Large Heart: good or bad?

Metaphorically, of course, it’s great if someone says you’ve got a large heart. Medically, apparently it’s more ambiguous.

A few years ago, as a result of an employment health exam I was told that my heart was too large and that’s a bad condition. Naturally, upon receiving such news I began googling and learned that a large heart can be a serious problem. . . or it can be a sign that one is athletic. Many top athletes, not surprisingly, have large, muscular hearts that work better than those of us mere mortals.

Anyway, I forgot about the whole subject until yesterday, when I received results of my latest employment health exam and was again told I have a large heart. So, again I’m wondering, does that mean I’m in trouble or does it mean the exact opposite, that my heart is better than normal? Incidentally, they also noticed a heart echo, which they also seemed concerned about.

Here’s what others say on the subject.

[quote]Cardiomegaly is a medical condition wherein the heart is enlarged. It is generally categorized in the following manner:

Cardiomegaly due to dilation
Cardiomegaly due to ventricular hypertrophy
Left ventricular hypertrophy (LVH)
Right ventricular hypertrophy (RVH)
Left atrial enlargement
It is not always negative; athletes often have enlarged hearts. However, it can often be associated with other serious medical conditions. . .[/quote]


. . . only in the past two decades has the application of echocardiography and other noninvasive imaging techniques permitted definition with some precision of the alterations in cardiac dimensions associated with athletic conditioning.

The athlete’s heart reflects a normal physiologic response to exercise. However, the constellation of findings on physical examination. . . of a well trained athlete can occur in certain pathological cardiac conditions, which may result in misdiagnosis and mislabeling of otherwise healthy individuals. Athletes can certainly have cardiovascular disease. Distinguishing between non-pathological changes in cardiac morphology associated with training (athlete’s heart) and certain cardiac diseases with the potential for sudden death is an important and not uncommon clinical problem.

. . . when a long-term demand is imposed on the heart, pump function is maintained by means of cardiac adaptive responses. . . increasing septal and free-wall thickness to normalize myocardial wall stress (La Place’s law). When chronic volume overload occurs, left ventricular end-diastolic diameter increases, with a proportional increase in septal and free-wall thickness to normalize wall stress. The increase in the diameter and in ventricular wall thickness can be considered appropriate compensation for the chronic volume overload placed on the hearts of athletes, who require sustained increases in cardiac output during competition.

In a well-trained athlete, the constraints due to La Place’s law may be compensated for by increasing myocardial mass. A larger myocardial mass reduces the cardiac wall tension required for cardiac ejection. An athlete in need of a high capacity for oxygen transport benefits from a large stroke volume, a low heart rate, and a thickened ventricular wall. Thus, the changes in cardiac dimensions that occur with training result in an increased efficiency of cardiac performance.

Clinical Findings

Athletes often have a slow resting heart rate, a third and fourth heart sound may be present as well as a systolic murmur. The resting ECG more frequently shows variations from the accepted normal (Table 1) and Holter monitoring more frequently picks up various rhythm disturbances than in age matched controls (Table 2). . .[/quote] … _made.html

I’m no Lance Armstrong. I’m not even an athlete anymore, but for many years until about a decade ago I did a fairly substantial amount of running, cycling and other intense aerobic activities, and I try to keep up with them from time to time. So I wonder if those activities way back then may have enlarged my heart and through basic aerobic maintenance over the years it’s remained slightly large, in a healthy athletic way, or is that possibility very remote and more likely it’s bad news.

I know, few of you are medical experts and I really ought to get the opinion of a competent doctor back in the States, which I intend to do some day. But I’m just curious if anyone is at all familiar with these issues.

I know, few of you are medical experts and I really ought to get the opinion of a competent doctor back in the States, which I intend to do some day. But I’m just curious if anyone is at all familiar with these issues.[/quote]

Sounds plausible, but of course seeing a cardiologist would be the obvious answer. Confusd by the “heart echo”, though, as a cardiac echo is usually a diagnostic procedure to map the heart.


