|
|
| (23 intermediate revisions by 7 users not shown) |
| Line 1: |
Line 1: |
| {{Template:Cardiomegaly}} | | __NOTOC__ |
| | '''For the WikiPatient page for this topic, click [[{{PAGENAME}} (patient information)|here]]''' |
| {{DiseaseDisorder infobox | | | {{DiseaseDisorder infobox | |
| Name = Cardiomegaly | | | Name = Cardiomegaly | |
| ICD10 = {{ICD10|I|51|7|i|30}} |
| | Image = cardiomegaly-2.jpg| |
| ICD9 = {{ICD9|429.3}} |
| |
| ICDO = |
| |
| Image = cardiomegaly-2.jpg|
| |
| Caption = |
| |
| OMIM = |
| |
| MedlinePlus = |
| |
| eMedicineSubj = |
| |
| eMedicineTopic = |
| |
| DiseasesDB = 30769 |
| |
| MeshID = D006332 |
| |
| }} | | }} |
| | {{Template:Cardiomegaly}} |
|
| |
|
| {{CMG}}; '''Associate Editor in Chief:''' {{CZ}} | | {{CMG}} |
|
| |
|
| | {{SK}} Enlarged heart; heart enlargement; |
| ==[[Cardiomegaly overview|Overview]]== | | ==[[Cardiomegaly overview|Overview]]== |
| | |
| | ==[[Cardiomegaly historical perspective|Historical Perspective]]== |
|
| |
|
| ==[[Cardiomegaly pathophysiology|Pathophysiology]]== | | ==[[Cardiomegaly pathophysiology|Pathophysiology]]== |
|
| |
|
| ==[[Cardiomegaly epidemiology and demographics|Epidemiology and demographics]]== | | ==[[Cardiomegaly causes|Causes]]== |
| | |
| | ==[[Cardiomegaly differential diagnosis|Differentiating Cardiomegaly from other Diseases]]== |
| | |
| | ==[[Cardiomegaly epidemiology and demographics|Epidemiology and Demographics]]== |
|
| |
|
| ==[[Cardiomegaly risk factors|Risk factors]]== | | ==[[Cardiomegaly risk factors|Risk factors]]== |
| Line 27: |
Line 26: |
| ==[[Cardiomegaly screening|Screening]]== | | ==[[Cardiomegaly screening|Screening]]== |
|
| |
|
| ==[[Cardiomegaly natural history|Natural History, Complications & Prognosis]]== | | ==[[Cardiomegaly natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| | |
| ==[[Cardiomegaly causes|Causes]]==
| |
| | |
| ==[[Cardiomegaly differential diagnosis|Differential diagnosis of cardiomegaly]]==
| |
|
| |
|
| == Diagnosis == | | == Diagnosis == |
| [[Cardiomegaly history and symptoms|History and Symptoms]] | [[Cardiomegaly physical examination|Physical examination]] | [[Cardiomegaly laboratory tests|Lab tests]] | [[Cardiomegaly electrocardiogram|Electrocardiogram]] | | | [[Cardiomegaly history and symptoms|History and Symptoms]] | [[Cardiomegaly physical examination|Physical examination]] | [[Cardiomegaly laboratory findings|Laboratory Findings]] | [[Cardiomegaly electrocardiogram|Electrocardiogram]] | [[Cardiomegaly chest x ray|Chest X ray]] | [[Cardiomegaly MRI|MRI]] | [[Cardiomegaly CT|CT]] | [[Cardiomegaly echocardiography or ultrasound|Echocardiogpraphy or Ultrasound]] | [[Cardiomegaly other imaging findings|Other Imaging Findings]] | [[Cardiomegaly other diagnostic studies|Other Diagnostic Studies]] |
| | |
| === Chest X Ray ===
| |
| | |
| *Cardiomgaly is traditionally defined as an increase in the cardiothoracic ratio to be > 0.5 on a '''PA''' film. To calculate the thoracic ratio, the width of the cardiac silhouette is divided by the width of the entire thoracic cage.
| |
| *'''If the heart is viewed on an AP film, the heart can appear to be artificially enlarged because the X ray beam moves from anterior to posterior direction and therefore the heart which lies anterior is magnified.'''
| |
| *:* Postero Anterior (PA) Projection: adult heart is 12 cm from base to apex and 8-9 cm in transverse direction
| |
| *:* Lateral Projection: The adult heart is 6 cm in the Antero Posterior (AP) direction
| |
| | |
| ====X-ray findings for left ventricular enlargement====
| |
| | |
| *Left heart border is displaced leftward, inferiorly, or posteriorly.
| |
| *Rounding of the cardiac apex
| |
| | |
| [[image:cardiomegaly-2.jpg|left|300px|thumb|Cardiomegaly. <br> Image courtesy of C. Michael Gibson MS. MD ]]
| |
| <br clear="left"/>
| |
| | |
| [[Image:Cardiomegaly-prosthetic-mitral-valve-001.jpg|left|300px|thumb|Cardiomegaly in a patients after mitral valve replacement. AP view. [http://www.radswiki.net Image courtesy of RadsWiki] ]] | |
| <br clear="left"/>
| |
| | |
| [[Image:Cardiomegaly-prosthetic-mitral-valve-002.jpg|left|300px|thumb|Cardiomegaly in a patients after mitral valve replacement. Lateral view. [http://www.radswiki.net Image courtesy of RadsWiki].]] | |
| <br clear="left"/>
| |
| | |
| ====X-ray findings for left atrial enlargement====
| |
| | |
| *'''Double density sign:''' Occur when the right side of the left atrium pushes into the adjacent lung.
