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What is Cardiomegaly Similar To?

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What is Cardiomegaly Similar To?

What is Cardiomegaly Similar To? Cardiomegaly, also known as an enlarged heart, shares similarities with several other cardiac conditions. By understanding the similarities and differences between these conditions, we can better comprehend the complexities of cardiomegaly and its impact on overall heart health.

Throughout this article, we will compare cardiomegaly to different heart-related conditions such as heart failure, hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, congestive heart failure, and atherosclerosis.

Additionally, we will delve into the underlying causes of cardiomegaly, the available diagnosis and treatment options, as well as strategies for managing and improving heart health in individuals with this condition.

Understanding cardiomegaly and its similarities to other heart conditions can provide valuable insights for both medical professionals and individuals seeking to maintain a healthy heart.

Understanding Cardiomegaly

Cardiomegaly, also known as an enlarged heart, is a condition characterized by an increase in the size of the heart. This can occur due to various underlying causes and may lead to a range of symptoms. Understanding the definition of cardiomegaly and recognizing its symptoms is crucial for early detection and appropriate management.

Cardiomegaly Definition

The definition of cardiomegaly involves an abnormal enlargement of the heart, affecting its structure and function. This condition can be caused by factors such as high blood pressure, heart valve problems, coronary artery disease, heart muscle diseases, or congenital heart defects. The enlargement of the heart can occur in one or both chambers, depending on the specific cause.

Enlarged Heart: Symptoms of Cardiomegaly

Individuals with cardiomegaly may experience a range of symptoms that can vary in severity. Some common symptoms associated with an enlarged heart include:

  • Shortness of breath
  • Fatigue
  • Irregular heartbeat
  • Chest pain or discomfort
  • Swelling in the legs, ankles, or abdomen

These symptoms may be indicative of other heart conditions as well, highlighting the importance of seeking medical attention for an accurate diagnosis.

Cardiomegaly vs. Heart Failure

Cardiomegaly and heart failure are two cardiac conditions that share several similarities in terms of their causes and treatment. While cardiomegaly refers to an enlarged heart, heart failure is a condition characterized by the heart’s inability to pump blood efficiently. Understanding the relationship between these two conditions is crucial for accurate diagnosis and effective treatment.

Similarities between Cardiomegaly and Heart Failure

Both cardiomegaly and heart failure involve abnormalities in the structure and function of the heart. Cardiomegaly can be a precursor to heart failure, as an enlarged heart may struggle to effectively pump blood, leading to heart failure. Additionally, certain underlying conditions, such as hypertension, coronary artery disease, and valve disorders, can contribute to the development of both cardiomegaly and heart failure.

In terms of symptoms, there is an overlap between cardiomegaly and heart failure. These may include shortness of breath, fatigue, chest pain, irregular heartbeat, fluid retention, and coughing. The severity of symptoms can vary and may depend on the underlying causes and the stage of the condition.

Causes of Heart Failure

Heart failure can have various contributing factors, including:

  • Hypertension (high blood pressure)
  • Coronary artery disease
  • Heart valve disorders
  • Cardiomyopathy (weakening of the heart muscle)
  • Heart defects present at birth
  • Infections (such as viral infections affecting the heart)
  • Cardiac arrhythmias (abnormal heart rhythms)
  • Substance abuse

Treatment of Heart Failure

The treatment of heart failure aims to manage and alleviate symptoms, improve heart function, and address the underlying causes. Depending on the severity and stage of heart failure, treatment options may include:

  1. Medications to control blood pressure, reduce fluid retention, and improve heart function.
  2. Lifestyle modifications, such as maintaining a healthy diet, exercising regularly, quitting smoking, and limiting alcohol consumption.
  3. Devices, such as pacemakers or implantable cardioverter-defibrillators (ICDs), to regulate and support heart function.
  4. Surgical interventions, including coronary artery bypass grafting (CABG) or heart valve repair/replacement.
  5. Cardiac rehabilitation programs to enhance overall cardiovascular health and recovery.

Early detection, timely medical intervention, and ongoing management play essential roles in improving the quality of life for individuals with heart failure.

