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Patients with cardiomyopathy, a stiffening and thickening of the heart muscle that weakens it, may develop an enlarged heart as it labors to pump an adequate supply of blood to the body. Coronary artery disease, in which plaque in the arteries interferes with the flow of blood, can cause the heart to enlarge.
Some of the many causes of enlarged heart include: 1  Coronary artery disease â fatty deposits or plaques build up inside one or more of the coronary (heart) arteries.  High blood pressure (hypertension) â blood pumps with more force than usual through the arteries, which puts strain on the heart.