Enlarged Heart (Cardiomegaly) On Chest X-ray

An enlarged heart is a common finding on chest X-ray.  Enlarged heart has many causes outlined below.  Sometimes it’s not the actual heart that is enlarged but fluid around it that causes the appearance.  Radiologists can’t tell the difference on X-ray.

What is cardiomegaly?

Cardiomegaly means enlargement of the heart.   This can involve a single chamber or the entire heart.   

What causes cardiomegaly?

One of the most common causes of cardiomegaly is congestive heart failure.   This is when the heart can’t pump or fill as well as it should.  This causes decreased functioning of the heart.

Disorders of the heart valves between the atria and ventricles can cause cardiomegaly.

Cardiomyopathy is a disease of the heart muscle which results in decreased function and cardiomegaly.

You can be born with heart disorders such as abnormal communication between the heart chambers which can result in cardiomegaly.

Myocarditis or inflamed heart muscle from various causes can cause cardiomegaly.

Other causes which can lead to cardiomegaly can include lung disease such as emphysema, pulmonary embolism (clots to the lung), pregnancy, anemia, kidney failure and sickle cell disease.

Sometimes it’s not your actual heart that is enlarged

Fluid around the heart or pericardial effusion can cause the appearance of an enlarged heart on chest X-ray.  We can’t differentiate the heart from the fluid around it.

A cyst or mass abutting the heart can give the appearance of an enlarged heart.  This will usually be a bulge or enlargement on one side of  the heart.  Sometimes we can’t tell.

What does cardiomegaly look like on a chest x-ray?

The heart will be larger then expected.  The radiologist will often make this diagnosis using his experience instead of precise measurements. The enlargement is often graded as mild, moderate and severe.

Symptoms of enlarged heart

Some of the causes of an enlarged heart can cause breathlessness such as heart failure.  Some of the causes can be life threatening like pulmonary embolism or clots to the lungs.

Many others such as heart valve problems or heart muscle disorders can have more chronic symptoms like chest pain, breathlessness, palpitations to name a few.

Can we tell the cause of cardiomegaly on chest X-ray?

In most cases we can not tell the cause  by only looking at the chest X-ray.  We need to combine the clinical history with further testing.  This will often include an ultrasound of the heart called an echocardiogram. 

Is cardiomegaly dangerous?

It can be depending on the cause and when it developed.  How dangerous cardiomegaly is will be more dependent on how your doing rather then how it looks on the chest X-ray.

Cardiomegaly treatment

The treatment of cardiomegaly will depend on what is causing it.  A cardiology specialist is best suited to diagnose and treat conditions of the heart.

Enlarged heart (cardiomegaly) on chest x-ray: summary

Cardiomegaly on chest X-ray has many causes.  It is diagnosed based on the radiologists experience.  We usually do not know the exact cause from an X-ray alone.  Further history, testing and specialty referral is often needed for appropriate diagnosis and treatment.

Disclaimer: The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

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