented with progressive dyspnea of 2 months' duration. Clinical examination was unremarkable. Chest radiograph showed enlarged cardiac silhouette. [ncbi.nlm.nih.gov]

• Abdominal Pain

  Advanced Search: • Use “ “ for phrases o [ “pediatric abdominal pain” ] • Use – to remove results with certain terms o [ “abdominal pain” –pediatric ] • Use OR to account for alternate terms o [teenager OR adolescent ] [merckmanuals.com]

  Abdominal pain: Like gas and bloating, abdominal pain is nonspecific and can have many possible causes. When pain is present, it may be noted in the region known for pain with appendicitis, McBurney's point. [verywellhealth.com]

  Retrospective analysis of a single center technique and results. 38 Acquistapace F...Capretti P 26888699 2015 14 An Unusual Cause of Abdominal Pain. [malacards.org]

  For several days before receiving the transplant, she had complained of abdominal pain. [healio.com]

• Cardiomegaly

  […] англо-русский и русско-английский словарь > cardiomegaly 4 cardiomegaly НБАРС > cardiomegaly 5 cardiomegaly Универсальный англо-русский словарь > cardiomegaly 6 cardiomegaly мед.сущ. расширение сердца Англо-русский медицинский словарь > cardiomegaly [translate.academic.ru]

  Fifty-five were reported to have cardiomegaly on echo, of which 33 (60%) did not have cardiomegaly identified on CXR. [ncbi.nlm.nih.gov]

  Cardiomegaly is of two types: Dilative cardiomegaly: The enlargement of the heart results from the dilation of the myocardium. Dilated cardiomyopathy, the most common form of non-ischemic cardiomyopathy, leads to cardiomegaly. [symptoma.com]

• Heart Failure

  Heart failure can involve the heart’s left side, right side or both sides. However, it usually affects the left side first. Learn about: Types of Heart Failure Classes of Heart Failure [heart.org]

  Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. [ncbi.nlm.nih.gov]

  Some of these can also help the heart pump more effectively. In very few people with cardiomegaly and severe congestive heart failure, a heart transplant may be recommended. [webmd.com]

  The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol. 1993 Oct. 22 (4 suppl A):6A-13A. [Medline]. [Full Text]. American Heart Association. Classes of heart failure. [medscape.com]

  Cardiomegaly is a nonspecific symptom seen in patients with chronic systolic heart failure (HEART FAILURE) or several forms of CARDIOMYOPATHIES. [sideeffects.embl.de]

• Heart Disease

  heart diseases I51.9 Heart disease, unspecified I52 Other heart disorders in diseases classified elsewhere I60 Nontraumatic subarachnoid hemorrhage I60.0 Nontraumatic subarachnoid hemorrhage from carotid siphon and bifurcation I60.00 Nontraumatic subarachnoid [icd10data.com]

  Heart Diseases Also called: Cardiac diseases If you're like most people, you think that heart disease is a problem for others. But heart disease is the number one killer in the U.S. It is also a major cause of disability. [icdlist.com]

  These include high blood pressure, coronary artery disease, chronic kidney and liver disease, infections of the heart, anemia, thyroid gland disease, diseases of the valves of the heart, sickle cell disease, and congenital heart diseases, to name a few [symptoma.com]

  Heart Disease Heart disease (coronary artery disease) occurs when plaque builds up in the coronary arteries, the vessels that supply blood to the heart. Heart disease can lead to heart attack. [medicinenet.com]

• Hypertension

  This study is a contribution to a better aetiological elucidation of "cardiomegaly" in the tropics and emphasizes the importance of arterial hypertension as one of its causative factors. [ncbi.nlm.nih.gov]

  Angiotensin-converting enzyme inhibitors and beta-blockers given for hypertension may have beneficial effects on cardiac function. [symptoma.com]

• Chest Pain

  Chest Pain Chest pain is a common complaint by a patient in the ER. [medicinenet.com]

  A 64-year-old woman presented eight days following pericardiectomy with a 2-day history of progressive dyspnea and new crushing chest pain. Chest x-ray revealed development of interval "cardiomegaly." [ncbi.nlm.nih.gov]

• Stroke

  Olympic sprinter shares his stroke story Learn the warning signs of stroke No bones about it: It’s time to fight heart disease with Best Friend Fridays The American Heart Association’s new effort looks to put pets in the workplace, while helping raise [americanheart.org]

