Introduction

Enlargement of the Heart is also called cardiomegaly. An enlarged heart is not a disease in itself; it is a sign of other heart conditions. This is a reaction to other causes in which the heart takes more effort to circulate blood in your body, and may be temporary or permanent.

Heart damage as a result of myocardial infarction (MI) or a heart attack, and other diseases of the heart, can cause an enlargement of the heart. Family history may also play a role in increasing the risk of cardiomegaly.

Recent studies suggest that an enlarged heart is associated with a higher risk of sudden cardiac death. Enlargement of the heart can be serious and may result in congestive heart failure.

This enlargement may diminish over time, but many people with an enlarged heart will need lifelong medications to manage their condition.

In this article, you will learn about enlargement of the heart, associated causes and symptoms, and the importance of diet management to keep your heart healthy.

Symptoms of cardiomegaly

For some an enlarged heart may not cause any symptoms. Other, non-asymptomatic people might exprience symptoms such as:

• Shortness of breath while lying flat 
• Irregular heart rhythm 
• Swelling in legs, feet and abdomen 
• Dizziness
• Fatigue
• Low energy 
• Heart fluttering

Causes of an enlarged heart

Cardiomegaly can be caused by damage to the heart muscle or any condition that makes the heart pump harder than usual, including pregnancy. The most common cause of an enlarged heart is coronary artery disease (CAD), which is a clogging of the arteries supplying the heart muscle with blood, and if severe, can lead to a heart attack.

Other causes or associated conditions include:

• Congenital heart defect (CHD) 
• High blood pressure 
• Disease of the heart muscle (cardiomyopathy)
• Anaemia 
• Thyroid disorders 
• Pregnancy
• Fluid builds up in the sac around the heart (pericardial effusion)
• High blood pressure in the arteries in the lungs (pulmonary hypertension)
• Chronic obstructive pulmonary disease (COPD) 
• Excessive iron in the body 
• In some athletes, the heart becomes enlarged due to prolonged and frequent exercise; however, this is not considered a disease and doesn't require treatment²
• Viral infections
• Valvular heart disease
• Kidney failure 

Obesity and heart disease relation

According to the WHO, obesity is defined as abnormal, excessive fat accumulation in the body.

Someone who is classified as overweight or obese will be more at risk of developing conditions like high blood pressure and diabetes, both of which are risk factors for cardiovascular disease (CVD).¹

Obesity is a chronic complex disease defined by excessive fat deposits that can impair health.

Classification as overweight or obese is determined by weight proportional to height as calculated by the body mass index (BMI).

 A BMI higher than 30kg/m² indicates obesity.

Obesity is a major risk factor for cardiovascular disease and is associated with the development of heart failure, sudden cardiac death (SCD), atrial fibrillation and impacts overall survival.

Abdominal obesity, for which abdominal circumference is a marker, is an indicator of poor cardiovascular outcomes and increases the risk of all-cause mortality.

Weight loss and diet management can improve associated risk factors, reduce cardiovascular mortality, and reduce the risk of cardiomegaly by preventing CAD.

Why is diet important?

Obesity has become one of the most widespread public health problems worldwide.

Because of excessive fat accumulation, the heart needs to pump more than usual; weight loss can reduce this burden on the heart. 

A healthy diet may promote weight loss and lower the risk of heart attacks and strokes. A deficit in energy or caloric intake with low levels of fats and carbohydrates, if done safely and accompanied by exercise, is recommended to reduce the risks associated with obesity.

Heart healthy diet

 Consuming a heart-healthy diet can help maintain heart health and prevent the development of coronary artery disease and other associated conditions, and therefore cardiomegaly. 

