Heart: A History

 

The heart’s no brain. It is a simple enough piece of muscular meat taking deoxygenated blood and oxygenating it by a passage through the lungs, then sending it on its way to nourish the cellular system. But if one little aspect of the organ goes wrong, you are toast in a very, very short time. And go wrong it does, plenty: it is “the most common cause of death throughout the world”—nearly a third of them—“sudden cardiac death after a myocardial infarction, or heart attack,” writes Sandeep Jauhar—who has already informed and entertained us about bodies and their discontents in his books Doctored and Intern—in the sharp, engrossing Heart: A History; in this case, a cultural, personal, and mechanical history.

The heart beats, on average, 3 billion times before it gives up the ghost, pumping blood through 100,000 miles of vessels, from big to microscopic and back again. All along the way are valves that flip open at the pressure of a pulse and then flip shut to keep the system going in one direction. In our inexorable march toward entropy, the heart is our hero, countering dissipation and disarray.

Heart “is about what the heart is, how it has been handled by medicine, and how we can most wisely live with—as well as by—our hearts in the future.” There will be excursions into the organ as metaphor to start. “Courage” is an easy one: “from the Latin cor, which means heart.” For romantic love we have the word “emotion” from the French émouvoir, meaning to stir up, as the heart does when agitated by the tides of feeling. As for its affiliation with sex, the heart shape is common in nature, “including silphium, which was used for birth control in the early Middle Ages and may be the reason why the heart became associated with sex and romantic love (though the heart’s resemblance to the vulva probably also has something to do with it.)”

Jauhar moves on to a series of chapters that are an artful blend of the historical and the personal: advances in heart medicine and the story of his family’s cardiac issues. Advances in echocardiography, the heart-lung machine, catheterization, angioplasty, pacemakers, ventricular defibrillators, and artificial hearts took the heart out of the realm of mystery and made its surgery an everyday event. Jauhar is particularly comfortable describing these miraculous inventions, their evolution and exactly how they operate.

At the same time he sews his family into the picture, including himself. Jauhar discovers he has some significant plaque blocking his arteries—he is in his late forties—which prompts him to investigate his family history of heart disease. One especially of interest is a grandfather who died of a heart attack at lunch after being bitten by a snake that morning at his shop (he didn’t know at the time, but it turned out to be a cobra). But could in fact his grandfather’s condition been congenital? Or, perhaps, and this is fascinating, could it have traumatic weakening incurred due to the horrors experienced during the partition of Pakistan, many years before?

The final chapters find Jauhar in a melancholic mood. He feels with the golden years of heart medicine behind us, each new tool or drug is going to be delivering diminishing returns. But more to the point, he believes the greatest changes to heart health are going to be in lifestyle, not science. Smoking, obesity, diabetes, high serum cholesterol all have their part to play in heart disease—as the famous “Framingham Heart Study” has borne out.

Moreover, though the heart may not be the seat of the emotions, it is highly responsive to them.. Jauhar was wise to partition his book into metaphor and mystery, for stress, the great bogeyman of the final pages—from the romantic breakup, depression, social disconnectivity, to the boss yelling at you, the drive to work, to the eighth cup of coffee to keep awake to do yet more work—and the general lack of down time is breaking our hearts in more ways than one. Watch that sugar, salt, and fat, but in the end, it’s the intake that comes through your Twitter feed and overflowing inbox that your doctor may one day tell you it’s time to swear off.

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