Heart

Heart Plot Summary

Introduction

Throughout human history, the heart has occupied a unique position in our culture and consciousness. More than just a vital organ, it has been revered as the seat of emotions, the source of courage, and the center of our very being. The ancient Egyptians left the heart in mummified bodies because they believed it was essential for rebirth. The Aztecs performed elaborate ceremonies where hearts were removed from living sacrifices as offerings to their gods. Even in modern medicine, when brain death has become the accepted definition of demise, many still associate a beating heart with life itself. This fascinating journey explores how our understanding of the heart evolved from mystical symbolism to mechanical marvel and beyond. We'll witness the centuries-long struggle to unlock the heart's secrets, from William Harvey's revolutionary discovery of circulation to the development of heart-lung machines and artificial hearts. Along the way, we'll encounter pioneers who risked their careers and even their lives to advance our knowledge. Whether you're interested in medical history, technological innovation, or the intersection between science and emotion, this exploration reveals how the heart remains central to our physical existence while continuing to shape our emotional and cultural lives.

Chapter 1: Ancient Perspectives: The Heart as Metaphor

For most of human history, the heart was shrouded in mystery. Ten thousand years ago, Cro-Magnon hunters engraved curlicue pictures of the heart on cave walls, though they had no understanding of its function. By 3000 BCE, the ancient Egyptians had developed remarkably prescient theories about the heart's purpose. The Ebers Papyrus described it as the center of blood supply, with vessels directed toward major organs. Unlike other organs removed during mummification, the heart was preserved, believed essential for the afterlife journey. In ancient Greece, philosophers like Plato viewed the heart's central location as evidence it was the center of life and morality. Plato proposed the heart served as a sentry—the thymos, the highest part of the mortal soul—through which blood rushes to warn that something is amiss. While this was far from a scientific understanding, it accurately described aspects of the fight-or-flight response. Meanwhile, Aristotle taught that the heart was the seat of intelligence and sensation, not the brain, a belief that persisted for centuries. The era's most influential medical figure was Galen, physician to Roman emperor Marcus Aurelius. Drawing from his observations of wounded gladiators and animal dissections, Galen proposed a scheme where the liver converted food into blood that traveled one way into the body, like water in an irrigation ditch, never to return. He believed blood passed from the right ventricle to the left through invisible pores in the septum, where "vital spirits" were added. Once in the left ventricle, the heart generated heat like a furnace to circulate blood through the body. Despite numerous errors, Galen's theories became medical doctrine for nearly 1,400 years. In the Middle Ages, the heart gained further symbolic significance. The Sacred Heart of Jesus became an emblem of monastic love in the Roman Catholic Church. In the thirteenth century, heart shapes began appearing in paintings of lovers, initially among aristocrats—hence the term "courtship." These heart shapes, or cardioids, are common in nature, appearing in leaves, flowers, and seeds of many plants, reinforcing the connection between the heart and love. By the fourteenth century, metaphors about the heart abounded: to "take heart" meant to have courage; to "speak from the heart" conveyed sincerity. The heart's association with emotional states wasn't merely symbolic. We now understand that the biological heart is extraordinarily sensitive to our emotional system. Studies show that grief, fear, and psychological trauma can cause profound myocardial injury. A 2004 study of nearly 30,000 patients found psychosocial factors, including depression and stress, were as strong risk factors for heart attacks as high blood pressure. This connection is dramatically demonstrated in takotsubo cardiomyopathy, or "broken-heart syndrome," where extreme stress weakens the heart, often following emotional trauma like the death of a spouse. From ancient rituals to modern medicine, our journey with the heart begins with understanding how deeply this organ has been intertwined with our conception of what makes us human. While we've moved beyond purely metaphorical understanding, these early perspectives reveal important truths about the connection between our emotional and physical hearts that continue to influence our approach to cardiac health today.

