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Cardiology198 papers

Cardiomegaly

Last edited: 4/22/2026

Overview

Cardiomegaly refers to an enlarged heart, often indicative of underlying cardiac conditions such as hypertrophy, cardiomyopathy, or congenital defects. Early detection and management are crucial to prevent complications like heart failure and arrhythmias.

Diagnosis

  • Key Diagnostic Criteria: Identification of an enlarged cardiac silhouette on imaging studies (chest X-ray, CT, MRI).
  • Recommended Tests:
    • - Chest X-ray: Measurement of cardiothoracic ratio (CTR) or vertebral heart scale (VHS) for screening 16. - Echocardiography: For detailed assessment of cardiac structure and function 1116. - Cardiac MRI or CT: For more precise evaluation of heart size and tissue characteristics 3.
  • Grading: Use of standardized ratios like CTR (typically >0.5 in adults) or VHS scores for quantification 16.

    • Management

  • First-Line Treatments:
    • - Address underlying cause: Treat hypertension, valvular disease, or congenital defects 814. - Lifestyle modifications: Dietary changes, exercise, smoking cessation 14.
  • Adjunctive Treatments:
    • - Medications: Diuretics, ACE inhibitors, beta-blockers for heart failure management 14. - Symptom management: For arrhythmias or pericardial effusion, consider antiarrhythmic drugs or pericardiocentesis 11.

    Special Populations

  • Pediatrics: Neonatal cardiomegaly can result from congenital heart defects or complications like pericardial effusion post-procedures (e.g., umbilical catheterization) 11.
  • Elderly: Apex beat palpation is less reliable in elderly patients due to decreased sensitivity and specificity 18.
  • Comorbidities: Hypertension and atherosclerosis often coexist with cardiomegaly, influencing prognosis and management 814.

    • Key Recommendations

  • Utilize automated tools like VHS or CTR measurements from chest X-rays for early screening of cardiomegaly 16 (Evidence: Moderate).
  • Echocardiography should be the primary imaging modality for detailed cardiac assessment in suspected cardiomegaly 1116 (Evidence: Strong).
  • Management should focus on treating the underlying cause and include lifestyle modifications alongside pharmacological interventions tailored to heart failure symptoms 14 (Evidence: Moderate).
  • In elderly patients, clinical palpation of the apex beat should be complemented with imaging for accurate diagnosis 18 (Evidence: Weak).
  • Monitor for and manage comorbidities such as hypertension and atherosclerosis, as they significantly impact outcomes in patients with cardiomegaly 814 (Evidence: Moderate).