Cardiomegaly vs. Hypertrophic Cardiomyopathy

Cardiomegaly and hypertrophic cardiomyopathy share several similarities in terms of their impact on heart health. Hypertrophic cardiomyopathy, like cardiomegaly, involves structural abnormalities of the heart muscles. It is characterized by the thickening of the heart muscle walls, particularly the left ventricle. This thickening can obstruct the blood flow and lead to various symptoms and complications.

Diagnosing hypertrophic cardiomyopathy requires a comprehensive evaluation that may include a physical examination, echocardiogram, electrocardiogram, and genetic testing. Similarly, cardiomegaly diagnosis involves thorough assessment methods such as imaging tests like chest X-rays, echocardiograms, and magnetic resonance imaging (MRI). Both conditions require specialized medical expertise to accurately diagnose and differentiate them from other cardiac disorders.

When it comes to management, treatment strategies for hypertrophic cardiomyopathy focus on mitigating symptoms, preventing complications, and reducing the risk of sudden cardiac arrest. This may involve medications, lifestyle modifications, and surgical interventions in severe cases. Similarly, the management of cardiomegaly involves addressing the underlying causes, such as hypertension or heart valve disorders, and implementing lifestyle changes to improve heart health.

It’s important to note that while cardiomegaly and hypertrophic cardiomyopathy share similarities, they are distinct conditions with different pathophysiological mechanisms. Cardiomegaly refers to an enlarged heart that can occur due to various causes, including hypertension, heart valve diseases, or congenital defects. On the other hand, hypertrophic cardiomyopathy is a genetic condition characterized by abnormal thickening of the heart muscle walls.

Cardiomegaly vs. Dilated Cardiomyopathy

When comparing cardiomegaly and dilated cardiomyopathy, it is important to understand the similarities and differences between these two conditions. While both involve the heart, there are distinct characteristics that set them apart.

Similarities between Cardiomegaly and Dilated Cardiomyopathy:

  • Both conditions affect the heart muscles and can lead to impaired heart function.
  • Cardiomegaly and dilated cardiomyopathy can cause the heart to become weak and enlarged.
  • They may both result in similar symptoms and complications.

Now, let’s explore the symptoms and prognosis of dilated cardiomyopathy:

Symptoms of Dilated Cardiomyopathy:

  • Fatigue and weakness
  • Shortness of breath
  • Swelling in the ankles, legs, and abdomen
  • Dizziness or fainting
  • Rapid or irregular heartbeats

The prognosis of dilated cardiomyopathy varies depending on individual factors such as age, overall health, and the presence of other medical conditions. However, early detection, proper treatment, and lifestyle changes can significantly improve the prognosis and quality of life for individuals with dilated cardiomyopathy.

It is essential to consult a healthcare professional for an accurate diagnosis, as the symptoms of dilated cardiomyopathy can overlap with other heart conditions. A thorough evaluation, including medical history, physical examination, and diagnostic tests, is crucial for determining the appropriate treatment approach.

In conclusion, while cardiomegaly and dilated cardiomyopathy share similarities in the effect they have on the heart, they are separate conditions with distinct characteristics. Understanding the symptoms and prognosis of dilated cardiomyopathy can help individuals and healthcare providers make informed decisions regarding diagnosis, treatment, and management strategies.

Cardiomegaly Dilated Cardiomyopathy
Affects the heart muscles Affects the heart muscles
Enlargement of the heart Weakness and enlargement of the heart
Similar symptoms and complications Similar symptoms and complications
Varying causes Varying causes
Requires proper diagnosis and treatment Requires proper diagnosis and treatment

Cardiomegaly vs. Arrhythmogenic Right Ventricular Cardiomyopathy

Cardiomegaly and Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) are two cardiac conditions that share certain similarities. While cardiomegaly refers to an enlarged heart, ARVC is characterized by abnormal heart rhythms. Let’s explore the commonalities between these two conditions and delve into the diagnosis and treatment options for ARVC.

Similarities between Cardiomegaly and Arrhythmogenic Right Ventricular Cardiomyopathy

Cardiomegaly and ARVC share several similarities in terms of their impact on the heart and overall cardiac function. Both conditions can result in the enlargement of the heart, leading to a compromised pumping capacity and potential disruption of normal heart rhythms. Patients with both conditions may experience symptoms such as shortness of breath, chest pain, palpitations, and fatigue.