Chapter 2: Breakthroughs (1628-1900): From Harvey to Rehn

The year 1628 marks a watershed moment in cardiac history when English physician William Harvey published "De Motu Cordis," a revolutionary treatise that completely upended Galen's 1,400-year-old theory of circulation. Through meticulous experimentation on both living animals and human cadavers, Harvey made a stunning discovery: blood continuously circulates through the body in a closed circuit, with the heart serving as a pump. In a simple but ingenious experiment, Harvey tied off a human arm with cloth, cutting off blood flow. He then relaxed the tourniquet so that arterial blood at higher pressure could pass but venous blood could not. The arm quickly swelled, leading Harvey to infer that blood flowed down arteries and drained through invisible connections into veins before returning to the heart. Harvey's discovery faced intense opposition. Publishing his findings risked his reputation and livelihood, as he noted, "I not only fear injury to myself from the envy of a few, but I tremble lest I have mankind at large for my enemies." Yet his careful measurements provided irrefutable evidence. He calculated that if the average heart expels two ounces of blood per beat at seventy-two beats per minute, the liver would need to produce 500 pounds of blood hourly if blood were consumed as nutrients rather than recirculated—an obvious impossibility. The next major breakthrough didn't come until the late 19th century, when surgeons finally dared to operate on the living human heart. In 1893, Dr. Daniel Hale Williams, a black surgeon at Chicago's Provident Hospital, performed what was then believed to be the first successful open-heart surgery. His patient, James Cornish, had been stabbed in the chest during a saloon fight. Williams made a six-inch incision, sutured a lacerated artery, and repaired a wound in the pericardium, the sac surrounding the heart. Remarkably, Cornish walked out of the hospital after two months. Even more groundbreaking was Ludwig Rehn's achievement on September 9, 1896. At Frankfurt State Hospital, Rehn operated on Wilhelm Justus, a 22-year-old gardener stabbed in the chest while walking in a park. Rehn made a fourteen-centimeter incision between Justus's ribs, bent a rib upward to create space, and found an inch-long wound in the right ventricle spitting blood with each contraction. "The sight of the heart beating in the opened pericardial sac was extraordinary," Rehn wrote. He inserted his finger into the wound and sutured it closed with three fine silk sutures, noting, "It was very disquieting to see the heart pause with each pass of the needle." These pioneers shattered centuries of taboo surrounding heart surgery. Just a decade earlier, the prominent surgeon Theodor Billroth had proclaimed that cardiac operations approached "a prostitution of the surgical act." Yet by 1907, Rehn could report that 120 heart surgeries had been performed worldwide, with a 40% success rate—a fourfold improvement over non-surgical approaches. At a surgical meeting in Berlin, Rehn confidently declared, "The feasibility of cardiac repair no longer remains in doubt." These breakthroughs fundamentally changed how physicians viewed the heart. No longer a mystical, untouchable organ housing the soul, it was recognized as a sophisticated but ultimately mechanical pump that could be studied, manipulated, and repaired. This paradigm shift opened the door to ever more ambitious cardiac interventions in the coming century. As one German surgeon noted, "With heart surgery, the last organ of the human body has now fallen to the hand of the surgeon."

Chapter 3: Surgical Frontiers (1950s): Cross-Circulation and Heart-Lung Machines

The 1950s witnessed an extraordinary leap in cardiac surgery, driven by two revolutionary approaches to the fundamental challenge of open-heart surgery: how to operate on a beating heart without the patient bleeding to death. At the University of Minnesota, surgeon C. Walton Lillehei developed a radical procedure called "cross-circulation" that would change cardiac surgery forever. A cancer survivor with a uniquely bold approach to medicine, Lillehei was determined to tackle congenital heart defects that were killing thousands of children annually. The concept of cross-circulation was inspired by fetal circulation in mammals. Since Lillehei couldn't stop a patient's heart for the time needed to repair complex defects, he proposed using a second person—typically a parent—to temporarily take over circulation. The parent and child would be connected through tubing, with the parent's heart and lungs oxygenating blood for both. On March 26, 1954, Lillehei performed the first cross-circulation operation on thirteen-month-old Gregory Glidden, who had a ventricular septal defect (VSD). With Lyman Glidden, the boy's father, lying just three feet away, Lillehei connected father and son vein-to-vein and artery-to-artery via a beer hose and milk pump. For thirteen and a half minutes, Lyman's heart and lungs kept both himself and his son alive while Lillehei repaired the hole in Gregory's heart. Though Gregory died of pneumonia eleven days later, Lillehei's second patient, four-year-old Pamela Schmidt, survived. A press conference announcing the success created a sensation. The media called the procedure "daring," "impossible," and "as extravagant and fantastic as any ever written in a shilling science thriller." However, cross-circulation was not without controversy. Critics called it murderous—the first operation in history that could potentially kill two people. After a series of deaths and a catastrophic incident where a donor mother suffered brain damage, the technique fell out of favor. Simultaneously, John Gibbon at Jefferson Medical College in Philadelphia was developing an entirely different solution: the heart-lung machine. Inspired by a young woman who died from a pulmonary embolism in 1931, Gibbon devoted nearly 25 years to creating a machine that could temporarily take over heart and lung function. With his research assistant (and wife) Mary Hopkinson, he performed countless experiments on animals, gradually improving his design. After years of refining his machine with IBM engineers, Gibbon performed the first successful open-heart surgery using a heart-lung machine on May 6, 1953. Eighteen-year-old Cecelia Bavolek underwent a five-hour operation to repair an atrial septal defect, with the machine taking over her circulation for approximately thirty minutes. These innovations transformed cardiac surgery. By 1957, the mortality rate for cardiac surgery had plummeted from 50% to 10%. As Lillehei wrote, "A physician at the bedside of a child dying of an intracardiac malformation as recently as 1952 could only pray for a recovery! Today with the heart-lung machine, correction is routine." The heart had become, as one writer put it, "an object of surgical assault." The human cost of this progress was substantial. Gregory Glidden and many others became medical martyrs whose sacrifices advanced the field. Their stories raise profound questions about medical ethics, informed consent, and the price of innovation. Yet without these pioneering surgeries and the willingness of desperate families to participate, many of today's routine cardiac procedures would not exist. As Lillehei said to justify his approach, "You don't venture into a wilderness expecting to find a paved road."

