Enlarged heart: symptoms, causes and treatment

Many people with an enlarged heart due to cardiomyopathy might not notice any symptoms at first, says the BHF. The most common symptoms of dilated cardiomyopathy are tiredness, chest pain, shortness of breath, swelling of the feet, ankles, stomach and lower back, and palpitations (feeling your heartbeat pounding or beating more quickly than usual). They often develop slowly and can usually be controlled with medication and other treatments after diagnosis.

The BHF lists very similar symptoms for hypertrophic cardiomyopathy and adds light-headedness and fainting. If the heart is struggling to pump, you may develop heart failure. The NHS says symptoms of heart failure include feeling out of breath when doing everyday activities or lying down, feeling weak, light-headed or very tired, swelling in your feet, ankles, legs or tummy, sudden weight gain, coughing at night and coughing up frothy pink phlegm.

• Tiredness and feeling weak.

• Shortness of breath, including when lying down.

• Swelling of the feet, ankles, legs or tummy.

• Palpitations, light-headedness or fainting.

• Chest pain.

• Sudden weight gain, or a cough at night.

The cause depends on which part of the heart is affected. For many people with dilated cardiomyopathy the cause is unknown, says the BHF; for others it runs in families because of a change in one or more genes. It can sometimes be caused by a heart valve problem, a viral infection that inflames the heart muscle, a heart attack, congenital heart disease, drinking too much alcohol, using recreational drugs, use of some cancer medications, or pregnancy if it causes peripartum cardiomyopathy.

The NHS adds that dilated cardiomyopathy can involve uncontrolled high blood pressure, an underlying disease of the tissues or blood vessels such as sarcoidosis, amyloidosis or lupus, and that peripartum cardiomyopathy is rare and sometimes develops during pregnancy or within 3 months of the baby's birth. In hypertrophic cardiomyopathy the NHS says the heart muscle cells enlarge and the walls thicken, and most people inherit it from their parents.

The NHS lists high blood pressure and coronary heart disease among the causes of long-term strain on the heart that can lead to heart failure, along with heart valve disease, cardiomyopathy, heart rhythm problems, chronic kidney disease, anaemia, haemochromatosis and thyroid problems.

An enlarged heart describes a heart that has become bigger than usual. The sources reviewed describe it through the conditions that cause it: in dilated cardiomyopathy, the BHF says the enlarged muscle walls give the heart a rounder shape instead of its usual cone shape, while in hypertrophic cardiomyopathy the muscle wall thickens.

The NHS describes cardiomyopathy as a general term for diseases of the heart muscle, where the walls of the heart chambers have become stretched, thickened or stiff, which affects the heart's ability to pump blood around the body.

The NHS says cardiomyopathy can be diagnosed after heart scans and tests such as an ECG, echocardiogram, MRI scan, heart rhythm monitor (24 or 48-hour ECG monitor) and exercise tests, and that a detailed family tree drawn by specialists may be required. If heart failure is suspected, blood and urine samples and a chest X-ray may also be used, and you are referred to a cardiologist.

If an inherited type is diagnosed, the NHS says you may be advised to have a genetic test, and relatives can then be tested so their condition can be monitored and managed early. The BHF says that if you are a parent, sibling or child of someone with the condition, you should be seen at a specialist inherited heart conditions clinic.

Treatment aims at the cause and the effects. The NHS says there is usually no cure for cardiomyopathy, but treatments can be effective at controlling symptoms and preventing complications, and not everyone needs treatment.

Lifestyle changes include eating a healthy diet and doing gentle exercise, quitting smoking, losing weight if overweight, avoiding or reducing alcohol, getting plenty of sleep (and diagnosing and treating any sleep apnoea), managing stress and keeping any underlying condition such as diabetes well controlled.

Medicines may be needed to control blood pressure, correct an abnormal heart rhythm, remove excess fluid or prevent blood clots. For heart failure the NHS describes diuretics to reduce fluid build-up, medicines to widen blood vessels and beta blockers to slow the heart. Hospital procedures include a septal myectomy or alcohol injection in some people with obstructive hypertrophic cardiomyopathy, ablation for heart rhythm problems, and a pacemaker or implantable cardioverter defibrillator (ICD). As a last resort a heart transplant may be needed. The NHS also says everyone diagnosed with heart failure should be offered cardiac rehabilitation.

The BHF says many people with dilated cardiomyopathy feel fine and have little or no symptoms, and those with symptoms find they are managed well with treatment and can have a good quality of life. However, some people have symptoms that get worse over time, and it is important to tell your healthcare professional if this happens.

On work, driving and exercise the BHF says you should generally be able to continue to work, but may not be able to do manual jobs involving strenuous activity; you should be able to enjoy most activities, but not some competitive sports and high-intensity exercise; and you should be able to drive, but might not be able to drive a lorry, bus or other commercial passenger vehicle. Talk to your healthcare professional about your own situation.

The NHS says to see a GP if you have symptoms of heart failure. Ask for an urgent GP appointment or get help from NHS 111 if you feel breathless when lying down or from everyday activity, are coughing up frothy pink phlegm, or have suddenly gained weight.

Call 999 if you are having severe difficulty breathing (gasping, choking or not able to get words out), your lips or skin are pale, blue or grey, or someone has passed out and is not responding normally. The NHS also says always to call 999 for chest pain and breathlessness like a heart attack, as can happen with broken heart syndrome (Takotsubo cardiomyopathy). Do not drive yourself to A&E.

On the NHS a GP arranges first tests such as blood tests and an ECG and refers to a cardiologist for echocardiography and further tests. People with inherited cardiomyopathy are seen in specialist inherited heart conditions clinics, and everyone with heart failure should be offered cardiac rehabilitation.

Some people choose a private cardiologist for faster access to an echocardiogram or MRI. It helps if results are shared with your GP and NHS team so that monitoring, medicines and family screening stay joined up.