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For
patients with cardiac enlargement, all underlying causes – such as high blood
pressure, hemochromatosis, thyroid problems, pulmonary blood clots, sleep apnea,
emphysema, chronic bronchitis, lupus or other inflammatory disease – should be
treated as completely as possible. This will decrease the chance of ongoing
damage to the heart. Metal exposure or alcohol or cocaine use should be
controlled or eliminated, when applicable. If medications for HIV or
schizophrenia are a factor, risks and benefits of continuing or changing
medications should be considered. Luckily, there are alternative medications in
many cases. Those with valvular heart disease should have their condition
treated with medication. Depending on a variety of factors, heart valve
replacement or repair – either through “open heart” surgery or with a catheter
entering the heart through a blood vessel at the groin, in a procedure similar
to that used for a coronary angiogram – may be recommended.
Cardiovascular or coronary artery disease (CVD or CAD)
can cause dilated cardiomyopathy and can severely complicate either form of
cardiac enlargement and should be aggressively treated. Treatment for and its
risk factors – smoking, high dietary and blood cholesterol levels, diabetes,
high blood pressure, being overweight and sedentary – includes the use of
medications, lifestyle changes, angioplasty with or
without coronary artery stenting, or bypass
surgery .
In
situations of either dilation or hypertrophy, heart failure can be treated with
medications like beta blockers (to relax the heart), ACE inhibitors or the newer
angiotensin receptor blockers (to decrease the pressure against which the heart
has to pump), diuretics (to ease breathing and help decrease excess fluid in the
lungs and body), and digoxin and other medications (“inotropes”) which improve
the heart’s pumping strength. In severe cases, salt and fluid intake may be
controlled.
Based on
a number of factors, the chance of irregular heart rhythms can be reduced by
using a variety of medications. For patients at highest risk, an implantable
cardioverter-defibrillator can be life saving. For slow or blocked heart
rhythms, a pacemaker may be needed.
Due to
the risk of blood clot formation in a weak, dilated heart, blood thinners like
warfarin (brand name Coumadin) are recommended for those with very poor heart
function or those who have already had an episode of clotting.
Cardiac
rehabilitation in the form of a structured exercise program can help reduce
symptoms and improve exercise tolerance for those with cardiac
enlargement.
For some
of those with hypertrophic cardiomyopathy, where the thickened heart muscle
blocks blood flow from the ventricle, there are procedures to reduce sections of
heart muscle and improve heart function. One of these, a septal myomectomy,
requires open heart surgery. A non-invasive option, called an alcohol septal
ablation, involves a procedure and catheter similar to an angiogram. Instead of
using contrast dye, however, alcohol is injected. This causes muscle cells in
the thickened septum to die, reducing blood flow blockage. Heart transplantation
is a last-resort option for selected patients with either type of cardiac
enlargement and severely decreased heart function. |