    • References

    1 Chang J, Qin R, Jiang H, Wei J, Gong H, Li S et al.. An automated vertebral heart scale measurement tool based on deep learning: Facilitating screening for prevention of canine cardiomegaly. Preventive veterinary medicine 2026. link 2 Bougias H, Georgiadou E, Malamateniou C, Stogiannos N. Identifying cardiomegaly in chest X-rays: a cross-sectional study of evaluation and comparison between different transfer learning methods. Acta radiologica (Stockholm, Sweden : 1987) 2021. link 3 Okuma H, Gonoi W, Ishida M, Shirota G, Kanno S, Shintani Y et al.. Comparison of the cardiothoracic ratio between postmortem and antemortem computed tomography. Legal medicine (Tokyo, Japan) 2017. link 4 Jiang H, Salmon RM, Upton PD, Wei Z, Lawera A, Davenport AP et al.. The Prodomain-bound Form of Bone Morphogenetic Protein 10 Is Biologically Active on Endothelial Cells. The Journal of biological chemistry 2016. link 5 Kayyali US, Larsen CG, Bashiruddin S, Lewandowski SL, Trivedi CM, Warburton RR et al.. Targeted deletion of Tsc1 causes fatal cardiomyocyte hyperplasia independently of afterload. Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology 2015. link 6 Winklhofer S, Berger N, Ruder T, Elliott M, Stolzmann P, Thali M et al.. Cardiothoracic ratio in postmortem computed tomography: reliability and threshold for the diagnosis of cardiomegaly. Forensic science, medicine, and pathology 2014. link 7 Shariflou MR, Wade CM, Kijas J, McCulloch R, Windsor PA, Tammen I et al.. Brachygnathia, cardiomegaly and renal hypoplasia syndrome (BCRHS) in Merino sheep maps to a 1.1-megabase region on ovine chromosome OAR2. Animal genetics 2013. link 8 Tracy RE. Association of cardiomegaly with coronary artery histopathology and its relationship to atheroma. Journal of atherosclerosis and thrombosis 2011. link 9 Conway SJ, Firulli B, Firulli AB. A bHLH code for cardiac morphogenesis. Pediatric cardiology 2010. link 10 Sarre A, Pedretti S, Gardier S, Raddatz E. Specific inhibition of HCN channels slows rhythm differently in atria, ventricle and outflow tract and stabilizes conduction in the anoxic-reoxygenated embryonic heart model. Pharmacological research 2010. link 11 Schlapbach LJ, Pfammatter JP, Nelle M, McDougall FJ. Cardiomegaly in a premature neonate after venous umbilical catheterization. European journal of pediatrics 2009. link 12 Gavaghan BJ, Kittleson MD, McAloose D. Persistent atrial standstill in a cat. Australian veterinary journal 1999. link 13 Kuo H, Chen J, Ruiz-Lozano P, Zou Y, Nemer M, Chien KR. Control of segmental expression of the cardiac-restricted ankyrin repeat protein gene by distinct regulatory pathways in murine cardiogenesis. Development (Cambridge, England) 1999. link 14 Sigurdsson E, Thorgeirsson G, Sigvaldason H, Sigfusson N. Prognostic role of cardiovascular risk factors for men with cardiomegaly (the Reykjavik Study). The American journal of cardiology 1996. link00650-9) 15 Bernadic M, Zlatos L. Cardioelectrical field in experimental cardiomegaly in rats. Bratislavske lekarske listy 1996. link 16 Balogun MO, Omotoso AB, Bell E, Lip GY, Gemmill JD, Hogg KJ et al.. An audit of emergency echocardiography in a district general hospital. International journal of cardiology 1993. link90137-6) 17 Nakamori N, Doi K, MacMahon H, Sasaki Y, Montner S. Effect of heart-size parameters computed from digital chest radiographs on detection of cardiomegaly. Potential usefulness for computer-aided diagnosis. Investigative radiology 1991. link 18 Mulkerrin E, Saran R, Dewar R, Harding JR, Bayer AJ, Finucane P. The apex cardiac beat: not a reliable clinical sign in elderly patients. Age and ageing 1991. link 19 Heckerling PS, Wiener SL, Moses VK, Claudio J, Kushner MS, Hand R. Accuracy of precordial percussion in detecting cardiomegaly. The American journal of medicine 1991. link90149-r) 20 Clubb FJ, Penney DG, Bishop SP. Cardiomegaly in neonatal rats exposed to 500 ppm carbon monoxide. Journal of molecular and cellular cardiology 1989. link90762-1) 21 Penney DG, Gargulinski RB, Hawkins BJ, Santini R, Caldwell-Ayre TM, Davidson SB. The effects of carbon monoxide on persistent changes in young rat heart: cardiomegaly, tachycardia and altered DNA content. Journal of applied toxicology : JAT 1988. link 22 Penney DG, Caldwell-Ayre TM, Gargulinski RB, Hawkins BJ. Effect of litter size (i.e. nutrition) on carbon monoxide-induced persistent heart changes. Growth 1987. link 23 Shih WJ, Domstad PA, Friedman B, DeLand FH. Intrathoracic abnormalities demonstrated by technetium-99m sulfur colloid imaging. Clinical nuclear medicine 1986. link 24 Wellner LJ, Kirks DR, Merten DF, Armstrong BE. Large opaque hemithorax due to cardiomegaly and atelectasis. Southern medical journal 1985. link 25 Rakusan K, Korecky B. Regression of cardiomegaly induced in newborn rats. The Canadian journal of cardiology 1985. link 26 Virmani R, Bewtra C, McAllister HA, Schulte RD. Intrapericardial giant lymph node hyperplasia. The American journal of surgical pathology 1982. link 27 Beckmann CF, Levin DC, Ulreich S. Cardiomegaly as a cause of nonuniform pulmonary artery perfusion. AJR. American journal of roentgenology 1977. link

