Cardiomegaly and 80% Ejection Fraction

[stringfellow]

I was diagnosed with cardiomegaly after a routine chest xray--and when they did an ultrasound, etc., my doc tells me that I have an 80% ejection fraction.  He said there's no other abnormalities, no unusual growth, etc.  He said there's nothing to worry about, but my layman's research of the Internet leaves me with questions.

[kenkeith]

QUOTE: "I was diagnosed with cardiomegaly after a routine chest xray--and when they did an ultrasound, etc., my doc tells me that I have an 80% ejection fraction.  He said there's no other abnormalities, no unusual growth, etc.  He said there's nothing to worry about, but my layman's research of the Internet leaves me with questions."

>>>>>Cardiomegaly (enlarged heart) can be dilatation (ie hypertrophic myocardio..chamber size increases) but it can be a condition wherein the heart enlarges and can be attributed to many reasons. The condtion assumes to be the direct effect of the thickening of the heart muscles and that happens when the heart is given an increased workload. Reasons for increased workload may be due to other health conditions present in the body such as viral illnesses and previous heart attacks can cause the heart to overwork. Additionally, drug abuse, inflammation of the heart, and uncontrolled hypertension are the known issues that may give rise to cardiomegaly.

Normal ejection fraction is 50 to 70% and that is the amount of blood pumped with each stroke.  An 80% EF is an indication the heart is overcompensating, and if consistently high and the underlying cause is not effectively treated the heart can/will go into heart failure mode.  For some insight, the heart normally dilates to increase cardiac output (amount of blood pumped in a minute cycle) and this the result of the Frank/starling phenomonon.  For an analogy a handspring is stretched and the recoil is greater...but over stretch the spring it will become flaccid.  BP, EF, HR, etc. are compensating factors that maintain a balance of blood flow between the right and left side of the heart. Increase CO:  dilate left ventricle, increase HR, and blood pressure (constrict or dilate vessels) helps control blood volume...etc. Any one of these factors will compensate to maintain a balance.

If the megaly is due to heart wall thickening, the underlying cause can be high blood pressure, sometimes an athletes heart, heart muscle disease, etc. The left ventricle heart wall thickening can/will increase the contractility strength and increase CO and if it is an athlete's heart the increase in contractility will lower the heart rate (usually below 60 at rest) as the heart is more efficient.  If the wall thickening has an underlying cause is pathological and if not successfully treated the heart wall will not relax and this rigidity will impair the amount of blood that fills the chamber during the diastole phase.  Also, the enlarged size can crowd out space for filling. The EF can be normal, etc. but it is pumping less blood with each heartbeat.  And the reduced CO will eventually provide less blood from the lungs and heart failure.  Worst case scenario.

Thank you for questions, and are the answers consistant with your research? If you have any further questions or comments you are welcome to respond.  

Ken

[Mom2four85]

I had this on several tests including an Xray, but it took until they did a cardiac catherization to find out my cause - cardiomyopathy with an EF of 40%.

It may be nothing, but they should at least check out all possibilities if you have symptoms or other cardiac problems.

[is_something_wrong]

Hello.

Chest X-ray is not a good way to determine heart size. It's not synchronized with the heart beats, so the doctor can't say for sure if the heart is filled with blood or not when the picture is taken.

If your ultrasound was OK, (which is the gold standard in determining heart and heart wall sizes) I wouldn't worry at all. 80% ejection fraction (I also had 80%) is essentially a sign of a strong heart, unless your doctor mentioned diastolic failure (which is often a result from long standing hypertension, where the heart walls increase in size but aren't able to relax when the heart fills up). Maybe you were a bit anxious during the test? I was. And that makes the heart contract stronger.

Cardiomegaly is often a sign of another heart failure, so-called dilated cardiomyopathy, where the heart dilates and weakens. But that would NOT present with an EF of 80%, in such cases, EF is far below normal.

Heart size also varies with condition level, body size, etc. An athletic male has a larger heart than an untrained female, for example.