Cardiomegaly. Causes and prevention

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Cardiomegaly is a disease accompanied by an increase in the size and weight of the human heart. The disease is otherwise called “bull heart” syndrome (due to the large key parameters of the myocardium).

It may have a congenital form or be an independent disorder that manifests itself as a result of pathologies of the heart and blood vessels.

Causes of cardiomegaly

Cardiomegaly in the fetus and newborns is called congenital or idiopathic.
Its cause is a hereditary predisposition to the disease. The prognosis for this form of the syndrome is unfavorable. Acquired cardiomegaly in children and adults is a consequence of health problems such as:

• arterial hypertension;
• heart defects;
• cardiac ischemia;
• emphysema;
• myocarditis;
• pneumosclerosis.

It should be noted: the disease cardiomegaly is not always associated with pathologies of the cardiovascular system. It can be caused by disturbances in the functioning of other organs.

Who diagnoses the disease and how

As a rule, pathology is diagnosed randomly. An enlarged heart in a child is usually detected on x-ray. The resulting image clearly shows the increased size of the main vital organ.

Some changes can also be seen on a cardiogram or echocardiogram. At the same time, the little patients themselves do not experience any unpleasant sensations or discomfort. Such a diagnosis is made against the background of sports activity or other diseases.

If complaints arise and the doctor purposefully orders an X-ray diagnosis of an enlarged heart in a child, then the prognosis is usually unfavorable. This indicates a deterioration of the condition, a severe course of the disease, which in a complicated form can be fatal.

You can perform timely diagnostics at JSC “Medicine”. The clinic is located in the center of Moscow at the address: 2nd Tverskoy-Yamskaya Lane, 10. You can get to it from the metro stations: Mayakovskaya, Belorusskaya, Novoslobodskaya, Tverskaya, Chekhovskaya.

Symptoms of cardiomegaly

Cardiomegaly is a clinically hidden syndrome. It is always disguised as signs of other diseases or occurs without obvious symptoms. In most patients, cardiomegaly manifests itself:

• tachycardia;
• pain in the heart area;
• shortness of breath;
• increased fatigue;
• peripheral edema;
• orthopnea.

Most often, the disease is discovered accidentally in adults during a regular medical examination.

If you notice similar symptoms, consult a doctor immediately. It is easier to prevent a disease than to deal with the consequences.

General information about pathology

Cardiomegaly is often called a “bull” heart due to a noticeable increase in the shape and size of the organ, the mass of which is constantly growing.

In medical practice, pathology is not considered an independent disease, but it develops against the background of existing malfunctions in the functioning of the heart muscle. According to WHO, the frequency of diagnosis of heart disease is 3-10 recorded cases per 100 thousand patients.

The main danger of cardiomegaly is associated with disruption of the normal mode of pumping blood through the vessels due to the expansion of the chambers. As a result, organs and tissues suffer from a lack of nutrients, and the heart rhythm is disrupted, provoked by oxygen starvation.

In addition, the risk of thrombosis increases, which can result in death, especially if the left ventricle is hypertrophied.

Doctors detect a dangerous pathology in a standard X-ray image taken in two projections - frontal and lateral. An X-ray shows an increase in the volume of all organ cavities; in some cases, the volume of the ventricles or atria can stretch more than 2 times.

Pathological changes are accompanied by signs of hypertrophy and thickening of muscle structures.

The consequence of myocardial transformation is impaired functional ability, the appearance and progression of heart failure. Using an x-ray, the doctor also has the opportunity to assess the condition of the pulmonary vessels, diagnose pulmonary hypertension, heart disease (congenital), and the degree of damage to the valve structure.

A false diagnosis of cardiomegaly cannot be ruled out. The reason may be due to mediastinal overlays (pericardial cyst), creating the illusion of an enlarged organ or its parts.

Differential diagnosis of cardiomegaly

To identify “bull heart” syndrome (as cardiomegaly is informally called), cardiologists use the following diagnostic methods:

• palpation of the cardiac region, listening to the heart;
• CT scan;
• echocardiography;
• Ultrasound of the heart;
• ECG;
• chest x-ray;
• blood analysis;
• biopsy (taking a tissue sample from the inner surface of the ventricles of the heart) is extremely rare.