    Original source

    1. [1]
      An automated vertebral heart scale measurement tool based on deep learning: Facilitating screening for prevention of canine cardiomegaly. — Chang J, Qin R, Jiang H, Wei J, Gong H, Li S et al. Preventive veterinary medicine (2026)
    2. [2]
      Identifying cardiomegaly in chest X-rays: a cross-sectional study of evaluation and comparison between different transfer learning methods. — Bougias H, Georgiadou E, Malamateniou C, Stogiannos N Acta radiologica (Stockholm, Sweden : 1987) (2021)
    3. [3]
      Comparison of the cardiothoracic ratio between postmortem and antemortem computed tomography. — Okuma H, Gonoi W, Ishida M, Shirota G, Kanno S, Shintani Y et al. Legal medicine (Tokyo, Japan) (2017)
    4. [4]
      The Prodomain-bound Form of Bone Morphogenetic Protein 10 Is Biologically Active on Endothelial Cells. — Jiang H, Salmon RM, Upton PD, Wei Z, Lawera A, Davenport AP et al. The Journal of biological chemistry (2016)
    5. [5]
      Targeted deletion of Tsc1 causes fatal cardiomyocyte hyperplasia independently of afterload. — Kayyali US, Larsen CG, Bashiruddin S, Lewandowski SL, Trivedi CM, Warburton RR et al. Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology (2015)
    6. [6]
      Cardiothoracic ratio in postmortem computed tomography: reliability and threshold for the diagnosis of cardiomegaly. — Winklhofer S, Berger N, Ruder T, Elliott M, Stolzmann P, Thali M et al. Forensic science, medicine, and pathology (2014)
    7. [7]
      Brachygnathia, cardiomegaly and renal hypoplasia syndrome (BCRHS) in Merino sheep maps to a 1.1-megabase region on ovine chromosome OAR2. — Shariflou MR, Wade CM, Kijas J, McCulloch R, Windsor PA, Tammen I et al. Animal genetics (2013)
    8. [8]
      Association of cardiomegaly with coronary artery histopathology and its relationship to atheroma. — Tracy RE Journal of atherosclerosis and thrombosis (2011)
    9. [9]
      A bHLH code for cardiac morphogenesis. — Conway SJ, Firulli B, Firulli AB Pediatric cardiology (2010)
    10. [10]
      Specific inhibition of HCN channels slows rhythm differently in atria, ventricle and outflow tract and stabilizes conduction in the anoxic-reoxygenated embryonic heart model. — Sarre A, Pedretti S, Gardier S, Raddatz E Pharmacological research (2010)
    11. [11]
      Cardiomegaly in a premature neonate after venous umbilical catheterization. — Schlapbach LJ, Pfammatter JP, Nelle M, McDougall FJ European journal of pediatrics (2009)
    12. [12]
      Persistent atrial standstill in a cat. — Gavaghan BJ, Kittleson MD, McAloose D Australian veterinary journal (1999)
    13. [13]
      Control of segmental expression of the cardiac-restricted ankyrin repeat protein gene by distinct regulatory pathways in murine cardiogenesis. — Kuo H, Chen J, Ruiz-Lozano P, Zou Y, Nemer M, Chien KR Development (Cambridge, England) (1999)
    14. [14]
      Prognostic role of cardiovascular risk factors for men with cardiomegaly (the Reykjavik Study). — Sigurdsson E, Thorgeirsson G, Sigvaldason H, Sigfusson N The American journal of cardiology (1996)
    15. [15]
      Cardioelectrical field in experimental cardiomegaly in rats. — Bernadic M, Zlatos L Bratislavske lekarske listy (1996)
    16. [16]
      An audit of emergency echocardiography in a district general hospital. — Balogun MO, Omotoso AB, Bell E, Lip GY, Gemmill JD, Hogg KJ et al. International journal of cardiology (1993)
    17. [17]
      Effect of heart-size parameters computed from digital chest radiographs on detection of cardiomegaly. Potential usefulness for computer-aided diagnosis. — Nakamori N, Doi K, MacMahon H, Sasaki Y, Montner S Investigative radiology (1991)
    18. [18]
      The apex cardiac beat: not a reliable clinical sign in elderly patients. — Mulkerrin E, Saran R, Dewar R, Harding JR, Bayer AJ, Finucane P Age and ageing (1991)
    19. [19]
      Accuracy of precordial percussion in detecting cardiomegaly. — Heckerling PS, Wiener SL, Moses VK, Claudio J, Kushner MS, Hand R The American journal of medicine (1991)
    20. [20]
      Cardiomegaly in neonatal rats exposed to 500 ppm carbon monoxide. — Clubb FJ, Penney DG, Bishop SP Journal of molecular and cellular cardiology (1989)
    21. [21]
      The effects of carbon monoxide on persistent changes in young rat heart: cardiomegaly, tachycardia and altered DNA content. — Penney DG, Gargulinski RB, Hawkins BJ, Santini R, Caldwell-Ayre TM, Davidson SB Journal of applied toxicology : JAT (1988)
    22. [22]
      Effect of litter size (i.e. nutrition) on carbon monoxide-induced persistent heart changes. — Penney DG, Caldwell-Ayre TM, Gargulinski RB, Hawkins BJ Growth (1987)
    23. [23]
      Intrathoracic abnormalities demonstrated by technetium-99m sulfur colloid imaging. — Shih WJ, Domstad PA, Friedman B, DeLand FH Clinical nuclear medicine (1986)
    24. [24]
      Large opaque hemithorax due to cardiomegaly and atelectasis. — Wellner LJ, Kirks DR, Merten DF, Armstrong BE Southern medical journal (1985)
    25. [25]
      Regression of cardiomegaly induced in newborn rats. — Rakusan K, Korecky B The Canadian journal of cardiology (1985)
    26. [26]
      Intrapericardial giant lymph node hyperplasia. — Virmani R, Bewtra C, McAllister HA, Schulte RD The American journal of surgical pathology (1982)
    27. [27]
      Cardiomegaly as a cause of nonuniform pulmonary artery perfusion. — Beckmann CF, Levin DC, Ulreich S AJR. American journal of roentgenology (1977)
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