Primary Care

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Primary Care

Primary Care

To prepare:

•Review Part 10 of the Buttaro et al. text in this week’s Learning Resources, as well as the provided x-rays.

•Reflect on what you see in the x-ray assigned to you by the Course Instructor.

•Consider whether the patient in your assigned x-ray has an enlarged heart, enlarged blood vessels, fluid in the lungs, and/or pneumonia in the lungs.

POST  1 TO 2 PAGES DISCUSSISON PAPER ON: A  description of what you see in your assigned patient x-ray. Then, explain whether the patient has an enlarged heart, enlarged blood vessels, fluid in the lungs, and/or pneumonia in the lungs. And explain your rationale behind  your diagnosis .



Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby.

Part 10, “Evaluation and Management of Pulmonary Disorders” (pp. 404–486)

Please use textbooks, national guidelines and journals articles < 5 years as references, avoid uptodate, amyo and Cleveland Clinic emed, webMD, Medscape as they are resources, no nd or no date, find the date or do not use

An enlarged heart (cardiomegaly) is symptom of another disorder rather than disease.
An enlarged heart can be visible on any imaging test, including chest X-ray, and is referred to as “cardiomegaly.” 
Other tests are then required to determine the cause of the heart’s enlargement.
An enlarged heart can be caused by temporary load on the body, such as pregnancy, or by medical condition, such as heart muscle weakening, coronary artery disease, heart valve abnormalities, or irregular heart rhythms.
Certain conditions can cause the heart muscle to thicken or one of the heart chambers to dilate, causing the heart to expand. 
An enlarged heart might be temporary or permanent, depending on the situation.
Correcting the cause of an enlarged heart may be possible to treat. 
Medication, medical procedures, or surgery may be used to treat an enlarged heart.
An enlarged heart can cause no indications or symptoms in some persons. 
Others may exhibit the following signs and symptoms:


Breathing problems


Heart rhythm that is abnormal (arrhythmia)


swollen (edema)


When should you see doctor?


If you have concerns about your heart, talk to your doctor. An enlarged heart is easier to treat if diagnosed early.


If you have any of the following signs and symptoms, you may be having heart attack:


Pain in the chest


Other parts of the upper body, such as one or both arms, the back, neck, jaw, or stomach, are uncomfortable.


Fainting due to severe shortness of breath


Make an appointment with your doctor if you notice any new signs or symptoms that could be related to your heart.




Conditions that cause your heart to pump harder than usual or damage your heart muscle might produce an enlarged heart. 
For unexplained reasons, the heart might grow larger and become weak. 
Idiopathic cardiomegaly is the medical term for this condition.


Your heart can grow due to congenital cardiac problem, injury from heart attack, or an abnormal heartbeat (arrhythmia). 
The following are some of the other conditions linked to an enlarged heart:


Blood pressure that is too high. 
To transport blood to the rest of your body, your heart may have to work harder, causing the muscle to enlarge and thicken.


High blood pressure can cause the left ventricle to expand, eventually weakening the heart muscle. 
High blood pressure might cause your heart’s upper chambers to expand.


Valve disease of the heart. 
Your heart has four valves that keep blood flowing in the proper direction. 
Your heart may grow if the valves are damaged by rheumatic fever, cardiac defect, infections (infectious endocarditis), an abnormal heartbeat (atrial fibrillation), connective tissue problems, certain drugs, or cancer radiation therapies.


This heart condition makes it more difficult for your heart to pump blood throughout your body. 
As the condition worsens, your heart may enlarge in an attempt to pump more blood.


The artery that connects your heart and lungs has high blood pressure (pulmonary hypertension). 
To transfer blood between your lungs and your heart, your heart may have to work harder. 
As result, your heart’s right side may grow.


The fluid that surrounds your heart (pericardial effusion). 
On chest X-ray, fluid accumulation in the sac that holds your heart might cause your heart to appear larger.


Your heart’s arteries are clogged (coronary artery disease). 
Fatty plaque in your heart arteries obstructs blood flow via your heart vessels, potentially resulting in heart attack. 
Your heart has to pump harder to get enough blood to the rest of your body when piece of heart muscle dies, causing it to expand.


Red blood cell count is low (anemia). 
Anemia is disorder in which your red blood cells aren’t enough to supply enough oxygen to your tissues. 
Chronic anemia, if left untreated, can cause rapid or irregular heartbeat. 
To compensate for the lack of oxygen in the blood, your heart must pump more blood.


Thyroid problems. 
Heart issues, including an enlarged heart, can be caused by both an underactive thyroid gland (hypothyroidism) and an overactive thyroid gland (hyperthyroidism).


Overabundance of iron in the body (hemochromatosis). 
Hemochromatosis is condition in which your body fails to effectively metabolize iron, leading it to accumulate in multiple organs, including your heart. 
Because the heart muscle weakens, this can result in an enlarged left ventricle.


Amyloidosis, for example, is rare illness that can harm your heart. 
Amyloidosis is disorder in which aberrant proteins circulate in the blood and may be deposited in the heart, causing it to expand and interfere with its function.


Factors that are at risk


If you have any of the following risk factors, you may be at higher risk of developing an enlarged heart:


Blood pressure that is too high. 
Having blood pressure reading of 140/90 millimeters of mercury or greater.


history of enlarged hearts or cardiomyopathy in the family. 
You may be more susceptible if close relative, such as parent or brother, has had an enlarged heart.


Congenital heart disease (CHD) is type of congenital cardiac defect 
You may be at higher risk if you were born with disorder that affects the structure of your heart.


Valve disease of the heart. 
The aortic, mitral, pulmonary, and tricuspid valves are four valves that open and close to direct blood flow through the heart. 
The heart may expand as result of conditions that damage the valves.




The risk of problems from an enlarged heart is determined by the location of the enlargement and the reason.


An enlarged heart can cause variety of complications, including:


Heart failure is serious condition. 
Heart failure is increased by an enlarged left ventricle, one of the most dangerous types of enlarged heart. 
Heart failure occurs when the heart muscle weakens and the ventricles stretch (dilate) to the point where the heart can no longer effectively pump blood throughout the body.


Clots in the blood. 
If your heart is enlarged, you’re more likely to develop blood clots in the lining of your heart. 
Clots can obstruct blood supply to important organs and potentially cause heart attack or stroke if they enter your bloodstream. 
pulmonary embolism is serious disorder that occurs when blood clots form on the right side of your heart and move to your lungs.


murmur in the heart. 
Two of the heart’s four valves — the mitral and tricuspid valves — may not close properly due to dilation in persons with enlarged hearts, resulting in blood backflow. 
Heart murmurs are the result of this flow. 
Heart murmurs should be checked by your doctor, even if they are not necessarily hazardous.


Sudden death due to cardiac arrest. 
The beating rhythm of your heart might be disrupted by an enlarged heart. 
Heart rhythms that are either too slow to flow blood or too quick to allow the heart to beat effectively might cause fainting, cardiac arrest, or sudden death.
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