A doctor may suspect cardiomegaly if he detects heart murmurs characteristic of this disease and protrusion of the organ upon palpation. Quite often, changes in size are visible on x-rays. But the most reliable information for cardiomegaly is provided by ultrasound.

Examination methods

Diagnosis of cardiomegaly begins with a physical examination of the patient. The doctor notes that the skin is pale, shortness of breath appears, and swelling appears. When the heart muscle is weakened and overall circulation is impaired, heart murmurs and congestive sounds in the lungs are heard. Then hardware diagnostic methods are used and laboratory tests are carried out.

X-ray

The radiograph has now been replaced by the chest x-ray. It allows you to see if there is a change in the size of the heart, and to calculate the ratio of the width of the shadow of the heart to the width of the sternum (the norm is up to 50%).

The overall picture shows blockages in the blood vessels of the lower parts of the lungs, pathology of the aorta and pulmonary arteries.

Electrocardiography

ECG serves as an auxiliary method that provides additional information. The images show thickening of the walls of the ventricles and atria, ischemia, scar changes after a heart attack, thinning of the heart muscle, as well as areas affected by cardiosclerosis.

Echocardiography

EchoCG is performed to study the anatomical features of the heart. This method also allows one to evaluate its function and explain the cause of the pathology. An echocardiogram shows the exact dimensions of the ventricles, valve apparatus and movement of the valves.

Catheterization of cardiac cavities

This method is used to prepare the patient for surgery. It allows you to assess hemodynamics and the degree of blood regurgitation. At the same time, coronary angiography is performed to study the patency of the coronary arteries.

Lab tests

Additional tests may also be required as part of the diagnosis of cardiomegaly:

• general and biochemical blood tests;
• lipid analysis;
• rheumatoid factor analysis;
• testing hormone levels;
• culture of bacteria (to detect infection).

Treatment of cardiomegaly

Treatment of cardiomegaly (with the exception of bull's heart syndrome in newborns) begins with eliminating the causes that caused the disease. Both drug therapy and surgical methods can be used here. For example, for arterial hypertension, medications reduce blood pressure, and for kidney disease, they remove excess fluid from the body. If cardiomegaly is caused by damage to the heart valves, a cardiac surgeon

restores them surgically.

In situations where the cause of the pathology is drugs or alcohol, the patient’s condition will improve only if he gives up the bad habit. Treatment results directly depend on the stage and causes. Some patients manage to recover completely, others have to take medications for the rest of their lives. In severe cases, a heart transplant is performed.

Clinical manifestations

Obvious symptoms of cardiomegaly are often absent or masked by the manifestation of other diseases that cause heart enlargement. Typically, when visiting a doctor, the patient reports only typical cardiac symptoms.

Symptoms in adults

It is impossible to diagnose cardiomegaly at home. However, a person should be alert to the following changes in their health:

• severe fatigue;
• shortness of breath after exercise;
• rapid pulse;
• shortness of breath at night;
• abdominal enlargement;
• swelling of the veins in the neck;
• ankle swelling;
• feeling of heaviness in the right side of the ribs.

All of these symptoms may indicate right or left ventricular failure. The sooner a person gets to the hospital, the greater the chance of starting treatment in the early stages of the disease and not taking only medications.

Signs of illness in children

A small child, especially an infant, cannot express his symptoms, but childhood cardiomegaly has an unfavorable course. Timely diagnosis of serious pathology directly depends on the attention of parents. They should be vigilant if the child:

• fast, shallow breathing;
• pale skin with a blue tint around the mouth and nose;
• Poor appetite;
• edema;
• increased sweating;
• rapid pulse.

Prevention of cardiomegaly

Since cardiomegaly (with the exception of the congenital form) is not an independent disease, prevention is aimed at preventing the development of provoking diseases. It is important to exclude risk factors that lead to increased blood pressure, coronary heart disease, and lung problems. It is also necessary to give up smoking, drugs, and alcoholic beverages.

