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HomeAnswersCardiologyheart diseaseWhat causes heart enlargement and intermittent palpitations?

What causes heart enlargement on chest x-ray?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Ilir Sharka

Medically reviewed by

Dr. K. Shobana

Published At November 21, 2019
Reviewed AtApril 17, 2024

Patient's Query

Hello doctor,

I had bronchitis and they did a chest x-ray, it showed my heart was enlarged. My primary doctor did an echo and the results are below. My family history, maternal grandfather died of a blood clot that went to his heart and caused a heart attack. Mother died after a heart valve surgery in the early '50s, right ventricular failure and she had pulmonary hypertension. My brother just had a triple bypass for blockages two weeks ago. My personal health issues are high blood pressure well-controlled, sleep apnea, morbid obesity, acid reflux, IBS, peripheral edema, small hiatal hernia, anxiety well controlled. My primary doctor said the echo results were nothing to be concerned with at this point and want to retest in a year. However, I had an echo done five years ago and none of these issues were present then. With family and personal history what do you think? Only symptoms would be intermittent palpitations (not too often) and SOB on greater exertion. Procedure: A complete two-dimensional transthoracic echocardiogram was performed (2D, spectral and color flow doppler). Interpretation and Summary is contrast injection was performed due to suboptimal images. Left ventricular systolic function is normal. The visually estimated left ventricular ejection fraction is greater than 55%. There is a mild left ventricular hypertrophy present. Respiratory variation of the IVC indicates normal right atrial pressures. The left atrium is mildly dilated. There is a trace amount of mitral regurgitation. The tricuspid regurgitant signal is inadequate for evaluating right ventricular pressure. There is a trace tricuspid valve regurgitation. No hemodynamically significant valvular aortic stenosis. No aortic regurgitation is present. There is no pericardial effusion. Left ventricle: The left ventricle is normal in size. There is no thrombus. There is mild left ventricular hypertrophy present. Left ventricular systolic function is normal. The visually estimated left ventricular ejection fraction is greater than 55%. The left ventricular wall motion is normal. Right ventricle: The right ventricle is normal in size. The right ventricular systolic function is normal. Atria: The left atrium is mildly dilated. Right atrial size is normal. Respiratory variation of the IVC indicates normal right atrial pressures. Mitral valve: The mitral valve leaflets appear normal. There is no evidence of stenosis, fluttering, or prolapse. There is a trace amount of mitral regurgitation. Tricuspid Valve: The tricuspid valve is normal. There is no tricuspid valve vegetation. No significant tricuspid stenosis. There is trace tricuspid valve regurgitation. The tricuspid regurgitant signal is inadequate for evaluating right ventricular pressure. Aortic valve: The aortic valve is trileaflet. There is no aortic valvular vegetation. No hemodynamically significant valvular aortic stenosis. No aortic regurgitation is present. Pulmonic valve: The pulmonic valve leaflets are thin and pliable, valve motion is normal. There is no pulmonic valvular stenosis. There is trace of pulmonic valvular regurgitation. Great vessels: The aortic root is normal in size. Pericardium / pleural: There is no pericardial effusion. Thrombus / mass: No intracardiac masses identified. MMode / 2D Measurements: RVDd: 3.4 cm, LVIDd: 4.9 cm, IVSd: 1.1 cm, LVIDs: 3.0 cm, LVPWd: 1.2 cm, FS: 37.6 %, Ao root diameter: 3.1 cm, EDV(Teich): 112.0 ml, Ao root area: 7.5 cm2, ESV(Teich): 36.4 ml, LA dimension: 3.3 cm, EF(Teich): 67.5 %, LA/Ao: 1.1, LVOT diam: 2.0 cm, LVOT area: 3.1 cm2, Doppler Measurements \T\ Calculations, MV E max vel: 100.0 cm/sec MV, V2 max: 98.8 cm/sec, MV A max vel: 93.0 cm/sec, MV max PG: 3.9 mmHg, MV E/A: 1.1, MV V2 mean: 69.4 cm/sec, MV mean PG: 2.0 mmHg, MV V2 VTI: 33.6 cm, MVA(VTI): 2.7 cm2, MV P1/2t, max vel: 99.8 cm/sec, Ao V2 max: 157.0 cm/sec, MV P1/2t: 61.2 msec, Ao max, PG: 9.9 mmHg MVA(P1/2t): 3.6 cm2, Ao V2 mean: 105.9 cm/sec, MV dec slope: 477.0 cm/sec2, Ao mean PG: 5.5 mmHg, Ao V2 VTI: 33.4 cm, AVA(I,D): 2.7 cm2, AVA(V,D): 2.9 cm2, LV V1 max PG: 8.2 mmHg, SV(LVOT): 90.2 ml, LV V1 mean PG: 4.0 mmHg, LV V1 max: 143.0 cm/sec, LV V1 mean: 91.8 cm/sec, LV V1 VTI: 28.7 cm, PA V2 max: 119.0 cm/sec, PA max PG: 5.7 mmHg, PA V2 mean: 72.6 cm/sec, PA mean PG: 2.5 mmHg, PA V2 VTI: 22.1 cm.

Answered by Dr. Ilir Sharka

Hello,

Welcome to icliniq.com.

I passed carefully through your medical history and cardiac ultrasound report. Your echo data seem to be fine, only there is a mild left atrial dilation. You cannot change your family history, but you can change and modify your lifestyle and your diet. The most important issues are to reduce your body weight, control your anxiety disorder, follow a physically active daily regimen. You should check your fasting blood, lipid profile, and glucose, and look after your blood pressure values.

Patient's Query

Thank you doctor,

The information helps to ease my mind. My blood pressure (last reading was 118/78 mmHg) and anxiety with medicines and therapy are very well controlled now. I am working on losing weight and I have recently lost 20lbs and I am actively working on losing more. My last fasting blood values were as follows. Glucose is 99 mg/dL, Cholesterol is 188 mg/dL, Triglyceride is 69 mg/dL, Non-HDL cholesterol is 141 mg/dL, Cholesterol / HDL ratio 4.00, LDL cholesterol 127 mg/dL, and HDL cholesterol 47 mg/dL. I want to ask a couple more questions if you do not mind. Any ideas what could have caused the LVH? Any worries about life expectancy with this issue? Any restrictions on exercise, or yard and house work with this issue?

Answered by Dr. Ilir Sharka

Hello,

Welcome back to icliniq.com.

Your blood lipid profile is perfectly normal. So, in my opinion, the mild LVH (left ventricular hypertrophy) could be attributed to different possible issues, arterial hypertension, genetics (family history for cardiac disease), obesity, and Sleep apnea (which is known to be an independent cardio-vascular risk factor). I do not think that this echo finding will change anything in your life expectancy, especially if you follow a healthy lifestyle and maintain normal blood pressure values. I would just advice trying to lose some pounds. It would help also improve sleep apnea. Consulting with a dietician would be helpful in this regard. I would also recommend performing regular physical activity, which is really helpful for a healthy mind and heart. I hope this helps.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Ilir Sharka
Dr. Ilir Sharka

Cardiology

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