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Have an echocardiogram (echo) done. Ask your doctor to take an X-ray. Get blood tests. Talk to your doctor about a cardiac catheterization and biopsy.
This is considered the best way to diagnose an enlarged heart.  An echo is a painless procedure in which the doctor uses ultrasound technology to examine the movement of blood through your heart on a monitor.  The anatomical structure and functional activities of the four chambers of your heart can be assessed with this test. The valves of your heart can also be observed If your doctor finds that the walls of your heart’s left ventricle are larger than 1.5 centimeters (about half an inch), your heart is considered enlarged.  This test records the electrical activities of your heart and can detect irregularities in your heart’s rhythm.  It can also aid in analyzing how a particular chamber of the heart has been enlarged.  The heart’s activities are recorded on a graph. An EKG provides information about heart rate, rhythm, and any conduction defects in the heart. If you and your doctor suspect you have an enlarged heart, your doctor will probably make you get an X-ray.  X-ray images can help your doctor see the size and condition of your heart. An X-ray can also help to determine if you have any irregular enlargement of parts of your heart, or if the shape of your heart has changed. An enlarged heart may disrupt the production and levels of certain substances in your blood.  By measuring the amount of these substances in your blood, a doctor can determine if you have an enlarged heart or a related condition. Catheterization involves inserting a tube (catheter) into your groin and threading it through your body into your heart.  A small sample of heart tissue can be removed and examined later.  This technique is not usually necessary, since other techniques of diagnosis are less invasive and easier to perform. During the procedure, the doctor might be able to capture images of the heart to visualize what your heart looks like.