  Join Heart & Stroke’s Community of Survivors or Care Supporters’ Community support groups. Sign up for the Heart & Stroke recovery newsletter. Get the latest research news and information, with tips and strategies to help you manage your recovery. [heartandstroke.ca]

  Treatment is centred round reducing symptoms and reducing risk of stroke, so the treatment for individuals may vary depending upon their symptoms and their stroke risk. [heartrhythmalliance.org]

  Cardiac arrest and sudden death, stroke or pulmonary embolism: If a blood clot breaks off, it can cause a heart attack, stroke or pulmonary embolism in your lungs. Heart failure: As the left ventricle enlarges, the risk for heart failure increases. [baptisthealth.com]

  Fabry disease patients are at increased risk of heart attack, heart disease, kidney failure, and stroke. Symptoms of Fabry disease can be treated with medication. [medicinenet.com]

• Dizziness

  Palpitations and dizziness may be there. In case of acute chest pain, severe difficulty in breathing and fainting, there is a possibility of a myocardial infarction, and one must seek emergency treatment. [symptoma.com]

  The symptoms you may experience include: shortness of breath chest pain heart palpitations (rapid, fluttering, or pounding heartbeat) arrhythmia (irregular heartbeat) dizziness fainting rapid exhaustion with physical activity swelling Living with cardiomegaly [heartandstroke.ca]

  Common symptoms of cardiomegaly include: difficulty breathing, dizziness, and the quickening or the slowing of one's pulse rate, and swelling of the ankles and legs. [caring.com]

  Most people ignore mild abnormalities in heart beats and dizziness until they turn worse. If you are suffering from similar symptoms, do not ignore them for you may be having a case of Cardiomegaly. [hxbenefit.com]

• Irritability

  […] specific neonate(consider age and overall infant status) Glucose concentration is only an indicator of glucose insufficiency General findingsAbnormal cry Poor feeding Weak Suck Temperature instability Neurologic signsTremores and jiteriness Hypotonia Irritability [slideserve.com]

  These include: overweight or obesity a sedentary lifestyle a diet high in red or processed meats smoking tobacco regularly consuming too much alcohol a history of irritable bowel disease (IBD) having type 2 diabetes Brain Some factors increase the risk [medicalnewstoday.com]

• Lethargy

  Sonogram: Jasmine the cardiomegaly cat History: This 13- year-old DSH FS cat presented for lethargy, anorexia and tachypnea. The patient has a history of diabetes, labored breathing, weakness in the hind limbs, anemia. [sonopath.com]

  […] neonate(consider age and overall infant status) Glucose concentration is only an indicator of glucose insufficiency General findingsAbnormal cry Poor feeding Weak Suck Temperature instability Neurologic signsTremores and jiteriness Hypotonia Irritability Lethargy [slideserve.com]

  A decreased blood supply to your brain, especially, can lead to feelings of fatigue or lethargy. Keep in mind that fatigue can be a symptom of many conditions and does not particularly mean that you have an enlarged heart. [wikihow.com]

A diagnosis of cardiomegaly is frequently based on radiological findings correlated to the clinical picture. A complete medical history and physical examination is mandatory.

Investigations include:

• Routine blood analysis with tests for thyroid function and viral infections.
• Chest X-ray to assess the shape and size of the heart and lungs. Usually the Danzer method is used, and cardiothoracic ratio > 0.5 indicates cardiomegaly [9].
• Stress test to assess cardiac function
• 2 D-Echocardiogram: The size of the chambers, dimension, volume and the thickness of the walls, pumping function, valve function, volume status and pericardial effusion, and congenital heart disease can be assessed.
• Doppler study to assess valvular function and hemodynamics
• Electrocardiogram to assess heart rhythm and evidence of old infarction or ischemia.
• Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI)
• Cardiac catheterization and biopsy may be rarely required in tumors or amyloidosis [10].

• Pericardial Effusion

  Echocardiography revealed a large pericardial effusion without signs of tamponade. After removing the catheter, the effusion gradually resolved. [ncbi.nlm.nih.gov]

  Pericardial Effusion How do you distinguish cardiomegaly from pericardial effusion? There is pulmonary congestion in CHF and pulmonary oligemia in pericardial effusion. Shape of the heart is helpful Water bottle appearance in pericardial effusion. [stritch.luc.edu]

  Causes include: dilated chambers: congestive cardiac failure dilated cardiomyopathy thickened walls: congestive cardiac failure hypertensive heart disease hypertrophic cardiomyopathy pericardial effusion: transudate: heart failure hypoalbuminaemia, e.g [gpnotebook.com]

