Cardiomegaly causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mugilan Poongkunran M.B.B.S [2]

Overview

Cardiomegaly is often caused by hypertension, but it can also occur as a result of other heart conditions, such as congestive heart failure. Common causes of cardiomegaly due dilation of the myocardium (not hypertrophy) are dilated cardiomyopathy (non-ischemic cardiomyopathy) and ischemic heart disease.

Causes

Life Threatening Causes

• Aortic dissection
• Myocardial infarction
• Pericardial effusion
• Pulmonary embolism
• Pulmonary hypertension
• Uremia
• Ventricular aneurysm

Common Causes

• Amyloidosis
• Anemia
• Arrhythmia
• Cardiomyopathy
• Congestive heart failure
• Hemochromatosis
• Hypertensive heart disease
• Hyperthyroidism
• Pulmonary hypertension
• Valvular heart disease

Causes by Organ System

Cardiovascular	ALCAPA, aortic dissection, aortic regurgitation, aortic stenosis, arrhythmia, atrial septal defect, carcinoid heart disease, cardiac myxoma, cardiofaciocutaneous syndrome, chronic thromboebolic pulmonary hypertension, coarctation of aorta, congenital heart disease, congestive heart failure, cor pulmonale, Costello syndrome, diabetes, Ebstein's anomaly, Eisenmenger's syndrome, endocardial fibroelastosis, endocarditis, epicardial fat pad, familial hypertrophic cardiomyopathy, heart attack, hypertension, hypertrichotic osteochondrodysplasia, idiopathic dilated cardiomyopathy, ischaemic heart disease, Kawasaki disease, mitral regurgitation, mitral valve prolapse, myocardial infarction, myocarditis, Naxos disease, patent ductus arteriosus, pericardial effusion, pericarditis, peripartum cardiomyopathy, polyarteritis nodosa, pulmonary embolism, pulmonary hypertension, pulmonary regurgitation, pulmonary stenosis, rheumatic fever, Salih myopathy, tetralogy of fallot, transposition of great vessels, tricuspid regurgitation, tricuspid prolapse, valvular heart disease, ventricular aneurysm, ventricular septal defect, X-linked dilated cardiomyopathy
Chemical / poisoning	Beryllium, carbon monoxide, cobalt, ethylene glycol, lead, mercury
Dermatologic	Cardiofaciocutaneous syndrome, Costello syndrome, hypertrichotic osteochondrodysplasia, multiple lentigines syndrome, Naxos disease
Drug Side Effect	Anagrelide, anastrozole, aspirin, atenolol, bleomycin, busulfan, carfilzomib, certolizumab pegol, chloroquine, didanosine, disopyramide, Donepezil, doxorubicin, doxorubucin, dronedarone, epirubicin, ethanol, fludrocortisone, 5-fluorouracil, hydrocortisone, imatinib mesylate, lapatinib ditosylate, letrozole, liposomal amphotericin B, lithium, mecasermin (recombinant human insulin-like growth factor I), oprelvekin, phenothiazines, phenylbutazone, pindolol, procainamide, propranolol, ropinirole, rosiglitazone, sunitinib malate, synthetic androgens, trastuzumab, triamcinolone , troglitazone, verapamil, zalcitabine, zidovudine, ziprasidone
Ear Nose Throat	No underlying causes
Endocrine	Acromegaly, carcinoid heart disease, cushing syndrome, hyperparathyroidism, hyperthyroidism, hypothyroidism
Environmental	No underlying causes
Gastroenterologic	Mulibrey nanism
Genetic	1p36 deletion syndrome, Alstrom syndrome, Barth syndrome, Becker muscular dystrophy, Beckwith–Wiedemann syndrome, cardiofaciocutaneous syndrome, carnitine palmitoyl transferase deficiency, congenital generalized lipodystrophy, Costello syndrome, Danon disease, Desmin-related myofibrillar myopathy, Duchenne muscular dystrophy, Emery-Dreifuss muscular dystrophy, X-linked, Fabry disease, familial hypertrophic cardiomyopathy, Friedreich ataxia, fucosidosis, Gaucher disease, glycogenosis type 2, glycogenosis type 2b, hemochromatosis, hereditary spherocytosis, Hunter syndrome, hypertrichotic osteochondrodysplasia, infantile sialic acid storage disorder, Isobutyryl-CoA dehydrogenase deficiency, Laing distal myopathy, long-chain acyl-CoA dehydrogenase deficiency, Malonyl-CoA decarboxylase deficiency, McLeod neuroacanthocytosis syndrome, MELAS, Morquio syndrome, mucopolysaccharidosis type IIIB, Hurler syndrome, Marfan's syndrome, Mulibrey nanism, multiple lentigines syndrome, myotonic dystrophy, Naxos disease, Noonan syndrome, Pompe's disease, Refsum disease, Salih myopathy, Sandhoff disease, sickle cell disease, Singleton-Merten syndrome, Tay-Sachs' disease, thalassemia, very long-chain acyl-CoA dehydrogenase deficiency, X-linked dilated cardiomyopathy, Yunis-Varon syndrome
Hematologic	Anemia, hemochromatosis, hereditary spherocytosis, McLeod neuroacanthocytosis syndrome, sickle cell disease, thalassemia
Iatrogenic	Water overload, postradiation, cardiac catheterization, cardiopulmonary resuscitation, heart surgery, percutaneous coronary intervention, postpericardiotomy syndrome
Infectious Disease	Brucellosis, chagas disease, coxsackie virus, cryptococcosis, cytomegalovirus, diphtheria, echovirus, Epstein-Barr, hepatitis, histoplasmosis, HIV, Lyme disease, psittacosis, rheumatic fever, rickettsial disease, schistosomiasis, toxoplasmosis, trichinosis, trypanosomiasis, typhoid fever, varicella
Musculoskeletal / Ortho	Becker muscular dystrophy, desmin-related myofibrillar myopathy, Duchenne muscular dystrophy, Emery-Dreifuss muscular dystrophy, X-linked, hypertrichotic osteochondrodysplasia, Laing distal myopathy, Mulibrey nanism, myotonic dystrophy, Salih myopathy,, Yunis-Varon syndrome
Neurologic	Costello syndrome, Friedreich ataxia, Mulibrey nanism
Nutritional / Metabolic	Alstrom syndrome, Barth syndrome, beri-beri, carnitine palmitoyltransferase deficiency, Fabry disease, fucosidosis, Gaucher disease, glycogenosis type 2b, Hunter syndrome, infantile sialic acid storage disorder, isobutyryl-CoA dehydrogenase deficiency, kwashiorkor, long-chain acyl-CoA dehydrogenase deficiency, malonyl-CoA decarboxylase deficiency, Morquio syndrome, mucopolysaccharidosis type IIIB, Pompe's disease, Refsum disease, Sandhoff disease, selenium deficiency, Tay-Sachs' disease
Obstetric/Gynecologic	Hemolytic disease of the newborn, infants born to diabetic mothers, peripartum cardiomyopathy, peripartum heart failure, pregnancy, twin-to-twin transfusion syndrome
Oncologic	Carcinoid heart disease, cardiac myxoma, lymphadenopathy, mediastinal mass, pheochromocytoma
Opthalmologic	Mulibrey nanism, Alstrom syndrome
Overdose / Toxicity	Anastrozole, busulfan, lithium, mecasermin (recombinant human insulin-like growth factor I), olanzapine, oprelvekin, phenothiazines, phenylbutazone, pindolol, procainamide, rosiglitazone, sunitinib malate, trastuzumab, troglitazone, verapamil, zalcitabine, zidovudine
Psychiatric	Takotsubo cardiomyopathy
Pulmonary	Coal worker pneumoconiosis, COPD, cor pulmonale, fibrosing mediastinitis, pulmonary embolism, pulmonary hypertension, sleep apnea
Renal / Electrolyte	Hypocalcemia, hypophosphatemia, renal failure, uremia
Rheum / Immune / Allergy	Amyloidosis, systemic lupus erythematosus
Sexual	No underlying causes
Trauma	Blunt or penetrating chest trauma, esophogeal perforation
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Alcoholism, athletes