Table: A Comparison of Cardiomegaly and Arrhythmogenic Right Ventricular Cardiomyopathy

Aspect Cardiomegaly Arrhythmogenic Right Ventricular Cardiomyopathy
Cause Various underlying conditions and factors can contribute to cardiomegaly, including high blood pressure, heart valve disease, and chronic conditions like diabetes and obesity. ARVC is typically caused by genetic mutations that affect the proteins responsible for maintaining the structural integrity of the heart muscle cells.
Diagnosis Cardiomegaly can be diagnosed through a combination of medical history review, physical examination, imaging tests like echocardiography, and electrocardiograms (ECGs) to assess the size and functioning of the heart. Diagnosing ARVC involves evaluating a patient’s medical history, conducting physical examinations, performing ECGs, echocardiograms, and cardiac MRI, as well as genetic testing to identify specific mutations.
Treatment Treatment for cardiomegaly focuses on addressing the underlying cause, managing symptoms, and reducing the risk of complications. This may involve lifestyle modifications, medications, and occasionally, surgical interventions. The treatment of ARVC varies depending on the severity of the condition and the presence of symptoms. It often includes the use of anti-arrhythmic medications, implantable cardiac defibrillators (ICDs), lifestyle modifications, and potentially, heart transplantation in severe cases.

It is important to note that while cardiomegaly and ARVC have some similarities, they are distinct conditions with different underlying causes and treatment approaches. Therefore, a comprehensive evaluation and accurate diagnosis by a healthcare professional is crucial to determine the appropriate treatment plan for each individual.

Cardiomegaly vs. Congestive Heart Failure

Cardiomegaly and congestive heart failure are two conditions that share similarities in their presentation and management. While cardiomegaly refers to an enlarged heart, congestive heart failure is characterized by fluid buildup in the body. Understanding the causes and management of these conditions is crucial for providing effective care.

Similarities between Cardiomegaly and Congestive Heart Failure:

  • Enlarged Heart: Both cardiomegaly and congestive heart failure involve an enlarged heart, which can lead to impaired cardiac function.
  • Cardiac Symptoms: Patients with cardiomegaly and congestive heart failure may experience similar symptoms, such as shortness of breath, fatigue, and swelling in the legs or abdomen.
  • Progression: Both conditions can progress over time if left untreated or not effectively managed, leading to worsening symptoms and potential complications.

Congestive Heart Failure Causes:

Congestive heart failure can be caused by various factors, including:

  1. Hypertension (high blood pressure)
  2. Coronary artery disease
  3. Heart valve disease
  4. Cardiomyopathy (damage to the heart muscle)
  5. Arrhythmias (abnormal heart rhythms)

Congestive Heart Failure Management:

Managing congestive heart failure involves:

  1. Lifestyle Modifications: Implementing dietary changes, engaging in regular physical activity, and quitting smoking can help improve heart health and manage symptoms.
  2. Medications: Prescribed medications, including diuretics, ACE inhibitors, beta-blockers, and vasodilators, may be prescribed to control blood pressure, reduce fluid buildup, and improve heart function.
  3. Medical Procedures: In some cases, surgical interventions such as coronary artery bypass grafting (CABG), valve repair or replacement, or implantation of a defibrillator may be necessary.
  4. Monitoring and Follow-Up: Regular monitoring of symptoms, medication adjustments, and follow-up appointments with healthcare providers are vital for effectively managing congestive heart failure.
Cardiomegaly Congestive Heart Failure
Enlarged heart Enlarged heart
Shortness of breath Shortness of breath
Fatigue Fatigue
Swelling in legs or abdomen Swelling in legs or abdomen
Progression over time Progression over time

Cardiomegaly vs. Atherosclerosis

In this section, we will explore the similarities between cardiomegaly and atherosclerosis, two cardiovascular conditions that impact the health of the heart. While cardiomegaly refers to an enlarged heart, atherosclerosis is characterized by the buildup of plaque in the arteries. Understanding the connection between these conditions can provide valuable insights into their prevention and management.

