July 25, 2008

Enlarged Heart Needs Immediate Attention


Dear Dr. Gott: I am a 59-year-old female. I am very obese but have no major illnesses and don't smoke or drink.

During a recent physical, my physician told me I have a very enlarged heart. He said as long as I don't have any more symptoms, I don't need to worry about it. Could you please explain to me what this means?

Dear Reader: Cardiomegaly (enlarged heart) can be caused by many things, some beneficial, others life-threatening.

There are two types of cardiomegaly: hypertrophy (increase in thickness of the heart muscle, usually in one chamber) and dilation (increase in size of one or more of the heart's chambers). There is one instance in which heart enlargement is beneficial: when it occurs as a result of regular aerobic exercise. This increases both hypertrophy and dilation, making the heart more efficient.

Mild cases may have no symptoms or may cause symptoms only during exertion. Symptoms may be caused by other heart or lung conditions.

Symptoms of moderate to severe enlargement can include loss of consciousness, shortness of breath, palpitations, chest pressure or pain, dizziness or lightheadedness and swelling of the feet, ankles or legs.

Cardiac hypertrophy is caused when the heart responds to increased stresses such as high blood pressure in the body or lungs. It usually affects one of the bottom two chambers.

Cardiac dilation often happens when the heart responds to direct damage such as a previous heart attack, myocarditis (heart-muscle inflammation), long-term alcohol abuse, HIV antiviral medications, hemochromatosis (excess iron) and more. It may also be associated with thyroid disease and in some cases has a genetic cause.

I urge you to see a cardiologist who can confirm the diagnosis and provide you with a treatment plan. A wait-and-see approach is more than inappropriate: It can be downright dangerous.

Write Dr. Gott c/o United Media, 200 Madison Ave. 4th floor, New York, NY 10016.

Originally published by PETER GOTT Newspaper Enterprise Association.

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