Causes in Alphabetical Order

1p36 deletion syndrome 5-Fluorouracil Acromegaly ALCAPA Alcoholism Alstrom syndrome Amyloidosis Anagrelide Anastrozole Anemia Aortic dissection Aortic regurgitation Aortic stenosis Arrhythmia Atenolol Athletes Atrial septal defect Barth syndrome Becker muscular dystrophy Beckwith–Wiedemann syndrome Beri-beri Beryllium Bleomycin Blunt or penetrating chest trauma Brucellosis Carbon monoxide Carcinoid heart disease Cardiac catheterization Cardiac myxoma Cardiofaciocutaneous syndrome Cardiopulmonary resuscitation Carfilzomib Carnitine palmitoyltransferase deficiency Certolizumab pegol Chagas disease Chloroquine Chronic thromboebolic pulmonary hypertension Coal worker pneumoconiosis Coarctation of aorta Cobalt Congenital generalized lipodystrophy Congenital heart disease Congestive heart failure COPD Cor pulmonale Costello syndrome Coxsackie virus Cryptococcosis Cushing syndrome Cytomegalovirus Danon disease Desmin-related myofibrillar myopathy Diabetes Didanosine Diphtheria Disopyramide Doxorubucin Dronedarone Duchenne muscular dystrophy Ebstein's anomaly Ebstein-Barr virus Echovirus Eisenmenger's syndrome Emery-Dreifuss muscular dystrophy, X-linked