Prevention of congenital cardiomegaly includes:

• registration before 12 weeks of pregnancy;
• compliance with medical recommendations;
• rejection of bad habits;
• eating only healthy foods.

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.

Bovine heart disease (cardiomegaly)

All information is provided for informational purposes only and does not constitute medical advice. The system, methods, methods of treatment, necessary medications can only be prescribed by your attending physician.

This is not about the heart of a bull. This is the medical name for the human heart, which, for a number of reasons, increases in size. According to scientific terminology, this condition is called cardiomegaly. An enlarged heart is accompanied by other pathological changes.

Causes

The size of the heart depends on age, gender, and individual characteristics. As your weight and height increase, your heart also increases in size. The average man has more than the woman.

Here are the heart sizes in different age categories:

It should be noted that these indicators are averages and differ slightly in different sources. We can talk about cardiomegaly only in cases where the size significantly exceeds the norm.

Cardiomegaly is not an independent disease, but a syndrome, a set of pathological changes in the heart. It is a consequence of both cardiovascular and extracardiac or extracardiac diseases.

Specific causes of this condition:

• Hypertonic disease.
• Heart rhythm disturbances
• Sclerotic changes in the myocardium in systemic atherosclerosis and cardiosclerosis.
• Inflammatory diseases of the myocardium – myocarditis.
• Acquired heart defects due to endocarditis, inflammation of the inner lining of the heart (endocardium).
• Rheumatism, systemic lupus erythematosus, and other systemic connective tissue diseases.
• Endocrine disorders - diabetes mellitus, increased or weakened thyroid function, diseases of the adrenal glands.
• Metabolic disorders - gout, obesity, vitamin deficiencies.
• Blood diseases manifested by anemia or thickening.
• Chronic pulmonary pathology – chronic obstructive bronchitis, emphysema, pneumoconiosis.
• Malignant neoplasms.
• Liver and kidney failure.
• Taking a number of certain medications, in particular antitumor and sleeping pills.
• Occupational hazards.
• Alcoholism.

An increase in heart size can also be physiological. In athletes, systematic exercise with increased stress on the heart leads to its increase over time. However, with the wrong sports regimen, frequent intensive training, the phenomenon of overtraining occurs. An enlarged heart in this condition acquires pathological features.

Another example is pregnancy. A woman must supply blood to both herself and her unborn child. Therefore, the circulating blood volume (CBV) and heart mass increase. However, during pregnancy, blood pressure (BP) often increases, the functioning of internal organs is disrupted, and chronic diseases become aggravated. All these pathological factors also lead to heart enlargement. In some cases, the cause of heart enlargement cannot be determined. Then they talk about idiopathic cardiomegaly.

In newborns and young children, congenital cardiomegaly is usually diagnosed. It is mainly caused by congenital heart defects. Heart defects are often associated with infections suffered during pregnancy and bad habits of the expectant mother. Gene-chromosomal disorders may also be the cause. In these cases, heart enlargement is often associated with other congenital anomalies.

Mechanism

The size of the heart is influenced by two factors - the thickness of the myocardium and the size of the chambers, atria and ventricles. The thicker the myocardium, and the larger the volume of the chambers, the larger the heart. Consequently, when the myocardium thickens (hypertrophy) or the atria and ventricles expand (dilate), the heart will enlarge. As for the bovine heart, both mechanisms are involved, dilatation and hypertrophy.

The exception is cardiac aneurysm. This condition is characterized by thinning and protrusion of the myocardium. Because of this, the heart increases in size. A cardiac aneurysm develops after a heart attack.

In general, with each disease, the formation of the bovine heart has its own characteristics. An example is hypertension. An increase in blood pressure is accompanied by an increase in the load on the left ventricle, and here the myocardium hypertrophies. Over time, excess blood filling of the left ventricle leads to its dilatation.

Approximately the same picture is observed in kidney diseases, metabolic disorders, accompanied by water retention in the body. The smaller the volume of urine excreted, the greater the volume of blood volume, and the greater the volume load on the left ventricle.

