Large heart clinically generally refers to cardiac hypertrophy, which can be categorized into physiological and pathological. Cardiac hypertrophy refers to the manifestation that the proportion of the heart width to the width of the thoracic cavity exceeds the normal value (less than 50%), and sustained pressure/volume overload can cause an increase in heart weight, i.e., cardiac hypertrophy. Remodeling and hypertrophy can occur in the athlete’s heart and are physiological adaptations. Exercise cardiac hypertrophy is not associated with myocardial fibrosis, cardiac dysfunction, or development of heart failure. Pathological cardiac hypertrophy is divided into two categories, cardiac enlargement and myocardial hypertrophy, according to the etiology. In the pathological state, the initial occurrence of cardiac hypertrophy is an adaptive compensatory response to maintain cardiac output, but prolonged cardiac overload will lead to myocardial remodeling, including left ventricular dilatation, myocardial fibrosis, apoptosis and necrosis of cardiomyocytes, resulting in decreased cardiac output and accelerating the process of heart failure.