Introduction

Similar to how muscles grow when you work them, the heart becomes larger when it is overworked. Advancements in pacemakers and medical devices can significantly impact patients with serious heart enlargement by improving their heart function. These devices can provide stabilised heart rhythms, ensuring optimum heart efficiency and consequently allowing a better quality of life.

Heart enlargement occurs when the heart becomes abnormally larger than normal, often indicating the presence of another underlying condition, such as high blood pressure or other heart conditions. Medical devices such as advanced pacemakers and cardiac resynchronisation therapy devices (CRT) have the unique ability to normalise irregular heart rhythms. It reduces the effort to pump blood to the rest of the body, allowing patients to return to their daily activities with ease.

This article will discuss the available treatment methods that can be used for treating heart enlargement, how these medical devices work, and whether this is a serious condition that needs more attention. 

Understanding heart enlargement

Heart enlargement, or cardiomegaly, is not a disease in itself, but an indicator of other underlying conditions affecting the individual’s health.¹ The heart is vital for pumping blood, oxygen, and nutrients across the body.² However, when the heart is stretched or thicker than usual, it induces more difficulty to pump blood to the rest of the body, potentially igniting complications.³ Therefore, the heart has no choice but to enlarge, to reduce the overload of pressure, and continue pumping blood adequately to the rest of the body.⁴

Heart enlargement typically involves either the entire heart, a side of the heart, such as the left or right or can be focused in a specific area, like the atria or the ventricles.⁴ Cardiomegaly does not necessarily cause life-threatening problems and is usually manageable.³ Depending on the causation, heart enlargement can be temporary or permanent, where instances like pregnancy can cause short-term stress on the heart.^3,5

How Does Cardiomegaly Occur?

Below are some of the main causes of cardiomegaly:

• Coronary artery disease: Increased fat deposits in the arteries can cause damage to parts of the heart muscle by blocking blood flow, subsequently causing cardiomegaly⁴
• High blood pressure (hypertension): The heart is forced to pump harder to compensate for increased pressures⁴
• Cardiomyopathy: A bundle of heart conditions that may cause heart enlargement due to damage to the heart⁴
• Anaemia: Low red blood cell count can be a reason for the heart to exert harder to pump oxygen throughout the body⁴
• Pericarditis: Is an inflammation in the membrane that surrounds the heart⁶
• Hemochromatosis: Excess absorbed iron that can cause an enlarged left ventricle of the heart⁷

Other causes: such as thyroid disorders, heart valve disease, congenital heart conditions and even infections like HIV.^4,5,8

Symptoms and risk factors

While many patients with cardiomegaly are asymptomatic, common noticeable symptoms can range from shortness of breath during rest, abnormal heart rhythms (arrhythmias), peripheral oedema, and palpitations.¹

Certain risk factors, including being inactive, having a family history of heart enlargement/ heart attacks, a history of hypertension, and drinking or smoking excessively, can increase the risk of cardiomegaly.³ While it has been established that an enlarged heart has various causations, where some are more dangerous than others, severe complications can occur if left untreated, such as blood clots, regurgitation, heart failure, cardiac arrest, and even death.⁵ Hence, patients must get urgent care with cardiomegaly, as this could lead to more serious consequences^.4

Treatment for cardiomegaly

Treatments for heart enlargement consist of medications, implantable devices, or surgical procedures as a last resort.³

Medications: Beta blockers, diuretics, ACE inhibitors, diabetic medications, blood thinners, or renin-angiotensin-aldosterone blockade may be prescribed by your doctor to help alleviate the intense workload on the heart.^3,4

Surgery: If medications and lifestyle modifications are insufficient to treat an enlarged heart, surgery may be a better option.⁵ These are specific to the type of cardiomegaly you have; however, revascularisation, heart valve repair, or coronary bypass surgery may be required.^3,5 Advanced treatment options such as implanting pacemakers or cardiac resynchronisation therapy could be useful if other methods are failing.^3,5

How pacemakers and cardiac resynchronisation therapy devices improve heart enlargement?

When the heart is not pumping enough blood to the rest of the body, a pacemaker can assist in this process.⁹ Pacemakers are implanted under the skin and near the collarbone for patients having issues with a regular heart rhythm, making it beneficial for patients with arrhythmias.^5,10]

Pacemakers have expanded in both advancement and range of devices, leading to better treatment and diagnosis monitoring.¹¹ An example is the biventricular pacemaker (CRT-P), which specifically targets the left and right ventricles of the heart to send electrical impulses, ensuring efficient contraction and avoiding heart failure.¹²

Implantable cardioverter defibrillator (ICD)

Similarly, to a pacemaker, an ICD can be implanted into the heart to normalise irregular heart rhythms through initiating low or high-energy shocks whenever required.^13,14 It has an additional feature to pacemakers to detect and avoid dangerously abnormal heart rhythms.¹⁵ An ICD delivers pacing, cardioversion, and defibrillation to restore the regular rhythm.¹⁵ The performance of your heart rhythm can be stored over time, which is crucial since the information can be collected by the doctor and used to assess the effectiveness of the therapy.¹³

While ICDs are greatly effective, a small percentage of 10% experienced interruptive or disturbing shocks from the ICD.¹¹ However, the benefits from an ICD preventing sudden cardiac arrest or arrhythmias outweigh this risk for patients.¹¹

Cardiac resynchronisation therapy (CRT) 

CRT is a powerful treatment option for patients with cardiomegaly and moderate to severe symptoms.¹⁶ It sends electrical impulses to the left and right ventricles to ensure the heart chambers on either side are in sync, hence, improving the efficiency of the heart pumping blood.¹⁶

There are two categories involved with cardiac resynchronisation therapy, these involve the implantation of the biventricular pacemaker, or the CRT-D, which is an implantable cardioverter defibrillator (ICD) joint in with the device, creating what is known as the CRT-D.¹² The CRT-D is similar to the biventricular pacemaker but can treat very fast paced heart rhythms and inhibit abnormal rhythms to restore regular pacing.¹²

Cardiac resynchronisation therapy (CRT) is a strong treatment for those with heart failure or cardiomegaly, although almost a third of patients have experienced no response to CRT.¹⁷

Left Ventricular Assist Device (LVAD) 

This device is often used as a bridge for heart transplant and is recommended for patients who are awaiting a heart transplant or are experiencing heart failure.⁵

Not enough research has gone into the surgical treatment methods of heart enlargement, including the incorporation of medical devices. While there is a global increase for the requirements of pacemakers, not every patient is receiving one.¹¹ Hence, further advancement in the cost-effectiveness and improvement in technology could enhance the accessibility of pacemakers for those with heart enlargement and other heart-related disorders.¹¹

FAQs

Can an advanced pacemaker help my enlarged heart?

Ensuring that your heart chambers are in sync will ensure an increased efficiency of the heart to pump blood to the rest of the body. Thus, reducing the load on the heart, which will subsequently restore the normal size of your heart over time.

Summary

Heart enlargement has various causes, engendering a complex condition to deal with. While lifestyle modifications and medications work for some patients, more serious cases require advanced interventions such as surgery and the implantation of medical devices. ICDs, CRT, and pacemakers can assist and monitor abnormal heart rhythms that could lead to cardiac arrest or even death. Lessening the load on the heart will increase its efficiency and hence, reduce heart enlargement, greatly improving patients’ lives.