Right atrial enlargement: signs and treatments


The heart is divided into four chambers that work according to very specific blood volumes and pressure. When these volumes and pressures are not balanced, several problems can arise.

Right atrial enlargement occurs when the right atrium, the first point of entry for blood returning from circulation in the body, is larger than normal. This can increase the amount of blood and the pressure of blood flow to the right ventricle and ultimately to the pulmonary artery in the lungs. An enlarged left atrium can also develop, causing problems pumping blood to the body.

While left atrial enlargement can cause chest pain and breathing problems, warning you of a dangerous condition, right atrial enlargement usually develops without any symptoms.

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Right atrial enlargement has several names, including hypertrophy, overgrowth, or dilation of the right atrium. There are nuances between the diagnoses, but the result is the same for all: the right atrium of the heart is more than normal. This means that the right atrium may hold more blood than it should, until more blood flows into the next chamber of the medium-sized heart.

There are several types of cardiomegaly , or enlargement of the heart. Enlargement can affect the entire heart or certain chambers, and you can be born with this condition or develop as a result of chronic conditions like high blood pressure.

How big is very big?

A normal right atrium can hold 11 to 40 milliliters (ml) of blood at a time. In people with enlarged atria, the atrium can hold much more. In rare cases, the right atrium can hold 700 ml. and even 1900 ml.

The different types of right atrial enlargement are classified according to how and when the problem develops. Idiopathic right atrial enlargement (IERA) is a rare condition that can exist with or without other heart problems.

Right atrial enlargement can also develop over time due to a number of other heart problems or conditions, such as high blood pressure or heart valve disorders.


In many cases, people with an enlarged right atrium do not have any symptoms and may not even be aware of it. In fact, one study found that 48% of people with congenital (present at birth) or idiopathic (spontaneous) enlargement of the right atrium have no symptoms. It is usually diagnosed incidentally or as a complication.

Symptoms are more common in people who develop complications from an enlarged right atrium or whose condition is due to other heart problems. Possible symptoms include:

When do discomforts occur in an emergency?

If you have any of the following symptoms, especially if they appear quickly and severely, call your doctor at 911 or go to the emergency room immediately:

  • Chest pain that continues after you rest or take medicine.
  • Difficulty breathing even at rest
  • Dizziness
  • Coughing up pink phlegm or blood
  • Loss of consciousness
  • Immunity


Some possible causes or conditions associated with an enlarged right atrium include:

  • Atrial fibrillation : an abnormal heart rhythm caused by abnormal electrical impulses in the heart.
  • Congestive heart failure : decreased ability of the heart to pump blood efficiently.
  • Chronic Obstructive Pulmonary Disease (COPD) : A chronic respiratory disease that can lead to heart overload.
  • Pulmonary hypertension – increased pressure in the pulmonary artery that can lead to heart failure.
  • Pulmonary stenosis : narrowing or restriction of the pulmonary artery.
  • Tetralogy of Fallot : congenital heart disease with specific abnormalities of the anatomy of the heart.
  • Tricuspid stenosis or regurgitation : Insufficiency or weakness of the tricuspid valve, which can cause blood to return to the right atrium from the right ventricle.
  • Pulmonary atresia : A birth defect that occurs when the valve that helps blood flow from the heart to the pulmonary artery does not form properly or does not form at all.
  • Septal defects : small holes that form when the heart forms.
  • Heart valve disease – Problems with the various valves in the heart that control blood flow.

Why Atrial Enlargement Doesn't Occur By Itself

An enlarged atrium over time usually indicates a serious heart problem. In many cases, a domino effect occurs when one problem leads to another. For example, valve abnormalities such as tricuspid valve regurgitation can cause pressure imbalances, leading to conditions such as pulmonary hypertension. Over time, pulmonary hypertension can lead to enlarged atria or more severe cardiomegaly and heart failure.


The first step your doctor will take is to undergo a physical exam and ask about your personal and family medical history. Your doctor will also do a physical exam and listen to your heart and lungs. You may even have a blood test to monitor your overall health and well-being.