Chapter 4: Technological Revolution (1960s-1980s): Catheters, Defibrillators, and Stents

The decades following the development of the heart-lung machine witnessed an explosion of innovations that would transform cardiology from a primarily diagnostic field into an interventional one. This revolution began with Werner Forssmann, a young German doctor who in 1929 performed an act of extraordinary daring. Against his supervisor's orders, Forssmann inserted a urinary catheter into a vein in his own arm and advanced it 65 centimeters until it reached his heart, documenting the feat with an X-ray. For this self-experiment, Forssmann was ridiculed by colleagues and fired, his supervisor telling him, "You qualify to work in a circus, not in a reputable clinic." However, Forssmann's technique, largely ignored for years, became the foundation for cardiac catheterization. In the late 1930s, André Cournand and Dickinson Richards at Bellevue Hospital in New York City refined the procedure to measure pressures and blood flow in the heart. Their work earned them the 1956 Nobel Prize in Medicine, shared with Forssmann, who by then had abandoned cardiology for urology. The next breakthrough came on October 29, 1958, when Mason Sones at the Cleveland Clinic accidentally injected dye directly into a patient's coronary artery during a procedure. To his surprise, the patient survived this supposedly lethal mistake. Sones realized he had discovered a way to visualize coronary arteries, a technique that would become known as coronary angiography. This innovation allowed cardiologists to finally see exactly where coronary blockages were located. With blockages now visible, the race was on to develop methods to clear them. Charles Dotter, a radiologist dubbed "Crazy Charlie" for his unconventional approaches, performed the first angioplasty in 1964 on Laura Shaw, an 82-year-old woman with a blocked leg artery and gangrene who had refused amputation. Dotter's technique was crude, essentially snowplowing plaque down the artery, but it worked, and Shaw's symptoms improved dramatically. The true revolution in coronary intervention came through Andreas Gruentzig, a German physician working in Zurich. In his kitchen, Gruentzig hand-crafted balloon-tipped catheters designed to compress arterial plaque against vessel walls. After successful experiments on animals and leg arteries, Gruentzig performed the first coronary balloon angioplasty on September 16, 1977, on Adolph Bachmann, a 37-year-old insurance salesman. The procedure was a success, restoring blood flow without the need for open-heart surgery. Within days, the coronary angioplasty revolution had begun. Simultaneously, Michel Mirowski was developing the implantable cardioverter-defibrillator (ICD) at Sinai Hospital in Baltimore. Motivated by his mentor's death from ventricular arrhythmia, Mirowski worked against widespread skepticism to create a device that could detect dangerous heart rhythms and automatically deliver a shock to restore normal rhythm. On February 4, 1980, after years of animal testing, the first human ICD was implanted. Though the device was initially crude—the size of a deck of cards and implanted in the abdomen—it successfully saved the patient's life when it detected and terminated a life-threatening arrhythmia. These innovations transformed cardiac care. By the 1980s, procedures that once required opening the chest could now be performed through a catheter. Millions of lives were saved by technologies that grew increasingly sophisticated. Today, millions of angioplasties are performed worldwide annually, most using stents to keep arteries open, while hundreds of thousands of patients live with implantable defibrillators that stand guard against sudden cardiac death. The technological revolution initiated in these decades continues to evolve, with ever-smaller devices and more precise interventions becoming routine aspects of modern cardiac care.

