Heart Breaking

MedPage Today

"I think the iterative technological advances will continue [in the field of cardiology].  But the big frontier is going to be in marshalling more resources to address the intersection of the emotional heart and the biological heart."
"I had this [personal] fear of the heart as the executioner of men in the prime of their lives."
"Sitting numbly in that dark room [after a CT angiogram revealed coronary artery blockages], I felt as if I were getting a glimpse of how I was probably going to die."
"You can't suture something that's moving [a beating heart], and you couldn't cut it because the patient would bleed to death [accounting for surgeons' fear of operating on the heart until the emergence of the 20th Century]."
"What came out of it [the 1948 Framingham Heart Study]  were the risk factors that we now know and treat. What was eliminated were things like emotional dysfunction and marital health [impacting on heart health]."
"I used to be so wrapped up in the rat race that I was probably putting an inordinate amount of stress on myself. Now I think about how to live a little more healthfully, to live in a more relaxed way. I have also bonded more with my patients and their fears about their own hearts."
Dr. Sandeep Jauhar, cardiologist, director, Heart Failure Program, Long Island Jewish Medical Center, New York

Though Heart is his third book, it’s his first foray into stories that revolve around the body’s most vital organ.  SergeyNivens/Getty Images/iStockphoto

Heart disease, despite enormous advances in treatment, pharmaceutical regimens, surgical interventions and associated care, remains North America's leading killer of adults. Even though in North America, post-heart attack mortality has dropped tenfold since the late 1950s. Yet, as much as medical science knows about the physiological-biological link with heart health, it knows very little of the psychological-emotional ties with the health of the beating, hard-working heart.

Dr. Jauhar, a best-selling author and frequent contributor to The New York Times, deplores this lack of attention to the part the human psyche and its stability plays on the health of the heart. He feels that when the Framingham Heart Study investigators set out to study thousands of Americans to identify vital cardiovascular risk factors in 1949, such as cholesterol, blood pressure and smoking, they overlooked the potential of psychosocial determinants in heart health as representing an unneeded complication.

It is now, he feels, past time that due recognition be given to that health component and he has himself addressed that link between emotional health and heart health for starters in his new book, Heart: A History. In the book he follows the history of cardiovascular medicine, exploring the immense technological advances, from open-heart surgery to the artificial heart. And he argues the need to devote greater attention to emotional factors influential in heart disease, citing unhappy relationships, poverty, income inequality and work stress.

There is no more vital organ in the human body than the heart; it is the engine that keeps everything running in good order. If it is not in good order the rest of the machinery is threatened. The heart's centrality to existence has long been recognized. In many cultures it is seen as symbolic of romance, sadness, sincerity, fear and courage (Latin word for heart: 'cor'). The heart in fact, is a pump circulating blood throughout the body, the only organ capable of moving itself as it beats three billion times in the average lifetime.

Its vitality, yet perceived fragile state made doctors fearful of approaching it at a time when all other organs of the body were addressed with surgical procedures when they went awry. It took the introduction of the 20th Century to give medical scientists the courage to assure themselves that the heart too could undergo operations in efforts to mitigate problems that arose with it. Since then, once-miraculous surgeries have become commonplace.

Studies indicate that stress and despair can have a huge impact on the condition of the heart. A condition known as Takotsubo cardiomyopathy (broken-heart syndrome), where the death of a life-partner, financial concerns or some other life-altering personal catastrophe is capable of weakening the heart, causes symptoms similar to that of a heart attack. Scientist Karl Person a century ago undertook a study of cemetery headstones, noticing that husbands and wives frequently died within a year of one another.

Dr. Jauhar's own family history with heart disease where several of his close relatives died after morbid run-ins with a failing heart, spurred him to study the link between emotional well-being and heart health. His paternal grandfather died at age 57 when an encounter with a black cobra triggered a fatal heart attack. Following graduation from medical school, Dr. Jaubar took a cardiology fellowship  and became director of the heart failure program at Long Island Jewish Medical Center.

He was 45 when he experienced his own frightening encounter with heart disease. A man who exercised regularly, led a healthy lifestyle, still found that his heart health had been compromised. He reviewed radiographic images of his heart with the realization that proceeding along the path that he had taken in concentrating on his professional career and perhaps abandoning some moderating elements in his personal life came at a price.

Studies indicate that people who feel chronically stressed by work or relationships, along with those who feel socially isolated become more susceptible to heart attacks and strokes. Some studies have shown that doctors allow their patients roughly 11 seconds to explain their reasons for a clinical visit before cutting them off. Dr. Jauhar appreciates how important it is to allow patients to talk of matters that concern them, to enable him to more fully understand their emotional lives.

In the process, he has also attempted to introduce new habits in his own life, in hopes of reducing stress. Trying out relaxation techniques in yoga and meditation, as an example. He has committed to daily exercise, devotes himself more frequently to time spent with his children. And finds in the process that he is now better able to relate to his patients.

The book isn’t meant to be an exhaustive recitation of history, as Jauhar punctuates his accounts with interesting notes about these physicians – including their failures.

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