The cardiomegaly It is the abnormal growth of the heart. It is not considered a pathology as such, but rather the clinical manifestation of some local or generalized disease. Depending on the entity that causes it, cardiomegaly can be temporary or permanent and mild or severe.
The enlargement of the heart does not always produce symptoms in patients. Some are even unaware of their illness and are only diagnosed accidentally. Others do have significant clinical signs, which are associated with irreversible heart damage..
The diseases that produce cardiomegaly are very varied. Most of these are concentrated in the cardiovascular sphere, but some other systemic or infectious can also cause cardiomegaly. As expected, treatment will depend on the cause and can be solely through medication, or even interventionist..
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Mild or transient cardiomegaly does not always present significant symptoms. The clinical manifestations usually appear when the heart has reached a very large size and its functional capacity is severely compromised..
Palpitations or irregular heartbeat are the first alterations caused by cardiomegaly. Elongation of muscle fibers and the cardiac nerve network may be the cause. The patient refers to feeling the heart "uncontrolled" or with beats that change rhythm occasionally.
It is not very intense but it is annoying. Its etiology is associated with small ischemic events due to the inability of the heart to irrigate its own blood vessels.
It is frequent that it occurs after an effort of variable intensity, but when it occurs at rest it is a sign of severe heart damage.
It is a typical symptom of heart failure associated with cardiomegaly. Like pain, it occurs after some physical activity.
It is common to find the patient panting, bent over, with one hand on his chest and showing that he is unable to breathe. Dyspnea at rest is common in very ill patients.
It is also directly related to heart failure. The improper handling of fluids that enter the heart causes them to leak and enter the lungs, irritating them and causing coughing. In very serious cases it can be accompanied by reddish expectorations due to the presence of blood.
The increase in volume or edema is another consequence of the mismanagement of fluids by the enlarged heart. Cardiac dysfunction causes slowed venous return and plasma leakage through vascular walls. It starts with swelling of the ankles and can progress to the abdomen.
Beyond shortness of breath, fatigue is a daily symptom in patients with cardiomegaly. Inadequate irrigation of the tissues involved in the movement appears to be the cause. It is accompanied by occasional pain in the legs and claudication.
There are two basic classifications for cardiomegaly. The first is a radiological classification, in which the size of the heart is related to the rest of the structures observed in a chest film. The second is based on the characteristics of the walls of the heart and its symptoms..
It is calculated with the following formula, using the measurements in centimeters that appear in the previous image:
Cardiothoracic index (CI) = A + B / C
Normal values will always be below 0.5 centimeters.
It includes any CI value above 0.5 but less than 0.6 centimeters. It is usually an occasional radiological finding.
Includes any CI value above 0.6 and less than 0.7 centimeters in adults. There may be symptoms of mild heart failure.
Values above 0.7 centimeters, but without the heart touching the rib wall.
Any size of the heart over 0.7 centimeters, but with the condition that the cardiac silhouette makes contact with the rib wall.
It is based on the thickness of the walls of the heart, although it depends primarily on the cause, the time of evolution and the patient's symptoms. The echocardiogram is essential for the diagnosis "in vivo" as well as the electrocardiogram.
As its name indicates, in this type of cardiomegaly the walls of the heart are thicker than normal, compromising the internal size of the cardiac chambers and their functioning..
In this case the walls of the heart are abnormally thin. When the heart muscle can no longer handle the normal pressures and volumes, it stretches and thus increases the size of its chambers. It usually occurs in chronic diseases.
Although most of the causes of cardiomegaly are of the cardiovascular sphere itself, there are many diseases that can cause it, including the following:
As the pressure in the arteries increases, the heart must work harder to pump blood. This causes it, like any muscle that makes repeated effort, to enlarge. Initially, it presents with hypertrophic cardiomegaly, but when it becomes chronic, the heart ends up giving way and dilating.
When any of the four valves of the heart fail, it does not carry out good blood flow management and can end up enlarging.
Valves can be damaged from birth due to congenital heart disease or as a result of infections, heart attacks, rheumatic fever, some drugs, or radiation therapy for cancer.
When the sac that surrounds the heart (pericardium) becomes inflamed or filled with fluid, it does not allow it to contract normally and, when overexerting, hypertrophy.
The decrease in hemoglobin or its defects causes an increase in the cardiac work and, therefore, its abnormal growth.
Chagas disease or American trypanosomiasis is a parasitic infection caused by the Trypanosome cruzi. This parasite travels in certain insects such as bed bugs or warblers, which when biting the human inoculate the trypanosome and it lodges in the cells of the heart, damaging them over time and causing irreversible cardiomegaly..
Other causes of cardiomegaly are thyroid disorders, connective tissue diseases, hemochromatosis and some diseases considered rare.
Although it is true that cardiomegaly is not a disease as such, there are common treatments for its relief while managing the cause that triggers it..
Antihypertensive drugs are the most common. Diuretics, calcium-antagonists, beta-blockers, digoxin, anticoagulants, and antiarrhythmics may also be indicated..
The pacemaker, technological equipment that provides an adequate rhythm to the heartbeat, is installed in patients whose heart no longer works as it should due to cardiomegaly.
Indicated to repair physical damage to the heart, such as a congenital abnormality, valve disease, coronary bypass and even heart transplantation.
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