In many cases, the expansion of the heart occurs primarily due to the left ventricle. Although this is not always the case. With stenosis (narrowing) of the aortic valve, blood is retained in the left ventricle and atrium, which leads to their dilatation and hypertrophy. This is accompanied by stagnation in the pulmonary (pulmonary) circulation. As a result, the right ventricle undergoes similar changes, and then the right atrium.

In case of lung diseases, the so-called cor pulmonale, when the right chambers of the heart hypertrophy and dilate. Myocarditis is accompanied by thickening of the inflamed myocardium, and, as a result, an increase in the size of the heart. With rheumatism, both the myocardium and the heart valves suffer. Therefore, here the thickening of the heart muscle is accompanied by dilatation of the heart chambers, caused by valve defects.

Many pathological conditions are accompanied by myocardial dystrophy (myocardial dystrophy):

• Coronary heart disease with cardiosclerosis.
• Chronic diseases of internal organs.
• Metabolic disorders.
• Anemia.
• Infections
• Intoxication with industrial poisons, drugs, alcohol.

Dystrophic changes in the heart muscle occur due to disruption of its nutrition and blood supply, or the direct effect of toxic substances. Such myocardium cannot fully contract. The heart fills with blood and dilates. In order to somehow cope with its functions, the heart muscle thickens. Both dilatation and hypertrophy lead to an enlarged heart.

Pseudocardiomegaly

This is false cardiomegaly. Here the heart shortens in the anteroposterior or vertical plane, and enlarges in the facial (frontal) plane. In this case, the original volume and dimensions of the organ remain the same - only its configuration changes.

This picture can be observed in hypersthenics. A feature of this body type is the characteristic stockiness, strength of bones, and relatively large transverse dimensions of the body. Due to the high position of the diaphragm in a hypersthenic person, the heart seems to spread out over it and looks larger.

The same is true for a high position of the diaphragm, caused by diseases of the abdominal organs with an increase in intra-abdominal pressure. In pregnant women, the diaphragm is also displaced, and cardiomegaly is both true and false.

In some patients, the thoracic lordosis, the physiological posterior curvature of the spine in the thoracic region, is smoothed (straight back syndrome). In those suffering from this type of vertebral curvature, the heart is compressed by the relatively straight spine and expands in the frontal plane.

Cardiac tumors are not encountered in clinical practice. But a tumor of the mediastinum, the lung, can compress and displace the heart. Another reason may be associated with the accumulation of effusion in the pleural cavity during exudative pleurisy. Since pleurisy mainly affects the right lung, the heart will shift to the left.

Exudative pericarditis is an accumulation of effusion in the cavity of the heart sac, pericardium. Here, too, the heart will look enlarged, but not due to hypertrophy and dilatation, but due to the presence of an inflammatory effusion.

Symptoms

The bovine heart cannot cope with its pumping function. Therefore, signs of heart failure, which can have varying degrees of severity, come to the fore. Depending on which parts of the heart are predominantly affected, heart failure can be left ventricular, right ventricular, or mixed.

Left ventricular failure occurs with impaired circulation in the pulmonary circulation. Patients will complain of shortness of breath and palpitations, which worsen with physical exertion.

Right ventricular failure is characterized by stagnation of blood in the systemic circulation. Swelling of the legs and feet occurs. In advanced stages, the liver enlarges and free fluid accumulates in the abdominal cavity. The skin and visible mucous membranes are pale or bluish.

Patients complain of chest pain. It can be burning, stabbing, or on the contrary, dull, diffuse. The rest of the symptoms depend on the disease that caused the cardiomegaly.

Diagnostics

A preliminary diagnosis is made based on complaints and examination of the patient, and data from auscultation (listening) of the heart. During auscultation, attention is drawn to dullness of tones and arrhythmia. Often the tones are split - instead of a two-member tone, a three-member tone is determined (quail rhythm, gallop rhythm). The first sound at the apex of the heart is weakened and shifted to the left. The apical impulse is also shifted to the left. It is felt as a pulsation when palpating the left half of the chest just below the nipple.

