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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.
Sometimes the heart enlarges and becomes weak for unknown reasons (idiopathic). A heart condition you're born with (congenital), damage from a heart attack or an abnormal heartbeat (arrhythmia) can cause your heart to enlarge. Other conditions associated with an enlarged heart include:High blood pressure. As a result, the right side of your heart may enlarge. 2  Fluid around your heart (pericardial effusion). 3  Accumulation of fluid in the sac (pericardium) that contains your heart may cause your heart to appear enlarged on a chest X-ray. 4  Low red blood cell count (anemia).