Cardiac enlargement is a common and important post-mortem finding. The presence of a big heart may provide a basis for determination of the mechanisms of death in an otherwise negative autopsy. In this article we will 1) define terms used to describe the morphology of the heart; 2) describe the ways the heart can enlarge; 3) review the reasons the heart may enlarge and 4) discuss the consequences of that enlargement. In so doing, we hope to assist the pathologist in evaluating cardiomegaly at autopsy and recognizing the significance of the cardiac enlargement.
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