Congenital defects, myocarditis in children occur with the formation of the so-called. heart hump. An enlarged heart deforms the chest. It also increases, protrudes in the sternum, in the projection of the heart. The presence of a heart hump in children is a clear sign of cardiomegaly.

Once upon a time, back in the pre-instrumental era, along with auscultation and palpation, percussion of the chest was performed. The doctor tapped the chest with his finger, like a hammer. In the projection of a dense heart compared to the lungs, the percussion sound was dulled. This is how the doctor determined the right, left, and upper border of the heart. Now percussion is rarely used in clinical practice.

Bovine heart can be diagnosed using a routine plain chest x-ray. The X-ray clearly shows an enlarged, deformed shadow of the heart.

To exclude pseudocardiomegaly, chest radiography is performed in two projections.

However, complete information can only be obtained using echocardiography (ultrasound of the heart). Here the sizes of the heart chambers, the thickness of the myocardium, the duration of the phases of the cardiac cycle, and other indicators are determined.

Treatment

Therapeutic tactics depend on the causes of bovine heart. If it is caused by ischemic heart disease or hypertension, antihypertensive and blood pressure-lowering drugs are prescribed. Beta blockers, angiotensin-converting enzyme inhibitors, sartans, not only reduce blood pressure, but also partially eliminate myocardial hypertrophy.

For symptoms of heart failure, cardiac glycosides are indicated - digitalis (digitalis) preparations. But these drugs are prescribed only by a doctor and taken under medical supervision.

For myocarditis, antibiotics, anti-inflammatory drugs, and immunostimulants are prescribed. For myocardial dystrophies, vitamins and restoratives are indicated. Mildronate (Meldonium) has proven itself well as a drug that improves myocardial nutrition.

For systemic connective tissue diseases, non-steroidal anti-inflammatory drugs and drugs for specific treatment aimed at suppressing excessive immune activity are indicated.

For decompensated defects, especially in children, valve replacement surgery may be necessary. For patients with bull's heart, proper rest and giving up bad habits are important.

Material prepared by: Anesthesiologist-reanimatologist Andrey Anatolyevich Dotsenko
Last modified: 2020-07-21 Date of writing: 2019-10-31

Forecast

It is impossible to completely cure the problem of myocardial failure, and the development of heart failure often ends in death. Properly prescribed therapy only helps to improve the patient’s quality of life.

It is quite difficult to accurately predict the consequences of a bull's heart. It is necessary to take into account the general health of the patient, the severity of the underlying disease, as well as the adequacy of the prescribed treatment.

Congenital cardiomegaly is considered the most life-threatening type of disease; its prognosis is unfavorable. But to save life, treatment must begin immediately after the initial symptoms of the acquired syndrome are detected on an x-ray. In this case, the likelihood of slowing down the hypertrophic process and reducing the risk of complications increases.

How the heart enlarges

Despite the abundance of reasons that cause the development of cardiac pathology, the formation of a “bull’s heart” occurs according to one of the scenarios.

• The first way. The provoking factor is hypertension. Pathological changes in the tissues of the valves result in hemodynamic failure. As a result of increased resistance of the vessel walls, blood cannot move freely in the desired direction. This leads to an increase in the strength of heart contractions and the growth of muscle fibers, which ultimately ends in hypertrophy. Progressive changes spread throughout all chambers, triggering the development of cardiomegaly.
• Second way. The syndrome is provoked by signs of myocarditis or cardiomyopathy. Due to ongoing tissue inflammation (myocarditis) or abnormal size and volume of the myocardium (cardiomyopathy), the heart muscle undergoes thickening. Over time, all organ cavities are involved in the pathological process, the structures of which suffer from intoxication. The result is the appearance of hypertrophic changes, which cause cardiomegaly.

The formation of a large mass of the main organ in an adult occurs under the influence of various types of pathologies. If you do not begin timely treatment of the problem, its progress threatens total hypertrophy.