Dropping Heart

DROPPING HEART (German Tropfenherz, French coeur en goutte), a term proposed by Kraus (Fr. Kraus) to designate that form of the heart which __, : .

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dulum - hanging heart- I

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bach), dropping heart- I ; \

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extremely low-dropped diaphragm, above which the heart is located almost vertically, resembling a truly elongated drop. Due to the median and vertical (rather than oblique) position of the heart, its right border is formed not only as usual by the right atrium, but also by the right ventricle (see figure). Such a heart occupies a more medial position. In this connection, when determining the size of the heart by roentgenological methods, the right dimensions of the dropping heart (TV) are relatively larger, and the left dimensions (Tl) are relatively smaller than in a normally positioned heart. In addition, in the dropping heart, the arch of the pulmonary artery and the left atrium protrudes further to the left. This sometimes misleads, giving reason to assume enlargement of the left atrium. Due to the vertical position, the transverse diameter (T) of the dropping heart appears reduced. In reality, taking into account the position of the heart, body build, development of the entire body musculature, etc., the dropping heart is in most cases not reduced. In a minority of cases, there is a discrepancy between the size of the heart and the height, body build, etc., of a given person, i.e., hypoplasia of the heart. Often, an increased mobility of the dropping heart is determined. The dropping heart is usually observed in people with general underdevelopment of the organism, thin, with a long neck, a long, narrow and flat chest, enteroptosis, weak and hypotonic musculature, i.e., in that type of people whom Stiller described as suffering from "asthenia universalis." This type is currently defined as asthenic. People with a dropping heart often complain of palpitations and shortness of breath. During physical exertion, they experience shortness of breath, tightness and pain in the chest, and sometimes even fainting. Auscultation reveals no deviations from the norm. Descent of the trachea synchronous with the pulse is often determined (Oliver-Cardarelli sign). The appearance of this sign is explained by the fact that the heart, suspended from the vessels, pulls the trachea during its contraction. The electrocardiogram of such people is characterized by very small waves of lead I and maximum waves of lead III. The dropping heart often (but not always) possesses low working capacity, its reserve forces are reduced, and it is sensitive to all kinds of stresses and irritations. The cause of the reduced working capacity of the heart is the weak and hypotonic musculature characteristic of asthenics; the reduction of the influence of the lowered diaphragm on blood circulation (Wenckebach) is also of importance: a normal diaphragm during inspiration sucks blood into the chest cavity and squeezes it out of the hepatic veins, whereas a lowered and weakly contracting diaphragm no longer performs this function of its own, and thus one of the important factors promoting the movement of blood is excluded.