Your doctor may suggest a diet plan known as the ’dietary approach to stop hypertension’ (DASH). DASH has been proven to lower high blood pressure and levels of ‘bad’ cholesterol in the blood.²

Limit your food intake

• Limit the quantity of food per serving on your plate
• Eat low-calorie, high-nutrient and low-sodium foods

Eat vegetables and fruits

Vegetables and fruits are a good source of vitamins and minerals, as well as low in calories and high in fibre

• Eat green leafy vegetables
• Eat fresh fruits instead of packed or canned fruits
• Drink juice of fresh fruits instead of packed juice or concentrate

Eat whole grains

• Whole grains are rich in fibre and nutrients
• Whole grains help control weight gain, blood pressure and are useful in maintaining heart health
• Add whole grain flour, barley, whole grain wheat bread, brown rice, or oatmeal to your diet

Choose low-fat protein sources

• Lean meat, poultry and fish, low-fat or fat-free dairy products, and eggs are the best sources of protein
• Choose fresh chicken instead of fried chicken
• Fish is often healthier than a high-fat meal
• Some fish - like salmon - are rich in omega-3 fatty acids, which can lower fats in blood called triglycerides, improving ‘good’ cholesterol and lowering ‘bad’ cholesterol⁶
• Other sources of omega-3 fatty acids include flaxseeds, walnuts, soybeans, and canola oil
• Legumes, beans, lentils, and peas are good sources of protein
• Eating plant-based protein instead of animal protein lowers the amount of fat and cholesterol in your body

Choose low-sodium food

• Low-sodium food items reduce the risk of developing high blood pressure 
• Herbs and spices are low in sodium 
• Eat fresh vegetable soups
• Eat fresh foods instead of packaged/preserved foods

Limit unhealthy fats

• Eat less saturated and trans fats to lower your risk of heart disease, lessening the risk of high blood pressure and ‘bad’ cholesterol buildup
• Avoid foods rich in saturated fats, e.g. butter, plant oils, processed meats and fatty meat cuts, and creams and cheeses 
• Avoid foods rich in trans fats, e.g. deep-fried foods and processed or baked treats
• Incorporate more vegetables, fruits, and nuts in your diet

Diagnosis and tests

Testing for cardiomegaly will start with discussing your symptoms and history, both personal and familial.

Your doctor may listen to your heart with a stethoscope to check for a murmuring sound.

If you have signs of heart failure, swelling in your legs, ‘crackle’ sounds in the lungs due to fluid buildup or engorged neck veins, your doctor may ask you to undergo a more thorough test to rule out enlargement of the heart and other conditions.¹

Some common cardiac tests include:

• Chest X-ray 
• Cardiac CT Scan 
• Transthoracic echocardiogram (TTE)
• Electrocardiogram (ECG)
• Stress test 
• Cardiac MRI (CMR) 
• Genetic testing 

Treatment

Your doctor may prescribe medications according to your signs and symptoms.

Your doctor may ask you to make amendments to your lifestyle such as quitting smoking, reducing salt intake in food, reducing alcohol intake, and controlling your fluid intake.

Common heart medications which may be prescribed to you include: 

• Antiarrythmics 
• ACE Inhibitors, e.g. ramipril, to treat high blood pressure
• Beta blocker,s e.g. propranolol to lower heart rate 
• Diuretics, e.g. furosemide, to help drain congested fluid

An especially severe case of cardiomegaly may need surgical treatment. Most commonly, surgery would involve replacement or repair of the valves of the heart affected, including the mitral and aortic valves, as these may become stenosed in cardiomegaly.

Summary

An enlargement of the heart above its normal size is also called cardiomegaly. Patients with cardiomegaly may experience a number of symptoms similar to those associated with heart failure and commonly require medical treatment to manage their condition. 

Obesity is a major risk factor for associated conditions like high blood pressure, heart failure, and coronary artery disease (CAD). These conditions, especially CAD, are in turn some of the biggest indicators for developing cardiomegaly.

To reduce the load on the heart, diet management is key for people with enlarged hearts. Small changes in food choices, such as following the DASH diet or generally avoiding foods rich in ‘bad’ cholesterol, can help keep your heart healthy.