cardiomegaly
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Introduction
Enlargement of the heart.
Etiology
- cardiac chamber enlargement
- left ventricle
- chronic volume overload
- cardiomyopathy (congestive heart failure)
- ischemic
- nonischemic
- decompensated pressure overload
- high output states
- severe anemia
- thyrotoxicosis
- bradycardia
- left atrium
- left ventricular failure
- mitral valve disease
- atrial myxoma
- right ventricle
- chronic left ventricular failure
- chronic volume overload
- decompenstated pressure overload
- right atrium
- multichamber enlargement
- hypertrophic cardiomyopathy
- acromegaly
- severe obesity
- glycogen storage disease, type II (infants, children)
- left ventricle
- pericardial disease
- pericardial effusion -> with or without pericardial tamponade
- effusive constrictive pericarditis
- pericardial cyst or loculated effusion
- pseudocardiomegaly
- epicardial fat
- chest wall deformity
- pectus excavatum
- straight back syndrome
- low lung volumes
- AP chest X-ray (vs PA)
- mediastinal tumor or cyst
Clinical manifestations
- point of maximum impulse may be > 10 cm from mid-sternal line or lateral to the mid-clavicular line
- point of maximum impulse may be > 3 cm in diameter
- point of maximum impulse may be lower than 5th intercostal space
Laboratory
- complete blood count
- chem 7
- liver function tests
- thyroid function test
- lipid panel
- atrial natriuretic peptide (ANP)
Diagnostic procedures
- electrocardiogram
- exercise stress testing or myocardial perfusion study to assess coronary artery disease
Radiology
- chest X-ray (also see heart)
- echocardiography
- radionuclide ventriculography
- computed tomography provides better indication of pericardial thickness than echocardiography
- coronary angiography (as late step in the evaluation of coronary artery disease)
Management
- treat specific etiology