Similarities between Cardiomegaly and Atherosclerosis

Both cardiomegaly and atherosclerosis involve the heart and its functioning:

  • Cardiomegaly: In cardiomegaly, the heart muscles become enlarged, leading to an impairment in the heart’s ability to pump blood efficiently.
  • Atherosclerosis: Atherosclerosis occurs when plaque, consisting of cholesterol, fat, and other substances, builds up in the arteries, narrowing the blood vessels and impeding blood flow.

These conditions also share common risk factors:

  • Sedentary lifestyle
  • Unhealthy diet high in saturated and trans fats
  • High blood pressure
  • Diabetes
  • Obesity
  • Smoking

Atherosclerosis Prevention

Preventing atherosclerosis involves adopting a heart-healthy lifestyle. The following strategies can help reduce the risk:

  1. Engage in regular physical activity to maintain a healthy weight and improve cardiovascular health.
  2. Follow a balanced diet that includes fruits, vegetables, whole grains, lean proteins, and healthy fats. Limit the consumption of processed foods, sugary beverages, and foods high in saturated and trans fats.
  3. Manage blood pressure and cholesterol levels through medication, regular check-ups, and lifestyle modifications.
  4. Quit smoking and avoid secondhand smoke.
  5. Control blood sugar levels if you have diabetes through proper medication and diabetes management.

Atherosclerosis Risk Factors

Several factors can increase the risk of developing atherosclerosis:

  • Age: The risk increases with age, as the arteries naturally become less flexible and more prone to damage.
  • Family history: A family history of heart disease or atherosclerosis can increase the likelihood of developing the condition.
  • Gender: Men are at a higher risk than premenopausal women. However, the risk for women increases postmenopause.
  • High blood pressure: Hypertension can damage artery walls and increase the risk of atherosclerosis.
  • High cholesterol: Elevated levels of LDL cholesterol, often referred to as “bad” cholesterol, contribute to the development of plaque.

By understanding the similarities between cardiomegaly and atherosclerosis and taking proactive steps to prevent atherosclerosis, individuals can minimize the risk of developing cardiovascular complications and maintain a healthier heart.

Causes of Cardiomegaly

Cardiomegaly, or an enlarged heart, can be caused by various underlying factors. Understanding these causes is crucial for accurate diagnosis and effective management of the condition. Let’s explore the primary underlying causes of cardiomegaly:

1. Heart Conditions and Diseases

Cardiomegaly can result from heart conditions and diseases that put excessive strain on the heart muscle. Some common conditions include:

  • Coronary artery disease: Narrowing or blockage of the coronary arteries, which supply blood to the heart, can lead to cardiomegaly.
  • Heart valve disorders: Malfunctioning heart valves, such as in mitral valve regurgitation or aortic stenosis, can cause the heart to enlarge.
  • Cardiomyopathy: Cardiomegaly may be a result of various types of cardiomyopathy, including hypertrophic, dilated, or arrhythmogenic right ventricular cardiomyopathy.

2. High Blood Pressure

Persistent high blood pressure, also known as hypertension, can cause the heart muscles to thicken and enlarge, leading to cardiomegaly.

3. Infections and Inflammation

Infections in the heart, such as myocarditis or endocarditis, can cause inflammation and damage to the heart muscle. This can result in cardiomegaly.

4. Genetic Factors

In some cases, genetic factors may predispose individuals to develop cardiomegaly. Genetic abnormalities, such as certain gene mutations, can affect the structure and function of the heart, leading to enlargement.

5. Other Underlying Factors

Other underlying causes of cardiomegaly can include:

  • Anemia: A low red blood cell count can reduce the oxygen-carrying capacity of the blood, forcing the heart to work harder and potentially enlarge.
  • Thyroid disorders: Overactive or underactive thyroid glands can disrupt the normal functioning of the heart and contribute to cardiomegaly.
  • Alcohol abuse: Excessive alcohol consumption over a prolonged period can weaken the heart muscle, leading to cardiomegaly.

