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Enlarged Heart?
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Enlarged Heart?

8941091?1363618585
My brother has been to doctor after doctor, and he keeps getting shoved away or treated like his symptoms are not a big deal.  I have my own opinions about his symptoms, but a picture he sent me last night changes the situation and has scared me quite a bit.  I am not a doctor, but the picture concerns me because it may not be normal, and could possibly confirm his concerns about what he thinks he may have.  His symptoms include palpitations, "out of breath" when climbing stairs, sitting up, etc., fainting, chest pains, high blood pressure, and others I can't remember at the moment.   I am very concerned about him and would appreciate any help/insight/advice.
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Avatar_f_tn
What do you see in the picture that strikes you as abnormal?  My husband is a professor of human anatomy, has dissected a large number of people, and  does not see anything remarkable in the image.
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Avatar_m_tn
My brother thinks his heart is enlarged.  I have no idea what an enlarged heart looks like, but when he first got his xrays, his heart was not this big and in this picture you can tell it has "grown".  That is what concerns me.
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Avatar_f_tn
If your brother has a medical education, he may be correct in thinking his heart is enlarged.
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Avatar_m_tn
That's what I feared.  He sent me the CT scan he had done last October, and when you size the pictures so that the lung cavities are the same size, the heart has grown by 30%.  Does your husband have any insight to what the possibilities are for that, given his symptoms?
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976897_tn?1379171202
An Enlarged Heart (cardiomegaly) can be caused by a number of things and the underlying cause needs to be found. The cause is usually treatable. Causes can include heart muscle weakening, artery disease, high blood pressure, kidney disease, alcohol or drug abuse, inherited genes, valve disorders or even abnormal heart rhythms.
Once the heart reaches a certain size, the walls become too thin to work efficiently and then congestive heart failure starts. I assume that IF the heart is enlarged, they are running tests to find the cause?
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Avatar_m_tn
He has an appt. to see a doctor, but they couldn't schedule him in until April 9th.  If they find out it is from high blood pressure or something like that, my question would then be why does he have high blood pressure?  My hope is that one of his doctors will find the underlying cause for not only the enlarged heart, but everything else involved too.  If there's an imbalance somewhere causing his heart to work harder, they should find out where it is so it can be corrected.  Thanks everyone for the insight!
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3455166_tn?1347510733
Hi there, this is just my two cents but...

Does your brother have any sort of medical history, such as long term hypertension, diabetes, vascular issues and the like? Any bad habits like excessive alcohol consumption or smoking? Is he a sedentary individual?
Lots of stress by any chance?

Cardiac hypertrophy comes down to two overall forms - physiological and pathological enlargement. In the case of physiological hypertrophy, your heart gets larger and stronger to adapt to new changes, brought on by exercise usually, or in the case of women - pregnancy. Its common and normal. The ventricular enlargement is uniform, systolic and diastolic function is normal and the ventricle itself can expand, known as eccentric hypertrophy, which occurs mainly with endurance exercise and less intense weight lifting, whilst it the heart muscle itself (the myocardium) gets more "muscular" and thick to enable more forceful contractions. The muscle does not thicken inwards though, it grows out, with no reduction in chamber volume, unlike the pathological case where the myocardium grown inwards, reducing chamber volume.

Has he had an EKG stress test, echocardiogram and bloodwork done?

Are the doctors he's been to specialists or just GP's?
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Avatar_m_tn
He has been VERY sedentary pretty much his whole life, and definitely more so the past 5 years.  He sits in front of a computer all day long and lies in bed (now mostly because he is terrified to move too much).  He has a lot of anxiety which he has had basically his entire life, but more targeted now because of his symptoms.  He really hasn't had a medical history, but my grandpa (with whom he lives) has diabetes and other minor medical issues.  

He is getting bloodwork done right now, not sure about the echocardiogram, but I believe he has had a stress test and I cannot recall the results.  He has done a test where he was on an inversion table, and once they had him tilted in the upright position for 45 mins, found he did have a certain blood pressure problem (can't recall the name....maybe POTS???).  

He has a family doctor and he has been to a couple others, but again, I am not exactly sure if some of them were specialists or not...although I do recall him talking about seeing a couple who shunned him away and told him to take anxiety meds.  I know he does have an appt. with a cardiologist in a few weeks, and his doctor prescribed him clonazepam for the "adrenaline/sertraline imbalance", which he has agreed to try to either a) see if it really works or b) show his doctor that's not the problem (his doctor told him there were no other tests he thinks that would be helpful).  

Thank you so much for your help!
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Avatar_m_tn
Oh, and maybe I should mention he is only 24...
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Avatar_f_tn
You cannot measure or compare heart sizes in this way.  For one thing, you have to know what position he was in when the images were taken,  For another, the apparent lung capacity varies both with position and how deep a breath was taken.  There are a lot of other measurements to be taken.

This is not a simple business at all.  Here is how the pros do it:

http://www.ncbi.nlm.nih.gov/pubmed/22261772

But in order for you to run interference for your brother, or to get answers here, you need a lot more precise, first hand information.  There simply is not enough to work with yet.  For example, has he had an EKG, and if so, what were the results?  What were the stress test results? What did the blood tests show?

I would suggest that you go with him to his cardiologist appointment--bringing a notepad in which you have previously *written* your questions (because we all kind of forget what we wanted to ask, and what we learned, without this kind of prep).  Then report back to us here.
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159619_tn?1318997813
You need to step back a little and wait and see what the doctor says. None of us are doctors and can't really say if it's enlarged or not. Much depends on the type and quality of the image. What appears to be an enlarged heart may just be a different intensity that is picking up the pericardial sack around the heart where the first image did not. He may also have been suffering with pericarditis. When the pericardial sac has accumulated a large amount of fluid, the cardiac shadow on the chest x-ray can become larger than normal.This would also explain the symptoms you describe so don't jump to a conclusion that he has an enlarged heart, he needs to get an educated opinion from a Cardiologist, he may have a completely normal x ray if one was done today. Check out the picture in this link and notice how similar it is to his;

http://en.wikipedia.org/wiki/Pericarditis

Let us know how it goes,

Jon
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5135129_tn?1364125940
yeah the x ray pic shows an enlarge heart...so has he met a doctor???
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