Story of the heart: Literally as well as metaphorically

By Dr. Ananya Mandal, MDFeb 14 2011

Stephen Amidon, a novelist and co-author of The Sublime Engine: A Biography of the Human Heart, writes about the story of the human heart through the world of science, history, culture and our bodies with his brother Thomas who is a practicing cardiologist in Montana and a former medical director of The Hope Heart Institute. Thomas said, “Ironically, I did an angiogram on a patient last week who had very calcified and hardened arteries that were almost precisely in the shape of the Valentine heart… But I don't think the early depicters of that heart shape had access to the same view of the heart that I have.”

For example ancient Egyptians saw the heart as the part of the human that ascended to heaven, carried by a winged beetle. The Greeks saw it as the body’s center of courage and loyalty. For Plato, love rested in the mind, while his student, Aristotle, felt the seat of intelligence and sensation was the heart write the authors.

Stephen Amidon in his book speaks of the history of the heart retelling the story of Hugh Montgomery. This young 17th-century Irish nobleman fell from his horse onto a fence, opening a hole in his chest that doctors could not close. But the young rider did not die — he actually got better. He said, “And yet he had a hole in his chest, which exposed some inner workings.” Later in life, the boy’s father fashioned a metal plate to cover the injury. “But if you took that metal plate off, you could actually see something in there.” People around Europe thronged to see his insides but they thought it was his lung. “It wasn’t until Sir William Harvey, the greatest of all cardiologists, took a look inside his chest that he realized it wasn’t the lung at all that they were looking at — it was the heart… And this was really the first time anyone had seen the actual working of the heart,” Stephen said. The boy did not feel a thing when his heart was touched. Thomas says, “I encounter this on a regular basis when I perform procedures on patients…When I put catheters inside them, they’re amazed to realize that they’re not going to feel it inside their body. They may feel the initial needle puncture when I put a catheter in their artery, but when I’m up inside placing catheters inside the heart, taking pictures inside the heart, there is no innervation on the inside of the heart — you don’t feel it at all.”

What is most wonderful write the brothers is that weighing merely 15 ounces, the heart beats roughly once per second — that is about 2.5 billion times during an average lifetime — and it pumps 74 gallons of blood through the adult body every hour. Thomas says that one of the most important advances in medical technology was the ability to stop the heart during an operation. It was the development of the heart-lung machine in the 1950s, he says, that allowed surgeons to stop the heart and operate on it. This technique was crucial for a Minnesota surgeon named C. Walton Lillehei, who pioneered the treatment of congenital heart defects. Thomas says artificial hearts are a simple concept except for finding a way to have the blood that flows through the system not cause problems, like blood clots.

Stephen on the other hand says as heart transplants, surgical techniques and mechanization become more commonplace, will the heart lose any of its cultural and metaphorical significance? “One of the things that surprised me during the course of writing this book was how durable the heart’s metaphorical power has been — not just in the past 50 years in the great explosion of cardiology, but in the past 500 years since the great anatomists of the Renaissance began opening up bodies and began looking at the physical heart,” he says. “So perhaps there will be a day when we no longer touch our chest and kind of nod, and people understand we’re talking about qualities that can’t be explained by medicine — we’re talking about courage or devotion or inspiration…You can have a situation where someone receives an artificial heart, and afterward goes to their surgeon and says, ‘I thank you for this from the bottom of my heart.’ This will make complete sense to us,” says Stephen Amidon.

February is American Heart Month, created to raise awareness around heart disease that kills most in the US. In 2009, an estimated 785,000 Americans had a new coronary attack, and about 470,000 will have a recurrent attack. Tips to a healthy heart include regular exercise, control cholesterol, eat better, control blood pressure, lose weight, control blood sugar and stop smoking.