Transverse tubules are specialised invaginations of the cardiomyocyte sarcolemma. They play a crucial role in cardiac cells by facilitating the coordination of calcium signalling and contraction. They achieve this by housing many ion channels and establishing connections with important structural elements within the cell. The morphology of t-tubules exhibits significant variation across different species and within distinct regions of the heart, allowing for the customisation of their functionality to suit the individual physiological requirements of the organism. Smaller animals with higher heart rates possess more intricate and densely concentrated t-tubules in comparison to larger mammals. This indicates the need for fast calcium signalling. In heart failure, there are harmful alterations in the t-tubules. These changes include a reduction in their density and a rearrangement from their usual alignment. As a result, the heart’s ability to control calcium levels is compromised. As a result, there is a decrease in the strength of heart contractions and a lack of efficient relaxation, which both contribute to the symptoms and progression of the condition. This paper examines the present medications and interventions that specifically address t-tubule remodelling, which have demonstrated efficacy in restoring certain elements of t-tubule function. Additionally, it emphasises the capacity of physical activity to enhance t-tubule density and general cardiovascular well-being. Recent advances in imaging technology provide intriguing opportunities to investigate t-tubules in live cells. These observations have the potential to result in substantial enhancements in the therapy and control of heart failure.