What the heart knows

The history of cardiology through stories of daring innovations, painstaking research and chance discoveries.

Books: Heart: A History
Author: Sandeep Jauhar
Publication: Penguin Viking
Pages: 288
Price: 599

Did Christ die of cardiac ‘tamponade’ when a Roman soldier’s lance pierced his heart and blood poured into the pericardial sac to compress it? Is the heart the seat of emotions or their victim? Who are the pioneers who broke religious taboos and flouted medical caveats to operate on the beating heart, open it or even transplant it, making the romance of scientific advances vie with the romance of literary allusions? Are we reaching the limits of rapid technological advances in cardiac care and need to focus more on the prevention of disease than we do now?

These are some of the questions you will find discussed, in a very engaging manner, in Sandeep Jauhar’s book Heart: A History. He brings literary flair to his sharing of learning and his experiences as an American born cardiologist while lacing the narrative with illustrative accounts of heart problems in his own family. The book carries the reader on a cruise across several landmark advances in the understanding of heart disease and spotlights many breakthrough innovations which dramatically altered the scope and survival benefits of cardiac care.

Jauhar narrates the history of cardiology through stories of daring innovations, painstaking research and chance discoveries. He introduces you to Henry Dale Williams, an Afro-American surgeon whose forebears were slaves, as he daringly performs the first ever suturing of the outer layer of a living human heart in a victim of cardiac tamponade at Chicago in 1893. He then takes you to Frankfurt where, in 1896, Ludwig Rehn sutures the heart muscle itself. Alas, it was street crime that led to these dramatic beginnings of cardiac surgery, with both patients having their hearts stabbed by knives and not pierced by Cupid’s darts!

The book then takes you into the operating theatres and laboratories of many other pioneers, with an empathetic account of the challenges they faced within and outside the medical profession as they dared to boldly go where no one has gone before. These laureate histories feature the use of cross circulation by C Walton Lillehei’s, the father of open-heart surgery, John Gibbon’s development of the heart-lung machine, Werner Forssman’s daring experiment of pushing a catheter into his own heart, Mason Sones’ entry into the coronary arteries which provide blood supply to the heart muscle, Rene Favalaro’s first coronary bypass surgery, the accidental invention of the artificial pacemaker by William Greatbatch, Andreas Gruentzig’s balloon angioplasty and Christian Barnard’s heart transplantation. While Jauhar writes of coronary and congenital heart disease, he makes no mention of rheumatic valvular heart disease which still afflicts the poor in developing countries.

Jauhar is not merely fascinated with technological marvels. He thoughtfully reflects on the causes of heart disease and describes how the Framingham heart study identified the major behavioural and biological risk factors that lead to damaged coronary arteries. He narrates how Sir Michael Marmot identified social conditions as important contributory causes of heart disease. Hypertension (which killed Franklin D Roosevelt and launched the Framingham study) and tobacco (which kills 7 million globally today) emerged as major drivers of risk in the American study. Lower status with lack of decision-making ‘control’ in professional life among British civil servants and weakening of social relationships with changing cultural environments among Japanese migrants to the West were incriminated in Marmot’s research.

Somewhat unexpectedly, the author devotes much space to highlight psychological perturbations which are vastly underrated but very important risk factors for heart disease. He starts with the story of his paternal grandfather in Kanpur who had a sudden cardiac death when shocked by the sight of a dead cobra brought to his dining table by an insensitive neighbour. He then describes the Takotsubo cardiomyopathy or the broken heart syndrome, where the heart weakens in response to extreme grief or stress or a broken romantic relationship. The weakened heart assumes the shape of a Japanese octopus-trapping pot called takotsubo. Life-threatening disorders of the heartbeat are often triggered by psychological stress, as demonstrated by Nobel Laureate Bernard Lown. Jauhar ends the book referring to the deaths of his mother and maternal grandfather from heart attacks and the plaques detected in his own coronary arteries.

Despite all the glory attached to cardiac surgery and interventional cardiology, whose thrills we vicariously experience in several chapters, Jauhar concludes that prevention and reversal of heart disease through healthy living is the enduring message from the heart. He declares that “heart disease has psychological, social and even political roots’ and affirms that ‘to treat our hearts, we must repair our societies and minds”. He opines that cardiovascular medicine in its current form “will increasingly produce marginal advances in the years ahead”. He calls for a new paradigm, “one focussed on prevention — turning down the faucet rather than mopping up the floor”. As India experiences a surge in coronary heart disease, that is a good message to heed.

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