Risk Factors for Cardiomegaly

While the causes of cardiomegaly vary, several factors can increase the risk of developing this condition. Recognizing these risk factors can help individuals take preventive measures and seek early medical intervention. Let’s explore the primary risk factors associated with cardiomegaly:

Risk Factors Description
Age Advanced age is a significant risk factor for cardiomegaly, as the heart undergoes natural changes and may become weaker over time.
Smoking Cigarette smoking damages the blood vessels and increases the risk of heart diseases, including cardiomegaly.
Obesity Excess weight puts additional strain on the heart, increasing the risk of developing cardiomegaly.
Family History A family history of heart conditions or cardiomegaly can elevate an individual’s risk of developing the condition.
High Blood Pressure Uncontrolled high blood pressure is a significant risk factor for cardiomegaly, as it places excessive stress on the heart.
Diabetes Individuals with diabetes have an increased risk of developing heart conditions, including cardiomegaly.

By understanding the underlying causes and risk factors associated with cardiomegaly, individuals can take proactive steps to maintain heart health and reduce the likelihood of developing this condition.

Diagnosis and Treatment of Cardiomegaly

Diagnosing and treating cardiomegaly is essential for managing this condition and improving heart health. Medical professionals employ various diagnostic methods to accurately identify cardiomegaly and determine the most appropriate treatment plan for each patient.

Cardiomegaly Diagnosis

When it comes to cardiomegaly diagnosis, healthcare providers typically use a combination of medical history evaluation, physical examinations, and diagnostic tests. The process begins with a comprehensive review of the patient’s medical history, including any symptoms experienced and risk factors present.

During a physical examination, the physician assesses the patient’s heart sounds, checks for any abnormal heart enlargements or functioning, and examines for signs of fluid retention. This helps in determining the presence and severity of cardiomegaly.

Diagnostic tests that aid in confirming the diagnosis of cardiomegaly may include:

  • Echocardiogram: This non-invasive test uses sound waves to produce detailed images of the heart, helping to visualize its size, shape, and blood flow. It is a key tool in diagnosing cardiomegaly.
  • Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart, helping to detect any abnormal heart rhythms or evidence of stress on the heart.
  • Chest X-ray: An X-ray provides an overview of the heart and lungs, allowing physicians to identify any signs of an enlarged heart.
  • Cardiac MRI: Magnetic resonance imaging (MRI) produces highly detailed images of the heart, helping to assess its structure and function in more depth.

Once the diagnosis of cardiomegaly is confirmed, healthcare professionals then move on to developing an individualized treatment plan tailored to the patient’s needs and overall health.

Cardiomegaly Treatment

The treatment approach for cardiomegaly usually includes a combination of medical interventions and lifestyle modifications to manage the underlying cause, alleviate symptoms, and improve heart function.

Medical treatments for cardiomegaly may include:

  • Medications: Depending on the specific cause and symptoms, healthcare providers may prescribe medications to reduce blood pressure, control heart rate, manage fluid retention, or improve heart function.
  • Surgery: In certain cases, surgical procedures such as coronary artery bypass grafting (CABG) or valve repair/replacement may be necessary to address structural abnormalities within the heart.

In addition to medical interventions, the management of cardiomegaly also involves adopting a heart-healthy lifestyle. This includes:

  • Following a balanced diet: Eating a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can help manage weight, reduce cholesterol levels, and maintain overall heart health.
  • Regular exercise: Engaging in regular physical activity, under the guidance of a healthcare professional, can help strengthen the heart muscle and improve cardiovascular fitness.
  • Quitting smoking: Smoking is detrimental to heart health and can worsen the symptoms of cardiomegaly. Quitting smoking is crucial for improving heart function and reducing the risk of further complications.
  • Managing stress: Chronically elevated stress levels can have a negative impact on heart health. Implementing stress management techniques such as meditation, yoga, and deep breathing exercises can help alleviate stress and promote cardiac well-being.
  • Monitoring and managing other health conditions: Individuals with cardiomegaly should closely manage associated conditions such as high blood pressure, diabetes, and high cholesterol to prevent further strain on the heart.

By combining appropriate medical treatments with lifestyle modifications, individuals with cardiomegaly can effectively manage their condition, improve heart health, and enhance overall well-being.

Prognosis and Prevention of Cardiomegaly

When it comes to cardiomegaly, understanding the prognosis and taking steps to prevent its development or progression is crucial. Here, we will explore the potential outcomes of cardiomegaly and provide valuable insights on prevention strategies.

