Tubular heart : A case of Hypo-cardiomegaly of heart
Posted Oct 25 2010 7:45pm
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.
CT ratio will be less than 1/3rd of thorax. (Just more than aorta ! )
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.