  English Uncommon: cardiac failure, angina pectoris, atrial fibrillation, pericardial effusion, coronary artery disease, cardiomegaly, cardiac murmur, bradycardia. [mymemory.translated.net]

• Cardiomegaly on Chest X-ray

  To evaluate her dyspnea the X-ray below was obtained. Image 1 Bedside ultrasound can help you to rapidly identify the underlying cause of cardiomegaly seen on chest X-ray. [em.emory.edu]

  Specialty: Cardiology MeSH Code: D006332 ICD 9 Code: 429.3 Cardiomegaly on chest X-ray and a pacemaker Source: Wikipedia Coding Notes for I51.7 Info for medical coders on how to properly use this ICD-10 code Inclusion Terms: Inclusion Terms Inclusion [icd.codes]

  […] sustained cardiac arrhythmias, abnormal electrocardiograms, and cardiomegaly on chest X-ray. [ipfs.io]

• Abnormal ECG

  Reports were then categorised by the presence of indicators of cardiac disease in the request: none; non-specific (e.g. ankle swelling); specific (e.g. abnormal ECG), then further classified by whether the echo findings were clinically relevant. [academic.oup.com]

Treatment depends on the underlying cause. Treatment options include:

• Medications: Required for control of underlying disease, like hypertension, thyroid disease or infections. Diuretics may be given for certain conditions. Angiotensin-converting enzyme inhibitors and beta-blockers given for hypertension may have beneficial effects on cardiac function.
• Medical procedures: Cardiac catheterization with stenting can improve blood flow to the heart muscle in coronary artery disease. Implantable cardioverter-defibrillator can manage arrhythmias.
• Surgical procedures: For valvular disease. Severe congestive heart failure may require cardiac transplant.
• Lifestyle management: Stop use of alcohol, drug, or medication causing cardiomegaly. Diet, cessation of smoking, exercise and medication to help control high blood pressure is recommended.

Cardiomegaly leads to reduction in intrathoracic space and limits the ability of the lungs to fill adequately, leading to pulmonary dysfunction. Pulmonary embolism, cardiac arrest and sudden death may occur as complications of cardiomegaly. Congestive heart failure is a common outcome. Prognostic considerations depend on the underlying disease.

Causative and associated factors are [3] [4] [5] [6]:

• Coronary artery disease
• Hypertension
• Heart valvular disease (e.g. mitral regurgitation, pulmonary valve stenosis)
• Aortic coarctation
• Idiopathic dilated cardiomyopathy
• Hyperthyroidism and hypothyroidism
• Anemia
• Infective endocarditis
• Viral myocarditis (for example due to coxsackie virus)
• Rheumatic heart disease
• Chronic kidney disease leading to uremia 
• Previous myocardial infarction
• Lifestyle factors (sedentary lifestyle, obesity)
• Pregnancy (peripartum cardiomyopathy)
• Alcohol or cocaine abuse
• HIV infection
• Genetic and inherited conditions like congenital heart disease
• Sickle cell disease
• Hemochromatosis 
• Pericardial effusion
• Cardiac amyloidosis
• Athletic heart syndrome
• Atrial septal defect
• Primary congestive heart failure, or secondary congestive heart failure
• Connective tissue disease (e.g. systemic lupus erythematosus (SLE))
• Dilated cardiomyopathy due to thiamine deficiency
• Hypertrophic cardiomyopathy
• Hypoalbuminemia from malnutrition and chronic liver disease
• Glycogen storage disease type 2
• Myocardial fibroelastosis
• Primary tumors of the heart
• Drugs such as doxorubicin
• Acromegaly 
• Age related

Apart from the etiological factors, a family history of cardiomyopathy leads to increased risk of developing cardiomegaly. Specific prevalence of cardiomegaly, it being a sign and not a disease, is difficult to assess, and the epidemiological factors of underlying conditions are relevant.

