Heart enlargement, which is also known as cardiomegaly, then your heart is larger than its normal size. This usually a sign that something is going wrong in your body and can be caused either directly conditions affecting the heart and the body system that transports blood around your body, or indirectly by a problem with other organs like your lungs (in cases with COPD), your kidneys (through chronic kidney disease), your thyroid, or your liver (for example, with liver cirrhosis).¹ 

Peripheral edema is when a part of your body builds up fluid that isn’t supposed to be there. It most commonly shows up as swelling in your hands, legs and feet. It is often a symptom of an underlying condition, and usually one of the unfortunate side effects of heart enlargement.² If both conditions are present, your treatment will require coordination across a team of healthcare professionals to ensure that you manage your condition as best as you possibly could.

How heart enlargement causes peripheral edema

The clearest link between the two can be seen in heart failure, a cardiac condition. This does not mean that your heart has stopped working, but rather that it is failing to pump blood as efficiently as it should. As a result, the body does not receive enough nutrients and oxygen, and waste removal through the veins is reduced. 

A few of the main reasons why this might happen include:

• Ischaemic heart disease - when parts of your heart tissue die (usually due to the lack of oxygen to them during a heart attack), disabling your heart from pumping enough blood out of it. Your heart compensates by growing to try to accommodate more blood to pump in and out of³
• Valvular heart disease - when the valves in your heart are abnormally narrow, commonly due to an infection, causing less blood to flow through the heart. Your heart compensates by growing to try to widen the passage the values are blocking
• Hypertension/High blood pressure - the high force of blood against the walls in your heart puts it under such duress that it grows to try to manage the load
• Obesity - leads to cholesterol accumulating in your blood vessels and heart, causing less blood to flow through⁴

To understand how cardiomegaly and edema are related, you need to understand the structure of your heart. The heart has four chambers: two atria (upper chambers) and two ventricles (lower chambers). During heart failure, one side of your heart won’t be able to pump blood effectively. In right-sided heart failure, this happens in your right ventricle, and leads to your left ventricle growing in size in an effort to compensate for the inefficiency on the right.⁵

As a consequence, fluid builds up in your veins and increases pressure in the small blood vessels called capillaries (the tiny blood vessels that control blood flow and nutrient and waste exchange between your body organs and tissues). So this leads to fluid leaking into your tissues and/or organs 

• When fluid collects in your arms and/or legs, this is called peripheral edema
• When fluid collects in your abdomen, it is called ascites⁶

If you have swelling or tenderness in your legs or arms, or you were told you have cardiomegaly, and you were told you have a heart condition, or a condition related to your liver or your kidneys, then you should see your doctor as soon as possible.

How to effectively manage peripheral edema in heart enlargement

Managing peripheral edema in people with cardiomegaly requires medication, lifestyle changes or enhancements, and check-ups to monitor their progress. The goal is to relieve symptoms to improve your quality of life, and treat the cause as best as you can. 

Medications

• loop diuretic (like furosemide) to manage the fluid buildup in your limbs by removing excess water. It is important to take your dosage exactly as it is prescribed to ensure it works effectively. This helps reduce the pressure in your blood vessels and your heart⁷ 
• In most cases, after the different tests to help diagnose you are conducted, it is heart failure that is the main cause. To treat heart failure, your doctor will give you ACE-inhibitors like lisonipril that will relax and widen your blood vessels to reduce the pressure in them, thereby making it easier for blood to flow and putting less strain on the heart
• There are other medicines that might be more suitable for you, such as beta blockers 
• If you are of African/Carribean/African American descent, then please note that ACE-inhibitors won’t be as effective in you, and your doctor should prescribe you medication that has a combination of hydralazine and a nitrate⁸ 

Check-ups every one to two weeks are important to monitor your: 

• blood pressure
• Electrolytes level 
• kidney function⁹ 

Lifestyle changes

To give yourself a better quality of life, it is important to make a few changes to your lifestyle.

• Reduce salt intake
• less than 5g a day for most people
• less than 2g a day for black people as they are more sensitive to sodium¹⁰ 

Less sodium is important because salt is an electrolyte in your body that controls blood pressure. Consuming high amounts of salt, which is typical in the Western diet, will work against your health. If there is more salt, your blood pressure is higher and you run the risk of overworking your heart and increasing the amount of fluid in your limbs¹¹

• If you don’t already, you could try to move around more, and if you are able, exercise more. Research shows that cardiovascular exercise, commonly referred to as ‘cardio’, like running, brisk walking, swimming, or aerobic exercise, reduces your risk of heart disease by strengthening your heart muscle, lowering your cholesterol levels which helps lower your blood pressure
• maintain a healthy weight¹²

FAQs

How do I know that I have an enlarged heart and peripheral edema?

 Your doctor may recommend you: X-Ray, Echocardiogram and ECG tests to see your heart size and how well it is functioning. 

Common symptoms include 

• chest pain 
• feeling breathless when lying down 
• heart palpitations(feeling like your heart is racing)
• arrhythmia( when you feel like your heart is skipping a beat or isn’t making the normal sounds it makes) 
• swelling in your legs¹

If you have peripheral edema, your doctor may diagnose you from examining your limb. You may already be experiencing a swollen, tight feeling limb, you may feel that it is a bit heavier than usual and you might find it difficult to walk. Your doctor might order tests such as an X-Ray, a D-dimer test and doppler ultrasound to rule out other serious conditions, before diagnosing you with peripheral edema.²

Are there any long-term side effects to using loop diuretics? 

Yes, there are side effects to using loop diuretics. Your risk of experiencing them increases with age, if you have diabetes, liver disease, kidney disease and electrolyte imbalances. It is incredibly important to show up for your regular check-ins and not miss any medications as you do not want to trigger any adverse effects from irregular use of your medicines. Some side effects include:

• Mild digestive disorders
• Visual disturbances
• Tinnitus
• Deafness
• Blood disorders
• High glucose levels⁹

Summary

Peripheral edema is a common sign that your heart is enlarged, and more accurately, there is something wrong with your circulatory system. Managing peripheral edema in patients with cardiomegaly or an enlarged heart is systematic and needs appropriate guidance due to a risk of side effects in high risk patients and different levels of sensitivities to medication in people. Lifestyle changes are an important factor, and patients must be monitored for any changes that might impact their health or affect the medication they take.