Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Key diagnostic criteria for identifying cardiomegaly in a primary care setting include:
- Clinical assessment: Take a detailed history and perform a clinical examination to identify symptoms and signs suggestive of cardiac enlargement or heart failure, such as breathlessness, peripheral oedema, or abnormal heart sounds NICE NG106.
- Chest X-ray: Use chest radiography to assess heart size; cardiomegaly is suggested by an increased cardiothoracic ratio (heart size greater than 50% of the thoracic diameter) on chest X-ray NICE NG106.
- Electrocardiogram (ECG): Perform an ECG to detect abnormalities that may indicate cardiac enlargement or underlying cardiac pathology contributing to cardiomegaly NICE NG106.
- Measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP): Elevated NT-proBNP levels support the presence of cardiac dysfunction, which may be associated with cardiomegaly NICE NG106.
- Referral for echocardiography: If cardiomegaly is suspected clinically or on chest X-ray, refer for transthoracic echocardiography to confirm cardiac enlargement, assess ventricular size and function, and exclude valve disease or other structural abnormalities NICE NG106,NICE NG208.
In summary, cardiomegaly in primary care is initially suspected based on clinical features and chest X-ray findings, supported by ECG and NT-proBNP testing, and confirmed by echocardiography performed by experienced operators NICE NG106,NICE NG208.