Endocardial fibroelastosis Endocarditis Epicardial fat pad Epirubicin Esophogeal perforation Ethanol Ethylene glycol Fabry disease Familial hypertrophic cardiomyopathy Friedreich ataxia Fucosidosis Gaucher disease Glycogenosis type 2b Heart attack Heart surgery Hemochromatosis Hemolytic disease of the newborn Hepatitis Hereditary spherocytosis Histoplasmosis HIV Hunter syndrome Hurler's syndrome Hyperparathyroidism Hypertension Hyperthyroidism Hypertrichotic osteochondrodysplasia Hypocalcemia Hypophosphatemia Hypothyroidism Idiopathic dilated cardiomyopathy Imatinib mesylate Infantile sialic acid storage disorder Infants born to diabetic mothers Ischaemic heart disease Isobutyryl-CoA dehydrogenase deficiency Kawasaki disease Kwashiorkor Laing distal myopathy Lapatinib ditosylate Lead Letrozole Liposomal amphotericin B Lithium Long-chain acyl-CoA dehydrogenase deficiency Low output cardiac failure Lyme disease Lymphadenopathy Malonyl-CoA decarboxylase deficiency Marfan's syndrome McLeod neuroacanthocytosis syndrome Mecasermin (recombinant human insulin-like growth factor I) Mediastinal mass MELAS Mercury Mitral regurgitation Mitral valve prolapse Morquio syndrome Mucopolysaccharidosis type IIIB Mulibrey nanism Multiple lentigines syndrome Myocardial infarction Myocarditis Myotonic dystrophy

Naxos disease Oprelvekin Noonan syndrome Patent ductus arteriosus Percutaneous coronary intervention Pericardial effusion Pericarditis Peripartum cardiomyopathy Peripartum heart failure Phenothiazines Phenylbutazone Pheochromocytoma Polyarteritis nodosa Pompe's disease Postpericardiotomy syndrome Postradiation Pregnancy Procainamide Propranolol Psittacosis Pulmonary embolism Pulmonary hypertension Pulmonary regurgitation Pulmonary stenosis Refsum disease Renal failure Rheumatic fever Rickettsial disease Rosiglitazone Salih myopathy Sandhoff disease Schistosomiasis Selenium deficiency Sickle cell disease Singleton-Merten syndrome Sleep apnea Sunitinib malate Synthetic androgens Systemic lupus erythematosus Takotsubo cardiomyopathy Tay-Sachs' disease Tetralogy of fallot Thalassemia Toxoplasmosis Transposition of great vessels Trastuzumab Trichinosis Tricuspid prolapse Tricuspid regurgitation Troglitazone Trypanosomiasis Typhoid fever Uremia Valvular heart disease Varicella Ventricular aneurysm Ventricular septal defect Verapamil Very long-chain acyl-CoA dehydrogenase deficiency Water overload X-linked dilated cardiomyopathy Yunis-Varon syndrome Zalcitabine Zidovudine

Differential Diagnosis of Specific Chamber Enlargements

Left Atrial Enlargement

• Atrial aneurysm
• Infective endocarditis
• Left heart failure
• Mitral regurgitation
• Mitral stenosis
• Mitral valve prolapse
• Myxedma
• Patent ductus arteriosus
• Ventricular septal defect

Left Ventricular Hypertrophy

• Acromegaly
• Alcoholic cardiomyopathy
• Aortic coarctation
• Aortic regurgitation
• Aortic stenosis
• Chronic Renal Failure
• Familial dilated and hypertrophic cardiomyopathy
• Hypertrophic cardiomyopathy (HCM)
• Idiopathic dilated cardiomyopathy
• Mitral regurgitation
• Patent ductus arteriosus
• Restrictive cardiomyopathy
• Thalassemia

Right Atrial Enlargement

• Atrial aneurysm
• Atrial septal defect
• Ebstein's anomaly
• Pulmonic stenosis
• Right heart failure
• Tricuspid prolapse
• Tricuspid regurgitation
• Tricuspid stenosis
• Tumor

Right Ventricular Hypertrophy

• Atrial septal defect
• Chronic obstructive pulmonary disease (COPD)
• Cor pulmonale
• Eisenmenger's Syndrome
• Left ventricular hypertrophy or Left ventricular dilation
• Mitral stenosis
• Pickwickian syndrome
• Pulmonic regurgitation
• Pulmonic stenosis
• Tetralogy of fallot
• Transposition of the great vessels
• Tricuspid regurgitation
• Ventricular septal defect