Cardiomegaly is of two types:

• Dilative cardiomegaly: The enlargement of the heart results from the dilation of the myocardium. Dilated cardiomyopathy, the most common form of non-ischemic cardiomyopathy, leads to cardiomegaly. There is no wall hypertrophy in dilated cardiomyopathy, but left ventricular cavity size is increased with impairment in systolic function. Viral myocarditis for instance results in dilative cardiomegaly [7].
• Hypertrophic cardiomegaly: The cardiac muscle undergoes hypertrophy when a high workload is imposed for a prolonged period of time. Physiological and reversible cardiac hypertrophy is seen in athletes and pregnant women. Pathologic hypertrophy is the result of diseases that lead to increased demand on the heart, e.g., hypertension, cardiac valvular disease, and myocardial infarction. Chronic hypertension results in left ventricular hypertrophy due to increased afterload on the left ventricle [8]. In general, increased stress on myocardium to maintain stroke volume leads to muscle hypertrophy. In heart failure, a diminished ejection fraction leads to more stress on myocardium to maintain cardiac output. Left ventricular failure leads to enlargement of the remaining heart chambers as well.

Timely diagnosis and aggressive management of common cardiovascular diseases like hypertension, ischemic heart disease, etc., can prevent the development of cardiomegaly. Regular follow-up during the treatment of the causative diseases can prevent the complications of cardiomegaly. Once cardiomegaly has developed, proper and regular treatment can halt the enlargement and improve cardiac function.

Cardiomegaly is an abnormal enlargement of the heart that can arise from a number of underlying diseases and some physiological factors. Common associations are hypertension, coronary artery disease and cardiac valvular disease, endocarditis and genetic conditions. Exertional dyspnea, palpitations, arrhythmias, fatigue, and pedal edema are common presenting features. Cardiomegaly may lead to congestive cardiac failure [2].

Definition: Cardiomegaly is the enlargement of the heart due to any underlying disease.

Cause: There are a large number of heart diseases and other diseases that can lead to the enlargement of the heart. These include high blood pressure, coronary artery disease, chronic kidney and liver disease, infections of the heart, anemia, thyroid gland disease, diseases of the valves of the heart, sickle cell disease, and congenital heart diseases, to name a few.

Symptoms: Patient may experience shortness of breath, especially on exertion or lying down. There may be difficulty in breathing. Palpitations and dizziness may be there. In case of acute chest pain, severe difficulty in breathing and fainting, there is a possibility of a myocardial infarction, and one must seek emergency treatment. There may be fluid accumulation and swelling of the feet. Other symptoms may occur according to the underlying disease.

Diagnosis: The doctor will take a detailed history and carry out a detailed physical examination. You may require an electrocardiogram and stress test on a treadmill. The diagnosis of cardiomegaly requires an X-ray of the chest, and other studies of the heart like 2-D and Doppler echocardiography, computed tomography and magnetic resonance imaging. Rarely, a biopsy of the heart may be required.

Treatment and follow-up: The treatment is according to the causative disease. You will be advised to stop smoking and start certain diet or exercise regimes according to you condition. Medication will be given to control the disease and prevent further enlargement of the heart. Proper and prolonged follow-up is essential and sometimes lifelong treatment may be required. In some cased, medical or surgical procedures may be required.

1. Bonow RO, Mann DL, Zipes DP et al. Braunwald's Heart Disease, A Textbook of Cardiovascular Medicine. W B Saunders Company; 2012.
2. American Heart Association. Enlarged heart. Updated: Mar 27, 2013. Accessed: Feb 23, 2015
3. Cuspidi C, Rescaldani M, Sala C, Negri F, Grassi G, Mancia G. Prevalence of electrocardiographic left ventricular hypertrophy in human hypertension: an updated review. J Hypertens. 2012; 30(11):2066-73.
4. Chiu B, Sergi C. Dilated cardiomyopathy: etio-morphologic investigation. Front Biosci (Schol Ed). 2010; 2:112-6.
5. Campbell M. Schultz JC, Hilliard AA, Cooper LT, Rihal CS. Diagnosis and treatment of viral myocarditis. Mayo Clin Proc. 2009; 84(11):1001-9.
6. Natural history of coarctation of the aorta. Br Heart J. Sep 1970; 32(5):633-40.
7. Jefferies JL, Towbin JA. Dilated cardiomyopathy. Lancet. 2010; 375(9716):752-62.
8. Cingolani HE, Perez NG, Aiello EA, et al. Early signals after stretch leading to cardiac hypertrophy. Key role of NHE-1. Front Biosci. 2008; 13:7096-114.
9. Chon SB, Oh WS, Cho JH, Kim SS, Lee SJ. Calculation of the cardiothoracic ratio from portable anteroposterior chest radiography. J Korean Med Sci. 2011; 26(11):1446-53.
10. Lawler PR, Bergmark BA, Laubach JP, Lakdawala NK. Having a heavy heart: approaches to infiltrative cardiomyopathy. Circulation. 2014; 129(16):1703-11.