If these exams or tests are alarming, your doctor will go on to a heart test to learn more about how well your heart is working. One of the tools your healthcare provider will use is an electrocardiogram (EKG or EKG). It measures your heart's electrical signals and how well your electrical and pumping systems are working. However, it is usually more accurate in diagnosing left atrial enlargement than right atrial enlargement.

An ECG will provide your doctor with a lot of information, but even if the ECG detects a problem, there are many things that could be to blame. If your healthcare provider suspects that you have an enlarged right atrium or is trying to diagnose other heart conditions, they may order a series of tests, including:

With some imaging tests, your doctor can see in real time how blood is flowing through the chambers of your heart. You can also measure pressure and dimensions.

Your doctor may also perform non-cardiac tests, such as X-rays, to rule out other conditions that may be causing heart problems, such as breathing problems.

Why do athletes develop atrial enlargement?

Atrial enlargement can develop in athletes as a result of intense resistance exercise. Intense exercise can cause cardiac remodeling, which is a group of changes in the heart tissue due to the increase in blood volume that occurs during activity. Long periods of bulking can cause the heart to enlarge, mainly in the left atrium, but it can also occur in the right atrium.

Watch out

There is no consensus on the best treatment for right atrial enlargement. Surgery can be done in severe cases or even at an early stage to prevent further problems from developing.

Surgical options may include open heart surgery for resection (removal of excess tissue) or ablation . Ablation is a procedure in which the heart tissue heals. It is often used to correct abnormal heart signals that can cause acute or even fatal events, such as a stroke or heart attack.

Other more conservative treatment options include:

  • Watchful waiting or regular follow-up visits to monitor your progress.
  • Take medicines, such as beta- blockers , to improve the pumping function of the heart.
  • Taking anticoagulants to reduce the risk of blood clots in the atria due to improper blood pumping.
  • Using implanted devices, such as pacemakers or defibrillators , to control abnormal rhythms.
  • Taking medicine to control blood pressure or heart rate.

How long does it take to recover from open heart surgery?

Open heart surgery is major surgery. Even with less invasive heart surgery, you must prepare for a significant period of recovery and rehabilitation. If you have had open heart surgery, you will spend time in the ICU with a variety of drains and even a breathing tube for immediate recovery. Expect to spend up to two weeks in the hospital and then undergo outpatient cardiac rehab.


An enlarged right atrium can cause a number of serious complications. Since about half of all known cases of right atrial enlargement are asymptomatic, the condition can get worse over time, something that no one knows about. Ultimately, this can lead to more serious problems, such as:

Frequently asked questions

What causes an enlargement in the right atrium of the heart?

An enlarged right atrium can be caused by a birth defect, an anatomical problem with the heart, or chronic health problems such as high blood pressure.

Could an enlarged right atrium be fatal?

Yes. An enlarged heart can become ineffective at pumping blood where it needs to go or interrupting its normal electrical impulses. Both can lead to changes in heart rate or heart failure and even death.

Can the enlarged right atrium be reversed?

No. You cannot reverse an enlarged right atrium, but you can address the underlying cause if the enlargement is caused by something like high blood pressure or a faulty valve. Surgery is a treatment option, but your doctor can also monitor you and treat your symptoms with medicine.


Right atrium enlargement occurs when the right atrium fills with more blood than normal. This is not accompanied by any symptoms, so when you realize that something is wrong, it can progress and cause other complications. However, there are many treatment options, such as medications and surgery, that can help you manage this condition.

Get the word of drug information

An enlarged right atrium is a heart condition that can be dangerous in many ways. In many cases, it develops without any symptoms. It is often diagnosed while other problems are being investigated.

If you experience symptoms, they can include extreme fatigue, chest pain, and shortness of breath. See a doctor immediately. You may have an enlarged atrium or a number of heart conditions that can cause serious health problems.

In some people, right atrial enlargement is asymptomatic and never affects your health. If this happens, your healthcare provider can help you manage your condition with medications, treatments, or even surgery.

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