Cardiomegaly

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Clinical-manifestations 4 Laboratory 5 Diagnostic-procedures 6 Radiology 7 Management 8 More General Terms 9 References

Introduction

• Enlargement of the heart.

Etiology

• cardiac chamber enlargement

• left ventricle

• chronic volume overload

• mitral regurgitation
• aortic regurgitation
• left to right shunt

• patent ductus arteriosis
• ventricular septal defect
• AV fistula

• cardiomyopathy ( congestive heart failure)

• ischemic
• nonischemic

• decompensated pressure overload

• aortic stenosis
• hypertension

• high output states

• severe anemia
• thyrotoxicosis

• bradycardia

• severe sinus bradycardia
• complete heart block

• left atrium

• left ventricular failure
• mitral valve disease
• atrial myxoma

• right ventricle

• chronic left ventricular failure
• chronic volume overload

• tricuspid regurgitation
• pulmonic regurgitation
• left to right shunt ( atrial septal defect)

• decompenstated pressure overload

• pulmonic stenosis
• pulmonary artery hypertension

• primary
• secondary

• pulmonary embolism
• chronic obstructive pulmonary disease

• right atrium

• right ventricular failure of any cause
• tricuspid valve disease
• atrial myxoma
• Ebstein's anomaly

• multichamber enlargement

• hypertrophic cardiomyopathy
• acromegaly
• severe obesity
• glycogen storage disease, type II (infants, children)

• pericardial disease

• pericardial effusion -> with or without pericardial tamponade
• effusive constrictive pericarditis
• pericaridal cyst or loculated effusion

• pseudocardiomegaly

• epicardial fat
• chest wall deformity

• pectus excavatum
• straight back syndrome

• low lung volumes
• chest X-ray (vs PA)
• mediastinal tumor or cyst

Clinical-manifestations

• point of maximum impulse may be > 10 cm from mid- sternal line or lateral to the mid- clavicular line
• point of maximum impulse may be > 3 cm in diameter
• point of maximum impulse may be lower than 5th intercostal space

Laboratory

• complete blood count
• chem 7
• liver function tests
• thyroid function test
• lipid panel
• atrial natriuretic peptide ( ANP)

Diagnostic-procedures

• electrocardiogram
• exercise stress testing or myocardial perfusion study to assess coronary artery disease

Radiology

• chest X-ray (also see heart)

• cardiomegaly may be incidental finding
• a cardiothoracic ratio of >= 0.5 on PA film (widest transverse dimension of cardiac silhouette)

• echocardiography
• radionuclide ventriculography
• computed tomography provides better indication of pericardial thickness than echocardiography
• coronary angiography (as late step in the evaluation of coronary artery disease)

Management

• treat specific etiology

More General Terms

• sign/symptom

References

1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
2. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999
3. O'Gara, PT, Cardiac Enlargement, in: Primary Cardiology, Goldman L & Braunwald E (eds), WB Saunders, Philadelphia, 1998, pg 174

cardiomegaly