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Patients with cardiomyopathy, a stiffening and thickening of the heart muscle that weakens it, may develop an enlarged heart as it labors to pump an adequate supply of blood to the body. Coronary artery disease, in which plaque in the arteries interferes with the flow of blood, can cause the heart to enlarge.
According to the American Heart Association, an enlarged heart develops when the heart muscle thickens and enlarges to accommodate the additional stress, called hypertrophy. The organ increases its cell size because it is difficult for it to pump blood at its normal size.