1. DEEPIKA.R,
M . Sc Nursing II- year,
College of Nursing,
Madras medical college,
Chennai.
2. DEFINITION
Cardiomegaly, also known as
an enlarged heart, is a medical
condition in which the heart
becomes larger than its normal
size. It is often referred to
simply as “having an enlarged
heart.”
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3. The cardiac enlargement
process can be generalized
to all chambers or involve
only the left or right heart
chambers, or even a single
chamber, depending on the
location and type of
underlying lesion(s).
P R E S E N TAT I O N T I T L E
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5. The most common causes of cardiomegaly are
ISCHEMIC CARDIAC DISEASE AND
The ischemic cardiac disease occurs when
narrowed arteries, caused by fatty deposits that
build up in arteries, prevent blood from getting
to heart.
HIGH BLOOD PRESSURE.
CARDIOMYOPATHY
Cardiomyopathy may be a progressive cardiac
disease with several types. Diseases that damage
the cardiac muscle can cause it to enlarge. The
more damage that happens, the weaker and less
able to pump the heart becomes.
6. HEART VALVE DISEASE
Infections, connective tissue diseases, and a few medications can damage the valves
that keep blood flowing within the right direction through heart. When blood flows
backwards, the heart needs to work harder to push it out.
HEART ATTACK
During heart failure, blood flow to a part of the heart is blocked completely. the
shortage of oxygen-rich blood damages the heart muscle.
7. THYROID DISEASE
The thyroid gland produces hormones that regulate the body’s metabolism. Both
overproduction (hyperthyroidism) and underproduction (hypothyroidism) of those
hormones can affect the pulse rate, blood pressure, and size of the heart.
IRREGULAR CARDIAC RHYTHM (ARRHYTHMIA)
If you have an irregular heartbeat, rather than beating in its familiar lub-dub
pattern, the heart flutters or beats too slowly or quickly. An irregular cardiac rhythm
can cause blood to back up within the heart and eventually damage the muscle.
8. CONGENITAL CONDITIONS
Congenital cardiomegaly may be a heart disorder born with. Congenital heart defects
that cause this symptom to include:
Atrial septal defect (ASD), a hole within the wall separating the two upper
chambers of the heart
Ventricular septal defect (VSD), a hole within the wall separating the two lower
chambers of the heart
9. Coarctation of the aorta, a
narrowing of the aorta, the main
artery that carries blood from the
heart to the whole of the body
Patent ductus botalli, a hole within
the aorta
10. Cont,...
Ebstein’s anomaly, the issue with the
valve that separates the two right
chambers of the heart (atrium and
ventricle)
11. Tetralogy of Fallot (TOF), a mixture of
birth defects that disrupt the regular
flow of blood through the heart
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12. Lung disease, including chronic
obstructive pulmonary disease
(COPD)
Myocarditis
Pulmonary hypertension
Anemia
Connective tissue diseases, like
scleroderma
Drug and alcohol use
Other possible causes of cardiomegaly include:
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15. Development of cardiac remodeling and hypertrophy
with genetic and non-genetic components.
pathophysiological changes resulting in cardiomegaly include dilated hypertrophy,
fibrosis, and contractile malfunction.
Can cause cardiomyopathy or dilated cardiomyopathy.
Mechanical stretching, circulating neurohormones and oxidative stress are significant
changes in structural proteins and proteins that regulate excitation-contraction
cardiomyopathy mutations result in a molecular phenotype of hyperdynamic contractility,
poor relaxation, and increased energy consumption.
PATHOPHYSIOLOGY
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16. High blood pressure: Having a blood pressure measurement above 140/90 millimeters of
mercury.
A family history of enlarged hearts or cardiomyopathy: If an instantaneous loved one, like a
parent or sibling, has had cardiomegaly, you'll be more susceptible.
Congenital cardiac disease: If you're born with a condition that affects the structure of your
heart, you'll be at increased risk.
Heart valve disease: the heart has four valves — aortic, mitral, pulmonary and tricuspid that
open and shut to direct blood flow through your heart. Conditions that damage the valves may
cause the heart enlargement.
RISK FACTORS
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17. A chest X-ray could also be the primary test your doctor does because it can show whether your
heart is enlarged.
Echocardiogram (ECG or EKG) uses sound waves to look for problems along with your heart’s
chambers.
Electrocardiogram monitors the electrical activity in your heart. It can diagnose irregular cardiac
rhythm and ischemia.
Blood tests check for substances in your blood produced by conditions that cause cardiomegaly
like thyroid disease.
