Enlarged Heart in Children

By Batul Nafisa Baxamusa

Enlarged heart in children is not a disease in itself, but a very rare symptom of other underlying medical conditions. This article will cover all the information you need to know more on its causes.

Cardiomegaly is the medical term for enlarged heart in children. It refers to the enlarged heart size seen on an X-ray, a sign that shows the heart is an overworked organ. It is usually a symptom of some underlying disease or something that alters the functioning of the heart. Adults can develop cardiomegaly due to stress on the working of the body, pregnancy or a heart disease like weakening of the muscles of the heart, coronary artery disease, heart valve problems or abnormal heart rhythms.

What is an Enlarged Heart?

Enlarged heart or cardiomegaly as mentioned is not a disease in itself. It is a condition where one observes enlargement of the heart on a chest X-ray. It is related to the disease of the heart muscles, that is, myocardium. There are different types of cardiomyopathies. These include primary that involves ailments of the heart. Secondary that involves some other disease or toxins that affect other organs as well as heart. Let us see what causes cardiomegaly in children.

Causes of Enlarged Heart in Children

High stress levels on the heart causes it to enlarge as the chambers grow and allow more blood to be processed. Thus, depending on the nature of enlargement, the heart is stretched more than its limit. A swelling in the heart in children may also lead to death. Cardiomegaly is also called hypertrophic heart. When the left ventricle of the heart gets enlarged, it is called left ventricular hypertrophy. The causes of an enlarged heart like ventricular hypertrophy is due to some disease or condition that causes extra stress on the left ventricle. The left ventricle is the main chamber for pumping in the heart.

One of the causes can also be due to cardiomyopathy. In cardiomyopathy, the heart is prevented from pumping enough blood. This causes deficiency of blood requirement within the body, leading to a condition called congestive heart failure. There can be an increase in blood pressure in the lungs and it can lead to a condition called pulmonary hypertension.

At times pericarditis can also lead to this condition. The sac surrounding the heart, that is, pericardium gets irritated and starts swelling. The child will complain of a sharp pain in the left side or the center of the chest. Fever, dry cough, shortness of breath and fatigue are common signs. Pericarditis may last for a few weeks or may become a chronic condition that lasts as long as 6 months or beyond. Other than that, myocarditis, that is inflammation of the heart wall can also lead to cardiomegaly. It is generally due to a reaction to certain chemicals, infection, medications as well as radiation.

The main causes due to cardiomyopathy is viral infection. It is generally an overreaction of the immune system to a viral infection. This virus is commonly found to be the Coxsackievirus B (CVB). Bacterial infection, like endocarditis can also lead to enlargement of the heart in children. This condition is generally treated with the help of aggressive antibiotic medications.

Many times, it may be due to congenital heart diseases, nutritional deficiency, fast heart rhythms or even due to chemotherapy for treating cancers in children. Cardiomyopathy can also be due to genetic disease or have no known cause.

Types of Cardiomyopathy Causing Enlarged Heart

There are a few types of cardiomyopathy that causes dilation of the heart. The following are some of the causes:

Dilated or Congestive Cardiomyopathy

The most common type of cardiomyopathy that causes the heart to enlarge and stretch that makes it weak and pump blood inefficiently. This disease may also cause other conditions like irregular heart rhythms leading to arrhythmia or dysrhythmia, increased chances of developing blood clots and congestive heart failure. Many infections, especially viral infections may also cause an inflammation of the heart muscles or myocarditis that causes cardiomyopathy. Chemotherapy that is given for treating cancers also leads to dilated cardiomyopathy. Many times, 20% of the children suffering from this condition have someone in the family with cardiomyopathy, making it a type of hereditary disease.

As explained earlier, the blood flow to the various parts of the body is decreased in cardiomyopathy. Thus, the body begins to conserve nutrients in the essential organs like brain, kidneys, etc. by lowering the supply of these essentials nutrients to skin and muscles. There are many symptoms of dilated cardiomyopathy that are commonly seen in children. However, not all children exhibit these symptoms. The symptoms due to dilated cardiomyopathy include:

Ashen skin color or pale color
Sweaty skin
Rapid heart rate
Increased rate of breathing
Shortness of breath
Chest pain
Slow growth
Abdominal pain

The treatment of dilated cardiomyopathy is based on the child's age and overall health of the child. The progress of the disease and the tolerance to specific therapies, medications and procedures by the child also plays an important role. The doctor may try to help the heartbeat more effectively and decrease the stress on the heart with the help of certain medications. He may also prescribe drugs that prevent clots, inflammation and irregular heartbeats. The enlarged heart in children due to dilated cardiomyopathy may improve with improvement in the viral infection. However, it may also worsen and transplantation of the heart may be considered.

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy; also known by other medical terms like hypertrophic obstructive cardiomyopathy (HOCM), asymmetric septal hypertrophy (ASH), or idiopathic hypertrophic subaortic stenosis (IHSS), is a rare disease. In this condition, the muscular mass of left ventricles become larger than normal or the septum between the two ventricles is enlarged. This causes obstruction in the flow of blood from the left ventricle, leading to abnormalities.

One of the mitral valve separating the left atrium and left ventricle may get affected by the thickened septal wall. This leads to a leaking mitral valve. Thus, the blood moves backward from the left ventricle into the left atrium instead of flowing in the forward direction into the body. The causes of enlarged heart due to hypertrophic cardiomyopathy is mostly due to hereditary conditions. The symptoms due to hypertrophic cardiomyopathy are:

Pain in chest
Abnormal heart rhythms
Fainting spells

The course of treatment and medications given to treat this condition due to hypertrophic cardiomyopathy are similar to dilated cardiomyopathy. The treatment of hypertrophic cardiomyopathy may also include surgery. The surgical procedures may involve placing an artificial pace maker, removal of a part of the enlarged muscle or heart transplantation.

If you observe anything out of the unusual with your child's health, consult a doctor immediately. It is very important to trust your parental instincts and take immediate action to ease it. Your child's doctor knows what's best for your child. Follow medical advice and take some utmost care of your child and his/her heart health.