What Is Left Atrial Enlargement? (2024)

Left atrial enlargement (LAE) occurs when the upper left part of your heart—one of the heart’s four chambers—is larger than it should be. This is caused by too much pressure on the heart, which could be related to high blood pressure, stress, and underlying heart disease. It can also be caused by increased blood volume in the left atrium.

Some people with LAE experience symptoms like chest pain, fatigue, and breathing problems, while others have no symptoms at all. Left atrial enlargement is not a cause for worry in itself, but it is a sign that you may have a serious cardiovascular condition. LAE may resolve once the underlying cause is diagnosed and treated.

This article explains the causes and symptoms of left atrial enlargement, how it’s diagnosed, and how you can treat issues that might have led to the condition. It also covers prevention tips and the prognosis of this condition.

What Is Left Atrial Enlargement?

Left atrial enlargement is when the posterior left chamber of the heart, called the left atrium, becomes larger than normal.The condition develops over time and is caused by other conditions that increase the pressure or blood volume in the left atrium.

The exact prevalence of left atrial enlargement is not known, but it’s believed to be common. A Chinese study with around 12,000 subjects over the age of 35 found that about 6.4% of them had the condition. The incidence of LAE increases with age. People who are female, overweight, older, or have high blood pressure or diabetes are at greater risk for left atrial enlargement.

Who Does Left Atrial Enlargement Affect?

Health conditions most commonly associated with left atrial enlargement include high blood pressure, atrial fibrillation, mitral valve dysfunction, and left ventricle problems. These conditions can produce elevated left atrial pressures, elevated left atrial volume, or both—leading to LAE.

While left atrial size is influenced by aging, sex, and body size, these are not causes or risk factors for LAE. Underlying cardiovascular diseases can cause LAE no matter your age, sex, or body size. Also, people who do a lot of endurance-type exercises may see enlargement of the left atrium.

High Blood Pressure

High blood pressure is common in people with left atrial enlargement.One review in the American Journal of Hypertension of 15 studies over 12 years found that LAE was present in 16% to 83% of people with high blood pressure.In people with high blood pressure, LAE is often related to asymptomatic diastolic dysfunction.

Atrial Fibrillation

Atrial fibrillation (AFib) is a problem that causes arrhythmia, or irregular heartbeats. This causes the two upper chambers of the heart to beat differently than the two lower chambers. Persistent AFib may eventually enlarge the left atrium.

AFib can either be permanent (not going away), persistent (lasting for more than a week), or paroxysmal (usually lasting less than a day), and newer research confirms that LAE is both a cause and a complication of AFib.

A study in Norway found that people with enlarged left atriums were 60% more likely to develop AFib, and those with a severely enlarged atrium were four times more likely to develop AFib than people with normal heart chambers.

The researchers confirm that an enlarged left atrium is an independent risk factor for AFib, much like strokes and heart failure.

Mitral Valve Dysfunction

Some conditions associated with the mitral valve may contribute to LAE. The mitral valve is the heart valve that lies between the left atrium and the left ventricle. Mitral stenosis causes the mitral valve to narrow and makes it harder for the left ventricle to be filled.

Mitral regurgitation, on the other hand, causes blood to leak from the left ventricle into the left atrium.Both conditions make it difficult for the left atrium to pump blood to the left ventricle, resulting in increased pressure in the left atrium—and this eventually causes enlargement.

The connection between mitral valve problems and LAE is common.One 2013 study found that in people with mitral valve disease and LAE without symptoms, mitral valve replacement can decrease the size of the left atrium and help prevent symptoms due to LAE.

Left Ventricle Problems

Problems with the left ventricle put pressure on the left atrium, leading to the enlargement of the left atrium.Left ventricle and left atrium problems seem to go hand-in-hand.

For example, one 2019 study reported in the Journal of Hypertension finds that people with left ventricular hypertrophy (LVH) have higher systolic blood pressures (SBPs) and larger left atriums.

LVH is a condition where the muscle wall of the heart left chamber, the ventricle, becomes thickened.The SBP is the number on top in a blood pressure reading that indicates the amount of pressure that blood exerts on the vessels while the heart is beating.

Left Atrial Enlargement Symptoms

Sometimes, left atrial enlargement does not cause any symptoms. The occurrence of symptoms depends on the extent of the enlargement in the left atrium. If the increase in size is substantial, you’re likely to have symptoms.These may include:

• Chest pain
• Breathing problems, including shortness of breath and coughing
• Extreme fatigue
• Abnormal heartbeat
• Fluid buildup and swelling
• Fainting

The symptoms above are also characteristic of numerous conditions affecting the heart, including congestive heart failure.

Another symptom that can be caused by LAE is dysphagia, or difficulty swallowing. It’s due to the impingement (pressing) of a massively enlarged atrium on the esophagus.

LAE usually occurs as a result of underlying cardiovascular conditions and is often discovered when testing is done to look for these underlying conditions.

