Introduction

What is an enlarged heart?

Cardiomegaly is the medical term for an enlarged heart and occurs when your heart becomes bigger than it should be. This occurs because the heart walls become thicker as they are overworked. It can also occur because the chambers (which hold the blood) become larger, a function where your heart tries to compensate against a weak heartbeat.¹

What is an implantable cardioverter-defibrillator (ICD)?

An ICD is a small device that controls your heartbeat. It is especially for those who have irregular heart rhythms and acts as a replacement for the original pacemaker in your body, called the sinus node. A pacemaker is responsible for supplying electrical activity to allow the heart to beat in an orderly fashion. The goal of an ICD is to prevent life-threatening heart complications that may lead to cardiac arrest. (²

What happens when the heart becomes enlarged?

How does the heart become enlarged?

If your heart is working harder than it should be, it causes your heart to grow in size. Think of this like working out in the gym, the more you lift weights the bigger your biceps will get. Muscle growth will also occur when your heart is given a greater workload. The difference is that growing biceps means you become stronger, but for the heart, this could not be more different. Stretched and thickened heart muscles make them less efficient at pumping blood, so the heart becomes weaker.

There are several disorders that can cause your heart to become enlarged:³

• High blood pressure – Increased pressure means the heart must work harder. Think of this as if someone were to squeeze a drinking straw; you would have to work harder to keep drinking.
• Coronary heart disease – Blocked or narrowed blood vessels mean the heart must pump with more force to push the blood through the affected area
• Heart valve problems – Similar to coronary heart disease, when the heart valve becomes damaged, your heart must pump harder to push blood through your body
• Heart failure – When your heart can no longer pump blood effectively, it compensates by enlarging the chambers, which makes the condition worse as your heart becomes even weaker
• Congenital heart disease – these are conditions that you have from birth, and a number of these diseases can lead to your heart growing
• Pulmonary hypertension – The right side of your heart pumps blood into the lungs to get oxygen. If there is high pressure in the blood vessels around the lungs, the right side of the heart will have to work harder, eventually enlarging
• Thyroid problems – The thyroid can be overactive or underactive, both can cause the heart to beat too slow and too fast
• Cardiomyopathy – This is a disease caused by multiple factors, like excess iron intake and infection

How does an ICD work for heart enlargement?

What does an ICD do?

The ICD is a battery-operated device that is placed under the skin just below the collarbone. There can be one or more wires which run from the ICD into the heart via your veins. At the end of each wire is an electrode, which is responsible for measuring the electrical activity of your heart when it beats. This offers constant monitoring of your heartbeat. ⁴

How does the ICD Manage heart enlargement?

The greatest risk factor for heart enlargement is sudden cardiac arrest (the heart stops beating). ⁵ Prior to this, your heart will show minor warning signs such as irregular rhythms. An ICD is therefore an excellent device, simply because as it detects these warning signals, it will attempt to correct them by sending small shock signals to the heart. If this does not work, a larger shock will be given called the defibrillator, which corrects the heart rhythm.⁶

You can feel confident that your ICD has your case of heart enlargement under control. This takes a large amount of pressure off you and hopefully lifts your quality of life. This management is made even more effective since the ICD has its own database specific to you. Every time it intervenes with your heart, it will record the heart rhythms. This makes it easier for medical professionals to track your condition and make any critical adjustments to prevent serious problems from occurring. This offers you that extra safety for peace of mind. ⁷

Complications and limitations

The main complications to consider are from the surgery itself. More common complications are:

• Infection where the implant has been placed
• Allergic reactions to medication
• Bruising and bleeding
• ICD leads can cause damage to the veins they are placed

Less common are:

• Deep vein thrombosis, which in this case will often occur in the upper half of the body
• Internal bleeding around the heart
• Collapsed lung (pneumothorax)

It is important for you to be aware that complications may occur that are not linked to surgery. It has been known that sometimes the ICD can cause you to feel the shocks it is giving; in this case, you are advised to contact your doctor to adjust the ICD.⁸ Additionally, you should not partake in heavy contact sports such as rugby and weightlifting. This limitation is to prevent any leads connected to the ICD from becoming displaced.¹

A more psychological limitation of an ICD is that you may notice yourself becoming more anxious than previously. This might be because you are self-conscious about the implant being visible under the skin, or in case something goes wrong with the ICD itself. Rest assured, you can always arrange an appointment with your doctor to manage your heart enlargement and adjust the ICD to suit your case. Don’t suffer in silence, talk to your loved ones or medical professionals. This will allow you to realise that the ICD benefits far outweigh its appearance and that those around you would much prefer your heart enlargement to be under control.¹

The benefits of an ICD for people with an enlarged heart

We have already discussed how accessible management is for heart enlargement when you have an ICD, but what does this actually mean for you long-term? The data drawn from your own ICD can be used, alongside others, to further perfect treatment for heart enlargement, as it increases understanding of the disorder. This must give you a sense of comfort and satisfaction, as you have given back to an area of research that has directly affected you. Research can only increase the chances of you having more effective treatment if you were to ever need it in the future. This feeds back to your peace of mind and safety being a priority here. You can resume normal life as it were, taking brisk walks, partaking in non-contact sports, traveling, and most importantly, seeing loved ones without worrying about your unstable heart rhythms.⁹

Summary

An implantable cardioverter-defibrillator (ICD) is a life-enhancing device if you are suffering from heart enlargement. Heart enlargement, medically known as cardiomegaly, is a condition where your heart grows in size. It may be surprising, but this makes your heart weaker and less effective at pumping the all-important blood around your body. As a result, other complications may creep up, such as irregular heart rhythms and, in more severe cases, sudden cardiac arrest.

ICD is a treatment that helps manage these irregular heart rhythms, which reduces the risk of sudden cardiac arrest. It closely monitors the heartbeat and intervenes using shocks to correct any abnormal heart rhythms. These tiny wires measure your heart and allow the ICD to collect data over time, which allows the treatment to be adjusted specifically to your case of heart enlargement. The doctor can see how your heart is beating over a period which gives them better control over your condition.

This life-saving device does all the work for you, which gives peace of mind and confidence in your heart, keeping you alive. Living with an ICD can allow you to live what you knew life to be before heart enlargement. You feel empowered and can now enjoy a healthy quality of life with that extra assurance of your safety.