Enlarged R&L Atriums

[edprof]

59 year old male in excellent health diagnosed with aneurysm ascending aorta (4.2). No history of hypertension normal levels lipids etc. Had second opinion at CC in April.  Had 2 echos, 2 Cats scans and an MRI last Dec.  All results were normal--with exception of aneuerysm and mildly dilated right atrium----valves normal, no regurgitation, normal systolic function, aortic valve normal, no pulmonary hypertension, EF 50-55. Take Atacand 24 mg, Atenolo 25 mg, Vytorin 10/20 for prevention---no side effects.  12/07 had annual physical and MRI for anuerysm--results--BP 105/65, HR 54, Cholest: 121--HDL 40--LDL  62, Trig 97.  MRI study had both ventricles as being mildly dilated and both Atriums as being moderately dilated. My concerns are that appears that my heart has enlarged.  Why?  Have no side effects, speed walk daily 4 miles up and down hills, no shortness of breath, i feel good.  Eat a mediterrean diet, 2 glasses of wine a day, smoke one cigar a week. My general MD says not to worry about it because it is probably just the natural size of my heart---problem is that this is not consistent with previous studies.
Questions?

What could have caused the Atriums to become moderately dilated?  Could the test have been misread?  Is this connected to the anuerysm?
What can i do to correct this?  Is this a sympton of something else? Am i at risk?  Should i have a cadiologist read the MRI?

Any help would be appreciated

Thank You

[Darcy Green Conaway, MD]

The aneurysm could be of a few different causes: something congenital, long-standing hypertension, valvular disorders, connective tissue disorders. It sounds like this may be long-standing hypertension that is dilating the aorta and causing diastolic dysfunction (problem with the relaxation phase of the heart pumping)-- this can cause enlarged atria. I would not say that it is normal; I would gather all the data you have and compare the results, such as the cardiac echo and mri. I would definitely see a cardiologist if you haven't yet.