Cardiomegaly

Cardiomegaly means enlargement of any chamber/chambers of the heart.
It is termed right or left cardiomegaly, depending on whether the right or left chambers are enlarged. If only both upper chambers are enlarged it is called aortic hypertrophy. If only both lower chambers are enlarged, ventricular hypertrophy. Among all types of hypertrophies, Left Ventricular Hypertrophy [LVH] is most common. In this article I deal with only clinical aspects of LVH, because LVH is common, among all types of hypertrophies of the heart.

Clinical causes of LVH are:-

1. Heredity
2. Diabetes Mellitus
3. Anxiety Neurosis
4. Hypertension Idiopathic
5. Chronic Renal Failure
6. Prolonged stresses & strains
7. Excessive Alcoholism
8. Narcotics
9. Sedentary Lifestyle
10. Tobacco Smoking/Chewing

Clinical Diagnosis of LVH by signs and symptoms:–

Following Symptoms clinically judge LVH:-

1. Palpitation – Palpitation may associate with anxiety, nausea, restlessness, suffocation. Some patients complain of palpitation with anxiety, or with nausea, or restlessness, or with a feeling of suffocation. The most prominent symptom of palpitation is palpitation which is worse lying on the left side (effect of gravity).
2. Dyspnoea – The patient complains of difficulty breathing on slightest exertion. Sometimes difficult breathing is associated with feeling of suffocation even on rest.
3. Suffocation – The patient may complain of suffocation in a warm or closed room. Feeing of suffocation may be better in open air.
4. Retro-sternal pain – Patient complains of Retro-sternal pain which is worse lying on left side, due to gravitational force. Retro sternal pain may occur with or without palpitation.
5. Hypertension– High blood pressure is a prominent manifestation of LVH. High blood pressure manifests with various symptoms according to the individuality of patients. Some patients complain of body ache during hypertension. Some complain of pulsating pain at sides of the head or pulsating temples. Others complain of heat at the vertex during high blood pressure.
6. Fever, Cough & Coryza in heart patients causes a serious emergency condition. Cough in LVH may be due to edema of lungs & around heart, which results in prolonged and severe episodes of coughing.
7. Edema -Generalized edematous swellings in LVH indicate a severe condition of the heart.
8. Tachycardia – Pulse rate above 100/minute indicates tachycardia.

Confirmation of LVH:-

1. E.C.G. Electrocardiography shows:-

{A} Increased QRS Complex voltage in leads LI & LII

{B} Prolonged Time Interval 0.09 to 0.12 seconds in Leads LI, LII & LIII.

{C} QRS complex inverted and Prolonged in Lead LIII.

{D} QRS complex inverted (electronegative) in Lead aVF.

2. ECHO. Echocardiography shows increased dimensions of left ventricle
along with decreased ejection fraction.

MANAGEMENT OF LVH:

This section includes followings:-

1. Bed Rest to avoid unnecessary burden on heart pumping system.
Complete bed rest must be advised.

2. Avoidance of maintaining causes such as smoking, alcohol drinking habits. Change of place for peace of mind. Music therapy if change of place not possible. Other means to avoid excess stress and strain such as reading,
watching funny serials.

3. Edema must be treated by increasing urine output.

4. Fever, cough & coryza must be subsided as soon as possible.

5. Diet should be free of carbohydrates, fats, coffee, cold drinks, meat, gullet (Madda) and spices. Restrict salt intake. Minimum quantity of salt in vegetables. Raw salt intake such as in salads must be prohibited.
Fluid intake must be according to thirst. Advised to drink half of what is thirsted for. Excess water/fluid intake & salt increases the severity of LVH patients by increasing edema.

6. Advised to take plenty of raw vegetables such as cabbage, onions, garlic, tomatoes, ginger. Honey is backbone of heart. Soyabean is for strengthening the heart. Fruits should be used instead of chapattis.