Chapter 5: Mind-Heart Connection: How Emotions Affect Cardiac Health

The link between emotions and heart health has been recognized across cultures for millennia. The heart was traditionally considered the seat of emotions, and while modern science has relocated emotional processing to the brain, research increasingly confirms that emotional states profoundly impact cardiac function. This connection is far more complex and consequential than previously understood, challenging purely mechanical views of heart disease. Perhaps the most dramatic illustration of this connection is takotsubo cardiomyopathy, or "broken-heart syndrome," first recognized about three decades ago. In this condition, extreme emotional stress—such as the death of a spouse or a traumatic event—can cause the heart to weaken acutely, mimicking a heart attack. The heart muscle, particularly at the apex, balloons into a shape resembling a Japanese octopus trap (takotsubo), from which the syndrome derives its name. Though typically temporary, it can cause heart failure, life-threatening arrhythmias, or even death. Remarkably, this condition occurs almost exclusively in women, for reasons not fully understood. Studies following natural disasters have documented the powerful emotional effects on heart health. After a major earthquake in Japan's Niigata Prefecture in 2004, researchers documented a twenty-four-fold increase in takotsubo cardiomyopathy cases in the affected region. Similar patterns emerged in the United States following devastating tornadoes and tropical storms. The physiological mechanism appears to involve stress hormones like adrenaline damaging heart cells, with areas having higher concentrations of stress hormone receptors suffering the most damage. Chronic emotional states also play a critical role in heart disease. The Framingham Heart Study, which began in 1948 and has continued for decades, initially focused on biological risk factors like cholesterol and blood pressure. However, researchers eventually discovered that psychosocial factors were as important as traditional risk factors. Chronic stress, depression, anxiety, and social isolation all contribute significantly to cardiovascular risk. The Whitehall study of British civil servants revealed that even among financially secure government workers, those in lower-ranking positions with less job control had nearly twice the cardiac mortality of higher-ranking administrators. Cultural factors significantly influence heart health as well. Studies of Japanese immigrants to America found that those who maintained traditional Japanese social connections had much lower rates of heart disease than those who became more "Westernized," even when traditional risk factors were equal. This suggests that cultural dislocation and the loss of community bonds directly impact cardiac health. Similar patterns emerge in diverse populations, including African Americans in urban centers who face higher rates of hypertension and heart disease than their West African counterparts. Even animals demonstrate the cardiac impact of emotional states. In laboratory studies, rabbits fed high-cholesterol diets developed significantly less atherosclerosis when they were petted and played with regularly. Similarly, monkeys experiencing social stress developed more coronary artery disease than matched controls, despite similar cholesterol levels and blood pressure. These findings suggest mechanisms beyond traditional risk factors are at work. The implications of this research are profound. Treating heart disease may require addressing emotional and social factors alongside traditional medical interventions. Stress management techniques, social support networks, and lifestyle modifications that reduce chronic arousal may be as important as medications and procedures. As cardiologist Bernard Lown discovered, interventions like meditation can be as effective as beta-blockers in protecting against stress-induced arrhythmias. This holistic understanding reconnects the biological heart with its metaphorical counterpart, suggesting that emotional wellbeing is not merely a luxury but a vital component of cardiac health.

Chapter 6: Modern Challenges: Technology's Limits and Holistic Approaches

Despite extraordinary technological advances, cardiovascular disease remains the leading cause of death worldwide, claiming approximately 18 million lives annually. This sobering statistic highlights the complex challenges facing modern cardiac care. While spectacular innovations continue—from minimally invasive valve replacements to gene therapies—the field increasingly confronts the limitations of its predominantly mechanical approach to heart disease. The past half-century has witnessed a remarkable 60% reduction in cardiovascular mortality in developed countries, largely due to technological and pharmaceutical innovations. However, this progress has slowed significantly in recent years. Several factors contribute to this plateau: declining smoking rates have leveled off, obesity rates continue to climb, and diabetes cases are projected to nearly double in the next twenty-five years. But another explanation may be that cardiology in its current form has reached the limits of what it can accomplish through technological intervention alone. This diminishing return on investment is evident in several areas. For instance, efforts to shorten "door-to-balloon" times—the period from a patient's hospital arrival to restoration of coronary blood flow—have been remarkably successful, with median times dropping from 83 to 67 minutes in recent years. Yet surprisingly, these improvements have not translated into better survival rates. Similarly, while medications like beta-blockers and ACE inhibitors dramatically improved heart failure outcomes when introduced, newer drugs show increasingly marginal benefits despite enormous development costs. Meanwhile, the technological marvels themselves present new challenges. Implantable defibrillators save lives but can trigger severe psychological distress when they deliver shocks, leading to anxiety, depression, and post-traumatic stress disorder in many recipients. As one patient described, "Nobody told me what it would be like. They said you'd feel a little something, but they never told me it was like a donkey rearing his hind legs and with all the power he has hitting you right in the chest." Some patients become so traumatized they request their devices be deactivated, preferring to risk death rather than endure more shocks. Artificial hearts present similar dilemmas. While they can extend life, they often come with devastating complications including strokes, infections, and bleeding. The first permanent artificial heart recipient, Barney Clark, survived 112 days but endured multiple surgeries, seizures, kidney failure, and infections before succumbing to multi-organ failure. More recent continuous-flow devices eliminate pulsatile blood flow entirely—patients emerge from surgery without a pulse—creating physiological changes we're only beginning to understand. These challenges have prompted a shift toward more holistic approaches to cardiac care. Dean Ornish's pioneering Lifestyle Heart Trial demonstrated that comprehensive lifestyle changes—including a low-fat vegetarian diet, regular exercise, stress management, and group support—could actually reverse coronary artery disease without medications or surgery. Remarkably, psychological support proved more strongly correlated with disease reversal than exercise, suggesting the critical importance of addressing emotional wellbeing. The future of cardiac care likely lies in a more balanced approach that integrates technological innovations with greater attention to prevention and psychosocial factors. This means addressing the upstream causes of heart disease—poor diet, physical inactivity, chronic stress, and social isolation—rather than focusing exclusively on downstream interventions after disease has developed. It also requires recognizing that social and political factors, from neighborhood design to food policy, profoundly influence cardiovascular health. As cardiologist and researcher Peter Sterling suggests, we need to find ways to "reduce the need for vigilance and restore small satisfactions" in daily life. This might include city planning that encourages walking rather than driving, workplace policies that reduce chronic stress, and healthcare approaches that strengthen social connections. The biological heart, we now understand, cannot be separated from its metaphorical counterpart. To truly heal our hearts, we must attend not only to our arteries and valves but also to our emotions, relationships, and the societies in which we live.

