Right Atrial Enlargement (RAE): Causes and Treatment

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Right atrial enlargement means your heart has an abnormally large right atrium. This upper chamber of your heart receives oxygen-poor blood from your body. High blood pressure and blood volume cause right atrial enlargement. This usually means you have an issue with your heart or lungs that’s causing all of this.

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Right atrial enlargement is an abnormally large upper chamber of your heart. This happens when there’s too much blood or the pressure is high in your right atrium. These occur because of issues going on elsewhere in your heart or lungs.

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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Your right atrium is like the front door of your heart. This is the part of your heart where blood that needs oxygen comes in. From there, it goes through your tricuspid valve when it opens. That lets your blood move down into your right ventricle, which then sends it through your pulmonary valve. Once your blood goes through that valve, it can travel through your pulmonary artery to your lungs.

After getting oxygen from your lungs, your blood travels back to the left side of your heart. From there, your oxygen-rich blood goes out to your whole body to bring oxygen to your essential organs.

All of this happens each time your heart beats.

Athletes can develop an athlete’s heart that’s larger than that of someone who isn’t an athlete. Their heart muscle gets bigger with exercise just like their other muscles. This can be normal for them.

For non-athletes, however, right atrial enlargement is a sign that something else is happening. For example, high blood pressure in your lungs can make it harder for your right atrium to pump blood. Extra blood can come back into your right atrium from a leaky valve that doesn’t close right every time. If your right pumping chamber (ventricular) is weak, this can lead to more blood flowing back into the right atrium, enlarging it.

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Your right atrial enlargement prognosis depends on what's causing it, plus your symptoms and treatment. People who have symptoms tend to have worse outcomes than people who don’t have symptoms. Surgery has better results than other treatments.

Right atrial enlargement complications include:

• Abnormal heart rhythm in your atrium.
• Blood clot blocking an artery.
• Right-sided heart failure.

Some people have sudden cardiac death.

Right atrial enlargement affects people who have several different conditions. These include:

• Congenital heart disease that impacts your heart’s right side (tetralogy of Fallot and pulmonary stenosis or narrowing).
• Heart disease in valves that affect your heart’s right side (tricuspid stenosis, or a narrow valve opening).
• Cor pulmonale (weakness of the right ventricle due to problems in your lung), or other right heart failure.
• Supraventricular tachycardia (abnormal heartbeat that’s too fast).
• Right ventricular hypertrophy (your heart’s lower right chamber is enlarged).
• Atrial fibrillation (fast and disorganized heartbeat signals).
• Atrial flutter (abnormally fast atrial contractions).
• Chronic obstructive pulmonary disease (lung disease group known as COPD).
• Pulmonary hypertension.

Your healthcare provider will give you an electrocardiogram and review the results. They’ll look at the “P wave” that illustrates your right atrium’s contraction. If you have right atrial enlargement, this “P wave” will be higher than normal on the screen or printout. A normal P wave may be less than 1 mm high. An abnormal one can be almost 3 mm high. If you see this on your EKG, it doesn't necessarily mean that right atrial enlargement is causing a health problem for you. Be sure to discuss any questions with your provider.

Other ways to detect right atrial enlargement include:

• A fetal echocardiogram (to diagnose a baby before birth).
• Transthoracic echocardiogram (TTE).
• Cardiac computed tomography (CT) scan.
• Heart MRI.

Right atrial enlargement causes include:

• Pulmonary hypertension (high blood pressure in your lungs).
• Tricuspid valve regurgitation (blood going the wrong way when this valve doesn’t close right).
• Atrial fibrillation (abnormal heart rhythm with fast and irregular signals).

Some people get an idiopathic form of this issue. That means the cause is unknown. They may just be born with it, and may or may not have other heart problems as well.

The most common treatment for right atrial enlargement is to treat the underlying cause. In rare cases, your healthcare provider may recommend surgery for right atrial enlargement treatment. This makes your right atrium smaller.

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After surgery, you may need to take medicines to prevent:

• Abnormal heart rhythms.
• Blood clots.

If you aren’t having surgery, your provider may ask you to take low-dose aspirin. Your provider will discuss other medications or interventions with you depending on the cause of your right atrial enlargement.

You may be able to prevent right atrial enlargement if you get treatment for the issues that cause it. Causes may include atrial fibrillation or high blood pressure in your lungs.

Treating these causes may include:

• Medicines.
• Changes in how you live, such as eating and exercise habits.
• Medical procedures.
• Surgeries.

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Some people aren’t aware that they have right atrial enlargement.

Contact your healthcare provider if you have related right atrial enlargement symptoms. These may include:

• Heart palpitations.
• Abnormal heart rhythm.
• Difficulty breathing.
• Swelling.
• Tiredness.

Having symptoms of a heart problem can be a cause for concern. You should always check in with your healthcare provider if you have heart palpitations or anything else that doesn’t feel normal to you. Your provider can evaluate you and do tests if needed. Catching a problem early is the best way to handle a medical issue — before it has time to get worse.

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Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.

Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.

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• National Heart, Lung, and Blood Institute. What the Heart Looks Like (https://www.nhlbi.nih.gov/health/heart/anatomy). Accessed 8/5/2022.
• Zhang J, Zhang L, He L, et al. Clinical Presentation, Diagnosis, and Management of Idiopathic Enlargement of the Right Atrium: An Analysis Based on Systematic Review of 153 Reported Cases (https://pubmed.ncbi.nlm.nih.gov/33242857/). Cardiology. 2021;146(1):88-97. Accessed 8/5/2022.

When your heart needs some help, the cardiology experts at Cleveland Clinic are here for you. We diagnose and treat the full spectrum of cardiovascular diseases.

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