An enlarged heart shadow means that the size of the heart has increased, which can develop into heart failure, and some patients’ heart shadows may return to normal after active treatment. Enlarged heart shadow can be caused by various reasons, such as hypertension, ischemic cardiomyopathy, rheumatic heart disease, etc. In the early stage of hypertensive heart disease, the heart enlargement can be gradually returned to normal if the blood pressure level can be actively controlled, but it cannot be completely returned to normal if organic changes occur. Rheumatic heart disease, ischemic cardiomyopathy can not be completely cured, the condition will continue to develop, the heart shadow will gradually increase, and ultimately lead to heart failure, can not be cured, and need active treatment. Clinically, for patients with an enlarged heart shadow on imaging, it is necessary to improve the relevant examinations under the guidance of the physician, to clarify the specific cause of the disease, and actively treat it to prevent the eventual development of heart failure.