Cardiomegaly
Cardiomegaly: Excerpt from In a Page: Signs and Symptoms
Cardiomegaly is defined as enlargement of the heart above the normal size. When looking at a chest X-ray, one must be sure that an anterior-posterior view is being used, because the heart may appear falsely enlarged on a posterior-anterior view. When true cardiomegaly is present, further evaluation by echocardiography or other definitive testing is indicated to identify the cause of the enlargement.
Differential Diagnosis
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Congestive heart failure
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Ischemic heart disease
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Hypertension (with left ventricular hypertrophy)
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Valvular disease (primarily MR, AS, AR)
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Hypertrophic cardiomyopathy
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Congenital heart disorders (e.g., ASD, VSD, PDA, coarctation of the aorta, Ebstein's anomaly, tetralogy of Fallot)
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Idiopathic cardiomyopathy
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Alcoholic cardiomyopathy
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Lung disease (leading to right-sided enlargement)
–Pulmonary embolus
–COPD
–Cor pulmonale
–Primary pulmonary hypertension
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Subacute bacterial endocarditis
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Myocarditis
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Renal failure (risk of pericardial effusion)
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Anemia
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Scleroderma
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Systemic lupus erythematosus
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Sickle cell disease
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Marfan's syndrome
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Pregnancy
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Drugs (numerous drugs are cardiotoxic)
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Postradiation
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Normal, “athletic” heart
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Mediastinal mass
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Kyphoscoliosis
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Rheumatoid arthritis
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Less common etiologies include infiltrative diseases (e.g., amyloidosis, hemochromatosis, atrial myxoma, endocardial fibroelastosis, Fabry's disease, Hurler's syndrome, Pompe's disease), epicardial fat pad, carcinoid, acromegaly, hyper- or hypoparathyroidism, and severe cases of hypocalcemia, hypomagnesemia, and/or hypophosphatemia
Workup and Diagnosis
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Complete history and physical exam
–Associated symptoms may include fatigue, dyspnea at
rest and/or on exertion, palpitations, dizziness, or syncope
–Note use of alcohol or recreational drugs
–Family history of heart disease or sudden death
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Chest X-ray and ECG
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Echocardiogram is indicated in all patients to evaluate for valvular disease, chamber size, wall motion abnormalities, and ventricular function
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Stress testing if coronary artery disease is suspected
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Cardiac catheterization may be indicated to evaluate for coronary artery disease and valvular disease
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Laboratory studies may include CBC, ESR, electrolytes, BUN/creatinine, glucose, TSH, calcium, magnesium, and phosphorus
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Blood cultures are indicated in some cases
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Consider ANA, rheumatoid factor, and screening for pheochromocytoma (i.e., urinary metanephrines and VMA) and hemochromatosis (i.e., iron studies) in selected patients
Treatment
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Stabilize airway, breathing, and circulation
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Treat underlying cause
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Discontinue offending drugs
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Administer antiarrhythmics, digoxin, diuretics, and/or afterload and preload reducers as clinically indicated
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Periodic follow-up is based on severity of condition
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Transplant may be necessary in end-stage symptomatic heart failure that is refractory to medical treatment
–Implantable ventricular assist devices may be indicated for severe heart failure patients to serve as a temporizing measure until heart transplantation occurs
Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
More About Heart failure
More Medical Textbooks Online about Heart failure
Review other book chapters online related to Heart failure:
Medical Books Excerpts
- Cardiomegaly
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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