Cardiomegaly pathophysiology

Cardiomegaly Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Cardiomegaly occurs due to two main reasons. Hypertrophy causes the heart to enlarge due to thickening to the cardiac muscle, and dilation is an enlargement of the heart caused by stretching of the heart muscle and subsequent expansion in the size of the heart.

Pathophysiology

The left ventricle can be enlarged from two broad underlying conditions: dilation and hypertrophy.

• Left ventricular dilation can occurs as a result of volume overload. Conditions that cause volume overload can be further broken down as follows:
  • Valvular Disease: More common underlying valvular heart disease conditions would include mitral regurgitation and aortic regurgitation.
  • Congenital Heart Disease: Patent ductus arteriosus and a ventricular septal defect.
  • High output states resulting in volume overload: Anemia and thyrotoxicosis.
  • High stroke volume states: Complete heart block and prolonged severe sinus bradycardia.
  • Can occur as a result of ischemia and remodeling.

Pathology

Gross Pathology

Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Biventricular Hypertrophy

Biventricular Hypertrophy

Gross excellent example of concentric left ventricular hypertrophy

Left Ventricular Hypertrophy: Gross natural color anterior view intact heart showing disproportionate size of left ventricle by its inferior extent much below the right ventricle apex (quite good example)

Myocardial Infarct: Gross natural color apical section showing large left ventricle infarct and right ventricular hypertrophy

Right ventricular hypertrophy

Right ventricular enlargement due to a patent ductus arteriosus in a patient with hyaline membrane disease