Prognosis of Cardiomegaly

The prognosis of cardiomegaly can vary depending on several factors, including the underlying cause, the severity of the condition, and the individual’s overall health. In some cases, cardiomegaly can be managed effectively with proper treatment and lifestyle changes, leading to improved heart function and a positive prognosis. However, if left untreated or when the condition is severe, cardiomegaly can lead to complications such as heart failure, arrhythmias, and even premature death.

It is important to note that discussing the prognosis with a healthcare professional is essential for personalized insights and prognostic evaluation based on an individual’s specific circumstances.

Prevention of Cardiomegaly

Preventing the development or progression of cardiomegaly is crucial for maintaining heart health. While some underlying causes of cardiomegaly cannot be prevented, certain lifestyle changes and proactive measures can significantly reduce the risk.

  • Maintain a healthy weight: Obesity and excess body weight can strain the heart, leading to an increased risk of cardiomegaly. Strive to maintain a healthy weight through a balanced diet and regular exercise.
  • Exercise regularly: Engaging in regular physical activity can help strengthen the heart muscle and reduce the risk of cardiomegaly. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity activity per week.
  • Quit smoking: Smoking not only damages the lungs but also increases the risk of heart conditions, including cardiomegaly. Seek support and resources to quit smoking and protect your heart health.
  • Eat a heart-healthy diet: Incorporate a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Reduce the consumption of processed foods, saturated fats, and sugary beverages.
  • Control high blood pressure and cholesterol: High blood pressure and high cholesterol levels can contribute to the development of cardiomegaly. Monitor and manage these conditions with the guidance of a healthcare professional.
  • Manage stress levels: Chronic stress can have detrimental effects on heart health. Practice stress management techniques such as exercise, meditation, deep breathing, and engaging in hobbies.

By adopting a heart-healthy lifestyle and taking preventive measures, individuals can significantly reduce their risk of developing cardiomegaly and promote overall heart health.

Cardiomegaly and Heart Health Management

When it comes to managing heart health and cardiomegaly, making certain lifestyle changes can play a crucial role in maintaining a healthy heart. These changes can have a positive impact on overall cardiovascular well-being and help individuals with cardiomegaly lead fulfilling lives.

One of the key aspects of managing heart health is adopting a balanced and nutritious diet. Incorporating plenty of fruits, vegetables, whole grains, lean proteins, and healthy fats into your meals can provide essential nutrients and support heart health. Additionally, reducing the intake of processed foods, saturated fats, and excess salt can help reduce the risk of complications related to cardiomegaly.

Regular physical activity is also vital for keeping the heart strong and healthy. Engaging in activities like brisk walking, cycling, swimming, or any other form of exercise that you enjoy can help improve heart function, reduce the risk of heart disease, and aid in weight management. It is important to consult with a healthcare professional before starting any exercise program to determine any specific limitations or recommendations.

Furthermore, managing stress levels is crucial for maintaining heart health. Chronic stress can elevate blood pressure and have negative effects on heart function. Incorporating stress-management techniques such as mindfulness meditation, deep breathing exercises, or engaging in activities that bring joy and relaxation can help reduce stress levels and promote heart health.

FAQ

What conditions are similar to cardiomegaly?

Cardiomegaly is similar to conditions such as heart failure, hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and congestive heart failure.

What are the causes, diagnosis, treatment, prognosis, management, prevention, and risk factors associated with cardiomegaly?

The causes of cardiomegaly can include underlying heart conditions, high blood pressure, heart valve problems, and congenital heart defects. Diagnosis involves physical exams, medical history review, imaging tests, and heart function tests. Treatment options may include medications, lifestyle changes, and surgery. The prognosis of cardiomegaly varies depending on the underlying cause and the individual's response to treatment. Management involves regular monitoring, following treatment plans, and making lifestyle changes to improve heart health. Prevention strategies include maintaining a healthy lifestyle, managing underlying conditions, and avoiding risk factors such as smoking and excessive alcohol consumption.

What is cardiomegaly and what are the common symptoms?

Cardiomegaly, also known as an enlarged heart, is a condition where the heart is larger than normal. Common symptoms of cardiomegaly can include shortness of breath, fatigue, chest pain, irregular heartbeat, and fluid retention.

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