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.