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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.
A bilateral atrial enlargement can be caused by some conditions that usually cause your heart to pump harder than usual or they also can damage your heart muscle. In some cases the heart enlarges and becomes very weak, but that is usually for some unknown reasons. Also, very high blood pressure can cause this.