A cardiovascular test involves walking on a treadmill or pedalling a stationary bike while your
cardiac rhythm and breathing are monitored. It can show how hard your heart is functioning
during exercise.
DIAGNOSIS
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18. A cardiovascular test involves walking on a treadmill or pedalling a stationary bike while
your cardiac rhythm and breathing are monitored. It can show how hard your heart is
functioning during exercise.
Computerized tomography (CT) scans use X-rays to provide detailed images of your heart
and other structures in your chest. It can help diagnose valve disease or inflammation.
Magnetic resonance imaging (MRI) uses strong magnets and radio waves to provide pictures
of your heart.
DIAGNOSIS
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19. In pregnancy
During pregnancy, doctors can use a test called a fetal echocardiogram to
diagnose heart defects within the unborn baby. This test uses sound waves to
form pictures of the baby’s heart.
Your doctor might recommend a fetal echocardiogram if you've got a family
history of heart enlargement or heart defects, or if your baby has a genetic
disease like Down syndrome.
DIAGNOSIS
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21. Treatment of mild cardiomegaly centers upon the treatment of the underlying condition. In
moderate to severe cardiomegaly related to congestive heart failure, standard HF treatment
guidelines also apply
Patients at risk of cardiomyopathy have the benefit of risk factor modification like smoking
cessation, limiting alcohol intake, weight loss, exercise, and consuming a healthy diet.
Recommendations include treating any underlying risk factors like hypertension,
dyslipidemia, and diabetes.
Other underlying conditions, including obstructive sleep disorder, arrhythmias, anaemia,
and thyroid disorders also require treatment.
TREATMENT / MANAGEMENT
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22. Patients with early-onset hypertrophic cardiomyopathy who are asymptomatic are managed with
risk factor modification and also the addition of ACE inhibitor or ARB (if intolerant to ACE) and
β-blocker if there's a history of MI or reduced ejection fraction (EF).
Diuretics and salt restriction
Ace inhibitor or arb (if intolerant to ace) and beta-adrenergic blocker if they have reduced ef.
A hydralazine/nitrate combination when added to ace inhibitor, beta-adrenergic blocker, and
diuretics improve outcomes
TREATMENT / MANAGEMENT
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23. An ICD (implantable cardioverter-defibrillator) is placed in patients with EF 35%
CRT (cardiac resynchronization) is performed with or without ICD in patients with EF 35% or less
and moderate to severe symptoms with evidence of left bundle branch block
Patients with refractory congestive heart failure should receive optimal medical management. Also,
eligible patients are often considered for cardiac transplantation and bridge therapy like ventricle
assist device
P R E S E N TAT I O N T I T L E
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24. COMPLICATIONS OF AN
CARDIOMEGALY CAN INCLUDE:
Heart failure. An enlarged heart ventricle,
one among the most serious kinds of
cardiomegaly, increases the chance of heart
failure. In heart failure, your cardiac muscle
weakens, and also the ventricles stretch
(dilate) to the point that the heart can't pump
blood efficiently throughout your body.
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25. Blood clots. Having cardiomegaly may cause
you to more at risk of forming blood clots
within the lining of your heart. If clots enter
your bloodstream, they will block blood flow to
vital organs, even causing an attack or stroke.
Clots that develop on the right side of your
heart may travel to your lungs, a dangerous
condition called a pulmonary embolism (PE).
P R E S E N TAT I O N T I T L E
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26. Heart murmur. For people whose hearts
are enlarged, two of the heart's four valves
(the mitral and tricuspid valves) might not
close properly because they become
dilated, resulting in a backflow of blood.
This flow creates sounds called heart
murmurs. Although not necessarily
harmful, heart murmurs should be
monitored by your doctor.
P R E S E N TAT I O N T I T L E
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27. Cardiac arrest and sudden death. Sometimes
cardiomegaly can result in disruptions in your
heart's beating rhythm. Heart rhythms that are
too slow to move blood or too fast to permit the
heart to beat properly may result in fainting or,
in some cases, cardiopulmonary arrest or
sudden death.
P R E S E N TAT I O N T I T L E
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28. Eating a heart-healthy diet high in fruits and
vegetables, lean poultry, fish, low-fat dairy,
and whole grains
Limiting salt, alongside saturated and trans
fats
Avoiding tobacco and alcohol
Doing aerobic and strength-training
exercises on most days of the week
Checking your blood pressure and
cholesterol level regularly, and working
along with your doctor to lower them if
they’re high
prevention
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