Having a 'big heart' is not always a compliment: Heart transplant doctor explains the risks

On Instagram, Russia-based cardiologist Dr. Dmitry Yaranov, known as @heart-transplant_doc, recently addressed a common misconception: in medicine, having a “big heart” is rarely good news. His post began with a striking line: “They told me I have a big heart. But it was never a compliment.”

While the phrase may sound endearing in everyday life, medically, it often signals strain or damage. According to Dr. Yaranov, a heart that appears enlarged may actually be weaker, not stronger.

Understanding heart enlargement
Dr. Yaranov broke down the two main types of heart enlargement:

• Hypertrophy: The heart walls thicken, usually from high blood pressure or valve disease. Though it looks powerful, a stiff heart struggles to relax and fill properly.
• Dilation: The heart chambers stretch, often due to long-term stress. While it seems larger, the pumping function declines, reducing overall efficiency.

Doctors can detect these changes using imaging tools such as X-rays, echocardiograms, MRIs, or CT scans. “When you hear ‘big heart’ in the clinic, it usually means the heart is under strain — and a strained heart can become a failing heart,” Dr. Yaranov explained.

What research says
The Mayo Clinic defines an enlarged heart, or cardiomegaly, as a sign rather than a disease. It can result from heart failure, heart damage, or certain medical conditions. Temporary stress, such as pregnancy, may also enlarge the heart, though sometimes the change is permanent.

Cardiomegaly forces the heart to work harder to pump blood efficiently, which can eventually weaken it. Symptoms may include shortness of breath, irregular heart rhythms, swelling in the legs or abdomen, or waking up gasping for air. Treatment ranges from medication to surgical procedures, depending on the underlying cause.

Dr. Yaranov concluded by contrasting the medical and metaphorical meanings of a “big heart.” “In life, having a big heart is beautiful,” he wrote. “In medicine, we want your heart healthy, strong, and the right size.”

His message serves as a reminder that while emotional generosity is admirable, a physically enlarged heart is a serious condition requiring attention.