Do you mean heart murmur? If you have an enlarged heart in conjunction with a heart murmur or other symptoms, then they’ll probably order up some tests for you. That’s exactly what happened to me. I’m an avid bike rider and hiker, so I was asking similar questions of myself when the enlargement and murmur were discovered last spring. In my case, heart enlargement=bad

Why would you ask in an anonymous forum?

It could be bad or it might not be … go to see a specialist doctor asap and find out once and for all!

I wish MT were here to answer that question for you, mr/ms smarty pants. Fact is, this stuff is scary and confusing to go through, as you may or may not know. I had a chest x-ray, and then got some very concerned looks from the doctor after she put the stethoscope on me. Up to that point, my experience and MT’s are exactly the same. It was a perplexing moment. I’m not going to try to draw futher comparisons to me because I’m not MT’s doctor, and because it takes away from my point.

The point is, I had to wait another week for the next round of tests and results, and during that time it would have been helpful to talk to others in a similar situation, share links, and educate myself about what to expect, if for no other reason that to occupy my mind with something constructive. Why not share some experiences on the forum? I’m not a doctor, but at least I can get myself up to speed with a liberal arts understanding of the heart and its function, ask what the next test is trying to detect, and try to get ahead of the decisions I’ll have to make about treatment.

I’m not a worrier by nature, I prefer to educate my fears and try to make intelligent predictions based on the information at hand. The Doctor is lord and master in Taiwan, so it isn’t always the easiest thing to get them to work with you as a partner in your own care. It’s been about 6 months now, and I’m not done with this thing yet, but boy have I learned a lot. The waiting worrying and wondering has been by far the worst part.

[quote=“smileymiley”]Why would you ask in an anonymous forum?

It could be bad or it might not be … go to see a specialist doctor asap and find out once and for all![/quote]

It’s not all that anonymous. A good number of us know each other IRL. If you are going to live here for a while/ long time then Forumosa and your friends form a great support group.

Imo the more knowledge the better. From my limited knowledge the following relates;

In simple terms the heart is going to be enlarged because it has been made to work hard.

In an athletes case they work it hard and it enlarges, the athletes resting heart rate can end up really low because of how efficient their cardiovascular system is. Average is 72bpm and athletes can have resting heart rates in the 30 plus bpm range with the large heart pumping a big volume less often into larger more elastic piping.
Opposite and it will be a regular thing here amongst older non exercsing overweight expats is a smaller heart pumping blood into smaller plumbing that is less elastic and has been narrowed with fatty deposits and then combine that with smoking which constricts that plumbing even more and we have a few time bombs for stroke/ heart attack walking around Taiwan (this means you … enter your name here) [/color]

In medical conditions it is working hard for the wrong reasons. A leaky valve for instance or a hole in the heart means the heart is enlarging to try and maintain efficiency.

MT is a healthy looking dude, so hopefully its just a matter of the medical profession here not seeing many athletic hearts in those who are not young adults. I strongly suspect that will be the case (hope so MT)

MT, curious if you did any follow up on this?
I too have an enlarged heart. And mine is definitely not good.

It is Left ventricular hypertrophy (LVH) and caused by clogged arteries. My cholestrol was over 400. Definetly gentic.
3 years ago I had a quad bypass and a myoblast transplant. I have had a big improvment after the surgery.
(I had it done in the US)
Since then I have gone on the South Beach diet, take lipitor and other heart meds, and execise every day.

Did your father or grandfather have it or a stoke?
Have you had your blood lipid levels checked?

If it is related to cholestrol, it is easy to take care of it before you have a heart attack, unfortunatly for me, I didn’t find out until it was too late.
Good luck.

My heart scares the crap out of me to the point where I bury my head in the sand. My father died at 49, his mother at 34. I am way too fat (although I do exercise). Lalalala.