Complications of Left Atrial Enlargement

Left atrial enlargement can lead to dangerous complications. The most common include:

• Stroke
• Heart failure with preserved ejection fraction, a condition where your heart can pump blood normally but doesn’t relax the way it’s supposed to between beats
• Hypertensive heart disease, which describes changes in the left ventricle, left atrium, and coronary arteries
  

Diagnosis

A diagnosis of left atrial enlargement can be made by looking at the heart with an echocardiogram. This test uses an ultrasound to take pictures of the heart.

The test is performed with the person lying down on a table and the technician attaching metal electrodes to the person’s chest. The technician will then pass a small sound wave probe over the chest.

These sound waves bounce off the heart and echo back to the probe, producing images. The echocardiogram is a safe procedure that causes no pain or harm and has no side effects.

Other tests that may be used to diagnose LAE include magnetic resonance imaging (MRI) and computed tomography (CT) scans. These tests make measures of the left atrium to determine its size and if it is enlarged compared to its normal size.

Treatment

Treatment of left atrial enlargement focuses on identifying and treating the cause of it:

• High blood pressure treatment: High blood pressure is treated with medications and management of unhealthy habits, including a healthy diet low in salt. It also involves limiting alcohol, exercising, managing stress, and not smoking.
• Mitral stenosis treatment: Treatment options for mitral stenosis include diuretics to reduce fluid and anti-arrhythmic drugs to manage irregular heartbeat. Additionally, surgery can repair or replace the mitral valve.
• Mitral regurgitation treatment:Much like mitral stenosis, surgery can repair the problem.
• Atrial fibrillation: This condition is usually treated with lifestyle changes like weight loss, exercise, and stress management. Medicines like beta-blockers, blood thinners, calcium channel blockers, and heart rhythm medications may be prescribed. In some cases, surgery is needed.
• Left ventricular hypertrophy: This condition is usually treated with ACE inhibitor medications, beta-blockers, calcium channel blockers, or diuretics. Other treatments include procedures such as surgery or a stem cell transplant.

Preventing Left Atrial Enlargement

Keeping your heart healthy helps prevent heart disease like LAE. Protecting your heart means making these heart-healthy lifestyle choices:

• Eat heart-healthy foods: Your diet can make a big difference in heart health. Choosing heart-healthy foods like fruits and vegetables over foods high in saturated fats, sodium, and added sugars can help reduce your risk of heart problems.
• Limit alcohol intake: Alcohol adds calories to your diet and may cause weight gain. Among other things, it can raise blood pressure and triglycerides, which increases your risk of heart attack and stroke. Alcohol also increases the risk of developing atrial fibrillation.
• Get regular physical activity: Regular physical activity can not only lower your risk factors for heart disease, but also reduce your risk of type 2 diabetes, depression, and cancer. Adults are advised to get 150 to 300 minutes of moderate-intensity aerobic physical activity each week, 75 to 150 minutes of vigorous-intensity aerobic exercise each week, or a combination of both.
• Aim for a healthy weight: Eating heart-healthy foods and getting regular physical activity can help you meet and maintain your weight goals.
• Manage stress: Being stressed can cause your blood pressure to rise and increase your risk of heart disease. If you live with high stress, consider stress-management strategies like talking to a friend, family member, or mental health counselor. Relaxation techniques, medication, and being physically active are other ways to help manage stress.
• Don’t smoke: Not smoking is one of the best things you can do to protect your heart. Smoking hurts just about every organ in your body, including your heart, lungs, blood vessels, and more. The risk of smoking damaging your heart or blood vessels increases if you are taking birth control pills or have diabetes.
• Get good sleep: Sleep is vital to your health. It’s important to not only get enough sleep but also to get good-quality sleep. Sleeping helps your heart and blood vessels heal and repair. Adults should aim for seven to nine hours of sleep a night.
• Manage blood pressure and cholesterol levels: It’s also important to get your blood pressure checked once a year and your cholesterol tested as often as you need to according to your healthcare provider. High blood pressure and cholesterol can often be managed with lifestyle changes and, if necessary, medications.
  

Prognosis for Left Atrial Enlargement

LAE itself isn’t necessarily a serious problem, but it could indicate one. LAE could be an early sign of the following conditions:

• Atrial fibrillation (AFib)
• Stroke due to high blood pressure (hypertension) and carotid atherosclerosis
• Blood clots and embolisms
  

Talk to your healthcare provider about your risks and your best strategies for managing them.

Summary

Left atrial enlargement is a condition where the left atrium of the heart is larger than normal. It develops over time and is caused by conditions like high blood pressure, atrial fibrillation, and problems with the heart’s valves. LAE doesn’t always cause symptoms, but when it does, you may experience fatigue, breathing problems, chest pain, abnormal heartbeat, or swelling.

LAE can also put people at risk for additional heart problems, so it’s important to keep blood pressure and heart rhythms under control. If you have a family history of heart problems, tell your healthcare provider so your heart health can be monitored closely.