It is a great journey , the heart begins on the 22nd day of fetal life from a pair of tubes. It joins , folds, bends and grows into a 4 chamber power house and works like a bull for the next 70-80 years , before retiring.
It is an irony in certain population with chronic obstructive pulmonary disease (COPD) heart is stretched , elongated and assumes a tubular shape (Memories of the primitive fetal heart tube !) .The LV cavity becomes small , RV and LV gets aligned one behind the other bringing the CTR further narrow.
Tubular heart
CT ratio will be less than 1/3rd of thorax. (Just more than aorta ! )
Conditions
- COPD with emphysema
- Somes cases of hypoadrenalism(Addison) due to chronic volume hypovolemia and underfilling of the entire vascular system that includes the heart .
Here is a patient , 50 year old female with severe emphysema and contracted and elongated heart.
- Her CT ratio was 30% .Note wide rib spaces and pulling up of both diaphragm by fibrotic lung
- Note the LV apex conspicuously absent
- LV diastolic dimension was 30mm and systolic was 19mm
- End diastolic volume was critically low at 40ml .
- She was complaining of class 3 dyspnea.It was primary attributed to COPD but the contribution of under filled LV and resultant diastolic dysfunction is often overlooked.
Dr.S.Venkatesan MD 