If you have symptoms of a heart problem, your doctor will perform a physical exam and order tests to determine if your heart is enlarged and to find the cause of your condition. These tests may include:
- Chest X-ray. X-ray images help your doctor see the condition of your lungs and heart. If your heart is enlarged on an X-ray, other tests will usually be needed to find the cause.
- Electrocardiogram. This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack.
Echocardiogram. This test for diagnosing and monitoring an enlarged heart uses sound waves to produce a video image of your heart. With this test, the four chambers of the heart can be evaluated.
Your doctor can use the results to see how efficiently your heart is pumping, determine which chambers of your heart are enlarged, look at your heart valves, look for evidence of previous heart attacks and determine if you have congenital heart disease.
Stress test. A stress test, also called an exercise stress test, provides information about how well your heart works during physical activity.
An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored.
Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). During a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.
In a cardiac MRI, you lie on a table inside a long tubelike machine that uses a magnetic field and radio waves to produce signals that create images of your heart.
- Blood tests. Your doctor may order blood tests to check the levels of certain substances in your blood that may point to a heart problem. Blood tests can also help your doctor rule out other conditions that may cause your symptoms.
Cardiac catheterization and biopsy. In this procedure, a thin tube (catheter) is inserted in your groin and threaded through your blood vessels to your heart, where the doctor takes a small sample (biopsy) of your heart to be tested.
Pressure within the chambers of your heart can be measured to see how forcefully blood pumps through your heart. Pictures of the arteries of the heart can be taken during the procedure (coronary angiogram) to check for a blockage.
Treatments for an enlarged heart focus on correcting the cause.
If cardiomyopathy or another type of heart condition is to blame for your enlarged heart, your doctor may recommend medications. These may include:
- Diuretics to lower the amount of sodium and water in your body, which can help lower the pressure in your arteries and heart
- Angiotensin-converting enzyme (ACE) inhibitors to lower your blood pressure and improve your heart's pumping capability
- Angiotensin II receptor blockers (ARBs) to provide the benefits of ACE inhibitors for those who can't take ACE inhibitors
- Beta blockers to lower blood pressure and improve heart function
- Anticoagulants to reduce the risk of blood clots that could cause a heart attack or stroke
- Anti-arrhythmics to keep your heart beating with a normal rhythm
Surgery or other procedures
If medications aren't enough to treat your enlarged heart, medical procedures or surgery may be necessary.
Medical devices to regulate your heartbeat. For a certain type of enlarged heart (dilated cardiomyopathy), a pacemaker that coordinates the contractions between the left and right ventricles may be necessary. In people who may be at risk of serious arrhythmias, drug therapy or an implantable cardioverter-defibrillator (ICD) may be an option.
ICDs are small devices — about the size of a pager — implanted in your chest to continuously monitor your heart rhythm and deliver electrical shocks when needed to control abnormal, rapid heartbeats. The devices can also work as pacemakers.
If the main cause of your enlarged heart is atrial fibrillation, then you may need procedures to return your heart to regular rhythm or to keep your heart from beating too quickly.
- Heart valve surgery. If your enlarged heart is caused by a problem with one of your heart valves or if it has caused heart valve problems, you may have surgery to repair or replace the affected valve.
- Coronary bypass surgery. If your enlarged heart is related to coronary artery disease, your doctor may recommend coronary artery bypass surgery.
- Left ventricular assist device (LVAD). If you have heart failure, you may need this implantable mechanical pump to help your weakened heart pump. You may have an LVAD implanted while you wait for a heart transplant or, if you're not a candidate for heart transplant, as a long-term treatment for heart failure.
- Heart transplant. If medications can't control your symptoms, a heart transplant may be a final option. Because of the shortage of donor hearts, even people who are critically ill may have a long wait before having a heart transplant.
Lifestyle and home remedies
There are ways to improve your condition, even though you can't cure it. Your doctor may recommend the following lifestyle changes:
- Quit smoking.
- Lose excess weight.
- Limit salt in your diet.
- Control diabetes.
- Monitor your blood pressure.
- Get modest exercise, after discussing with your doctor the most appropriate program of physical activity.
- Avoid or stop using alcohol and caffeine.
- Try to sleep eight hours nightly.
Preparing for your appointment
If you think you may have an enlarged heart or are worried about your heart disease risk because of your family history, make an appointment with your doctor. If you have heart disease, your doctor may refer you to a heart specialist (cardiologist).
Here's some information to help you prepare for your appointment.
What you can do
- Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet or fast before tests.
- Write down your symptoms, including ones that may seem unrelated to coronary artery disease.
- Write down key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements you're taking.
- Take a family member or friend along, if possible. Someone who accompanies you may remember something you missed or forgot.
- Write down questions to ask your doctor.
Making a list of questions will help you make the most of your time with your doctor. For heart disease, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- What are other possible causes for my symptoms or condition?
- What tests do I need?
- What's the best treatment?
- What foods should I eat or avoid?
- What's an appropriate level of physical activity?
- Are there restrictions I should follow?
- How often should I be screened for heart disease? For example, how often do I need a cholesterol test?
- I have other health conditions. How can I best manage them together?
- Should I see a specialist?
- Should my children be screened for this condition?
- Is there a generic alternative to the medicine you're prescribing?
- Are there brochures or other printed materials I can take? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you questions, including:
- When did your symptoms begin?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- What is your typical diet?
- Do you drink alcohol? How much?
- Do you smoke?
- Are you physically active? How often do you exercise?
- Have you been diagnosed with other conditions?
- Do you have a family history of heart disease?