Summary

Throughout this exploration, we've witnessed the heart's remarkable journey from sacred symbol to mechanical marvel and beyond. A clear pattern emerges: each era's understanding of the heart reflects its broader worldview. Ancient civilizations revered the heart as the seat of the soul; Renaissance anatomists unveiled its mechanical functions; industrial-age surgeons conquered it with daring operations; and modern cardiologists deploy increasingly sophisticated technologies to repair its failings. Yet despite our technological mastery, the heart continues to defy purely mechanistic explanations, reminding us of the intricate connections between our physical, emotional, and social lives. This history offers profound lessons for our approach to health and medicine today. First, we must recognize that technological solutions, while powerful, have inherent limitations. The remarkable decline in cardiac mortality appears to be plateauing despite ever more sophisticated interventions. Second, truly effective cardiac care must address the whole person—their emotional states, social connections, and lifestyle choices—not just their arterial blockages or arrhythmias. Finally, preventing heart disease requires addressing its upstream causes through both individual choices and broader social policies. As we face growing epidemics of obesity, diabetes, and sedentary living, these insights become increasingly urgent. The heart, both biological and metaphorical, remains our most vital organ and most powerful symbol—demanding an approach to health that honors both its mechanical precision and its mysterious connections to our emotional lives.

About Author

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Sandeep Jauhar

Sandeep Jauhar has written several bestselling books, all published by Farrar, Straus, and Giroux. "My Father’s Brain," his most recent book, is a memoir of his relationship with his father as he succumbed to dementia. In the book, Jauhar sets his father’s descent into Alzheimer’s alongside his own journey toward understanding his father’s disease. It was named by The New Yorker and Smithsonian magazine as one of the best books of 2023.The book relates the complications that arise when family members must become caregivers. Though the conflicts are personal, they are also universal—conversations and conflicts that every family facing the mental erosion of an elder has. At the same time, the book explores everything from ancient conceptions of the mind to the most cutting-edge neurological―and bioethical―research. It delves into what happens in the brain as we age and our memory falters, how memory gives meaning to our lives, even as it changes with time, how dementia complicates our understanding of what it means to have a self — and what all this means for patients, their families, and society at large.Jauhar's first book, "Intern: A Doctor's Initiation," was an international bestseller and was optioned by NBC for a dramatic television series.His second book, "Doctored: The Disillusionment of an American Physician," was a New York Times bestseller and was named a New York Post Best Book of 2014."Heart: A History," his third book, was named a best book of 2018 by the Mail on Sunday, Science Friday, Zocalo Public Square, and the Los Angeles Public Library, and was the PBS NewsHour/New York Times book club pick for January 2019; it was also a finalist for the Wellcome Book Prize.A practicing physician, Jauhar writes regularly for the opinion section of The New York Times. His TED Talk on the emotional heart was one of the ten most-watched TED Talks of 2019. To learn more about him and his work, visit his website at www.sandeepjauhar.com or follow him on social media.

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