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Enlarged heart - no obvious symptoms - looking for Dr thoughts

I recently got diagnosed with an enlarged heart. Mild enlargement. Every chamber and symmetrical in nature. This was done by MRI. It showed no obvious inflammation, infarction or damage and the function of all four chambers, so I'm told, was normal. No valve issues.

The left ventricular wall thickness was 1cm and the ejection fraction was 60%. So, apart from being a bit big, this all sounds normal. I also did an exercise stress test that came back negative.

I have no symptoms - no dysnpea (even when exercising), no ascites, no oedema and am able to go about my day like anyone else. I don’t smoke and drink moderately.

I'm physically quite active. I cycle a few times a week and up to about 4-5 months ago I used lift weights. Up to about one year ago I used to kickbox four times a week. My true resting heart rate is generally lower than 60bpm (around 55 average) and sometimes I have clocked it in the 40s. I have prominent sinus arrhythmia with respiration and occasional junctional rhythm and occasional preventricular contractions. All of which, from what I have read, sounds like it could be a form of athletic heart.

However, a few things concern me that it might not be an athletic heart:

1) Occasional left bundle branch block has been noted on my ECGs. From what I’ve read, this generally does not show up in a an athletic heart, but is more often a sign of heart disease.
2) I get weird pains and aches in my mid back and just above my diaphragm that appear not to be muscular. Sometimes these occur at rest and sometimes while exercising. Never so bad that I have to stop what I’m doing so I don’t think it’s angina. I have been told that cardiomyopathy is often noted as producing weird chest pains even if not in the presence of ischemic heart disease.
3) I have small episodes where I get dizzy and light-headed for no obvious reason. I never feel like I’m going to faint, but generally weak and slightly ‘other-wordly’.

I have not been officially diagnosed with anything (yet) other than a large heart, but I have been put on ramipril 5mg per day as a trial to see if it changes anything to do with my heart size.

I’d be interested to hear if people think this sounds like DCM and my dizziness and weird aches are early symptoms or if it sounds like an athletic heart and the pain and dizziness could be coming from something else.

Any help appreciated as I just don’t know and my cardio is not willing to give me a diagnosis at this stage.
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replied December 26th, 2011
You don't give your age or past history, but nevertheless your mode of living certainly is consistent with an athletic heart, as is your slow heart rate and the findings on echocardiography and your normal exercise test. Your "weird pains" don't have anything to do with the heart. I don't know why you have had intermittant left bundle branch block (complete or incomplete LBBB?)on your electrocardiogram, nor do I know why you sometimes feel weak and dizzy. Sinus arrhythmia and occasional premature heart beats are not abnormal.
I see no harm in trying ramipril, but doubt that it will affect left ventricular thickness. There is some evidence that discontinuing an athletic lifestyle will be associated with decrease in left ventricular thickness. I see no evidence in your presentation for a hypertrophic ventricular cardiomyopathy. You should discuss with your doctor the possible causes for your episodes of weakness and lightheadedness and dizziness.
Please remember that I am unable to diagnoses medical conditions online.


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