| |
| *Convex left atria appendage: usually reflect prior [[rheumatic heart disease]]
| |
| *Splaying of the carina
| |
| *Posterior displacement of the left main stem bronchus on lateral radiograph
| |
| *Superior displacement of the left main stem bronchus on frontal view
| |
| *Posterior displacement of a barium filled esophagus
| |
| | |
| [[Image:Left-atrial-enlargement-001.jpg|left|300px|thumb|Double density sign]] | |
| <br clear="left"/>
| |
| | |
| [[Image:Left-atrial-enlargement-002.jpg|left|300px|thumb|Double density sign]] | |
| <br clear="left"/>
| |
| | |
| ====X-ray findings for right ventricular enlargement====
| |
| | |
| *Frontal view
| |
| | |
| :*Rounded left heart border
| |
| :*Uplifted apex
| |
| | |
| *Lateral view
| |
| :*Filling of the retrosternal space
| |
| :*Rotation of the heart posteriorly
| |
| | |
| ====X-ray findings for right atrial enlargement====
| |
| | |
| *On a frontal view, the right atrium is visible because of its interface with the right middle lobe.
| |
| *Subtle and moderate right atrial enlargement is not accurately determined on plain films because there is normal variability in the shape of the right atrium.
| |
| | |
| === Echocardiography or Ultrasound ===
| |
| * Echocardiogram recommended for those patients presenting suspected valvular disease, chamber size, ventricular function, and wall motion abnormalities
| |
| | |
| === Other Diagnostic Studies ===
| |
| * Exercise or pharmacologic stress testing may be indicated in those patients suspected of having [[coronary artery disease]]
| |
| * Patients suspected of having valvular disease or [[coronary artery disease]] may need a [[cardiac catheterization]] for full evaluation following [[echocardiography]]
| |
| | |
| ==Pathological Findings==
| |
| | |
| [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
| |
| | |
| [[Image: RVE Hyalin membran disease.jpg|left|300px|thumb|Right ventricular enlargement due to a [[patent ductus arteriosus]] in a patient with hyaline membrane disease]]
| |
| <br clear="left"/>
| |
|
| |
|
| == Treatment == | | == Treatment == |
| | [[Cardiomegaly medical therapy|Medical therapy]] | [[Cardiomegaly surgery|Surgery]] | [[Cardiomegaly prevention|Prevention]] | [[Cardiomegaly cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Cardiomegaly future or investigational therapies|Future or Investigational therapies]] |
|
| |
|
| == Pharmacotherapy == | | ==Case Studies== |
| | | [[Cardiomegaly case study one|Case #1]] |
| === Acute Pharmacotherapies ===
| |
| * Administration of [[digoxin]], [[diuretic]]s, [[antiarrhythmics]] and/or [[preload]] and [[afterload]] reducers per clinical indication
| |
| | |
| === Chronic Pharmacotherapies ===
| |
| A combination of [[diuretic]]s and [[angiotensin converting enzyme]] ([[ACE]]) inhibition is currently the standard of care. [[Digoxin]] may reduce the frequency of rehospitalization, but does not improve mortality.
| |
| | |
| == Surgery and Device Based Therapy ==
| |
| * In patients who are awaiting a transplant for end-stage symptomatic [[heart failure]], implantable [[ventricular assist devices]] may serve as a temporary aid for compensation.
| |
| | |
| === Transplantation ===
| |
| * In patients who are in end-stage symptomatic [[heart failure]], a [[heart transplant]] my be necessary.
| |
| | |
| == Future or Investigational Therapies ==
| |
| Mechanical strategies currently under investigation include:
| |
| #Development of devices to reduce the size of the heart | |
| #Development of a device to exclude that portion of the apex where clots may form.
| |
| | |
| ==Pathological Findings==
| |
| | |
| [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
| |
| | |
| [[Image:Biventricular Hypertrophy.jpg|left|300px|thumb|Biventricular Hypertrophy]]
| |
| <br clear="left"/>
| |
| | |
| [[Image:Biventricular Hypertrophy 1.jpg|left|300px|thumb|Biventricular Hypertrophy]]
| |
| <br clear="left"/>
| |
| | |
| [[Image:Left ventricular hypertrophy 2.jpg|left|300px|thumb|Gross excellent example of concentric left ventricular hypertrophy]]
| |
| <br clear="left"/>
| |
| | |
| [[Image:Left ventricular hypertrophy 1.jpg|left|300px|thumb|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)]]
| |
| <br clear="left"/>
| |
| | |
| [[Image:Right ventricular hypertrophy.jpg|left|300px|thumb|Myocardial Infarct: Gross natural color apical section showing large left ventricle infarct and right ventricular hypertrophy]]
| |
| <br clear="left"/>
| |
| | |
| [[Image:Right ventricular hypertrophy 1.jpg|left|300px|thumb|Right ventricular hypertrophy]]
| |
| <br clear="left"/>
| |
|
| |
|
| == References ==
| |
| {{reflist|2}}
| |
|
| |
|
| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| Line 152: |
Line 42: |
|
| |
|
| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Microchapter candidate]] | | [[Category:Disease]] |