Introduction

The medical term used for Heart Enlargement is Cardiomegaly. This is not a disease itself but a sign of an underlying heart condition caused by either high blood pressure, high blood glucose, or high cholesterol levels. Heart enlargement occurs when your cardiothoracic ratio is increased, meaning the transverse diameter of the outline of the heart on a chest radiograph is greater than or equal to 50% of the transverse diameter of the chest. It includes the expansion of the right or left ventricles or the atria. According to studies, the most common symptoms you can experience if you have cardiomegaly are mentioned below:¹ 

Common symptoms

• Fatigue and reduced ability to perform physical activities.
• Shortness of breath on effort or rest.
• Palpitations, or feeling of faintness or wooziness.
• Angina 
• Comorbidities like Hypertension and Diabetes Mellitus.

Understanding the causes of fatigue and weakness

You may often report fatigue and weakness if your heart is enlarged, because it is under stress and cannot pump blood systematically to the limbs and other organs. This may cause a low oxygen delivery and nutrient deficiencies in the body, contributing to fatigue and weakness. 

Reduced pumping efficiency of the heart

Experiencing shortness of breath, for instance, while performing physical activities may occur due to the heart’s decreased efficiency to pump blood.

Poor oxygen supply to muscles and tissues

This may cause fatigue, the most common symptom reported, as it makes it harder for your heart to supply oxygenated blood to the body. Let’s explore the associated conditions below that may help you understand the causes of fatigue and weakness clearly.

Associated conditions:

• Arrhythmias - A heart rhythm that is not normal. Your heart may be beating faster when you are at rest or it is not beating normally 
• Anemia- When your red blood cells or the concentration of haemoglobin in the red blood cells is lower than normal levels
• Fluid retention or oedema-  When too much fluid is trapped in your body, especially in the legs and ankles, it is called oedema
• Irregular heartbeats and swelling in the legs and ankles can also be experienced if you have an enlarged heart

Underlying causes:

The coexistence of Cardiomegaly with other cardiac conditions like Coronary Artery Disease, Hypertension, Diabetes, High Cholesterol, Kidney disease, and Valve disorders may also lead to fatigue and weakness. Staying active and maintaining vitality largely depends on regularly checking your blood glucose and blood pressure levels, taking medications as prescribed, and following a healthy, nutritious diet.

Medical management approaches

The recommended treatment depends entirely on the illness that causes the expansion of the heart.

Medications:

• Diuretics: These drugs are used to reduce oedema by removing extra fluid in your body via urine and decreasing swelling around the heart, thereby improving heart function. They are also responsible for reducing high blood pressure caused by fluid retention⁵
• ACE inhibitors/ARBs: Angiotensin converting enzymes (ACE) inhibitors are used to improve your heart function by reducing blood pressure, subsequently decreasing sodium and water levels, which causes oedema in your legs and ankles. These are also responsible for increasing your cardiac output and a reduction in left ventricular mass has also been observed when these are used.² Angiotensin receptor blockers (ARBs) are used for the treatment of high blood pressure and heart failure. ARBs block the hormone Angiotensin II, which is responsible for constricting your blood vessels, thereby leading to high blood pressure. They are more or less similar to ACEs and provide the same treatment⁴
• Beta-blockers: These are used to reduce the strain on your heart. Beta-adrenergic antagonists are a class of cardiovascular drugs that obstruct the adrenergic receptors and decrease the heart rate, cardiac output, and blood pressure. There are 3 generations of beta blockers. The 3rd generation beta blockers are used as cardiovascular vasodilators , which reduce cardiac remodeling and cardiac failure³

Lifestyle modifications to improve energy levels

According to reports, certain lifestyle modifications can help improve your energy levels and lower the risk of developing other heart diseases and stroke, but are dependent on severity.. The following are some examples:

Nutrition: 

A healthy low-sodium diet and small, frequent meals. For example, the Dietary Approaches for Stopping Hypertension(DASH) diet, a vegetarian diet, or a Mediterranean diet is recommended if you have high blood pressure, diabetes, high cholesterol, and kidney disease. If you add fruits, vegetables, low-fat dairy, poultry, and beans to your daily meals, you can noticeably boost your energy levels. Maintaining such diets has also been associated with lower intake of salt, potassium, calcium, and fibre, which reduces hypertension and other conditions. Additionally, if you stop smoking, limit alcohol, and avoid diets rich in unhealthy fats, you can see a comparative rise in energy.⁶

Exercise:

The chances of developing diabetes and hypertension are significantly increased if you are obese or overweight in comparison to an individual whose body mass index is in the normal range. Furthermore, this can lead to an increased chance of developing Heart Enlargement.⁹ So, at least 30 to 50 minutes of moderate activity, 4 times a week such as walking, or moderate weight lifting, along with a healthy diet, notably improves your energy levels, strengthens your muscles and bones, reduces stress, and improves sleep if you have cardiomegaly. This can help you to maintain a healthy weight, without prolonging or developing the condition.⁷

Regular checkups:

Regularly checking blood pressure, blood glucose levels, cholesterol levels, and maintaining a healthy weight is also very important. By getting regular check-ups, you can reduce the risk of developing other heart conditions like angina, congestive heart failure, or stroke.

Sleep and rest:

It has been reported that at least 7 to 8 hours of undisturbed sleep daily in a quiet, dark room can help in revitalizing and maintaining your energy levels. According to a study, a good night's sleep is all you need to reduce fatigue and weakness, and invigorate energy, whilst also helping maintain your heart's function.⁸

Assistive tools and devices:

If you use a rolling walker or a cane, this can help conserve your energy levels while walking. Similarly, using a wheelchair or mobility scooter for independence can also help. A shower chair might help reduce exhaustion while bathing, and a stair lift helps in preventing exhaustion while climbing stairs. If you experience oedema in your legs or stockings, then compression stockings are recommended for you to improve blood circulation and reduce swelling and fluid build-up. Incorporating the use of new technological aids, for example, smart watches or activity monitors to track daily heart rate, blood pressure, oxygen saturation, and exertion levels, assists in monitoring and keeping a check on health.

Supportive strategies

Psychological support: 

It has been reported that you can manage stress through regular meditation and practicing yoga, which can help reduce or prevent anxiety and depression.⁸ Patient and caregiver education on symptom monitoring, dietary restrictions, and medication compliance is very important. Caregivers are crucial in recognising symptoms that may exacerbate the condition and must seek medical help immediately, once identified.¹ 

When to seek medical help

If you experience any of the following symptoms: increased shortness of breath especially when you are at rest or lying flat, irregular, rapid heart beat or chest pain, fainting or sudden dizziness, worsening fatigue, swelling in the legs, abdomen or ankles, or sudden weight gain, a drop or rise in blood pressure and or blood sugar levels, coughing up pink, frothy sputum, you must seek medical help immediately.

Summary

Fatigue and weakness due to heart enlargement are reported mainly because of reduced cardiac efficiency and oxygen delivery to organs and other parts of the body. Managing symptoms involves treating the underlying condition with medications, adopting heart-healthy lifestyle changes like a nutrient-rich diet, routine monitoring, maintaining blood sugar and blood glucose levels, incorporating supportive strategies, and recognizing warning signs early. By taking your prescribed medicines, maintaining a healthy, balanced diet, and receiving great supportive care, you may see a clear improvement in your energy levels and ability to perform daily activities.