Sandhya Balaram, MD, associate professor or cardiovascular surgery at Icahn School of Medicine at Mount Sinai in New York City, says that “the heart changes shape to become more round and spherical and bigger than its normal size. If the heart muscle is failing and not working well, it’s the result of other problems in the heart causing it to become weak.”
While some people are born with genetic diseases that trigger this condition, it’s rare, says Dr. Balaram. Heart disease is the much more common reason for it – this could be due to blocked heart arteries, high blood pressure that has been left untreated, or long-term alcohol abuse.
Since an enlarged heart is a serious issue, patients will have symptoms well in advance. The most common signs are fatigue, shortness of breath, and swelling of the abdomen or legs due to fluid retention.
Breathing issues might be particularly noticeable at night when you’re laying down. This is because the heart is struggling to pump well so fluid starts to back up into the lungs, making it harder to breathe. “The heart and lungs are closely related, they’re married, so when the heart has trouble then the lungs have trouble too,” Dr. Balaram says.
Other signs that indicate that something isn’t right include, weight gain without a change in diet or exercise, coughing, chest pain, fainting, or dizziness.
There are different degrees of symptoms, depending on the person, but shortness of breath and fluid retention are the most common. These typically come out of nowhere and persist.
Once an enlarged heart is detected, there’s treatment to relieve the symptoms and help the heart pump better, but there’s no fix. “Medical treatment doesn’t make the heart stronger, it just helps the heart work a little better,” says Dr. Balaram.
Some doctors might recommend surgery to treat the underlying cause of the enlarged heart – such as clogged arteries or a valve problem – and the last resort is a heart transplant. “Usually, it’s just controlling the symptoms and seeing how the muscle does over a period of time,” says Dr. Balaram. “We keep up with the patient in terms of how it looks, and then plan further treatment from there."