Heart dominates, but does it ?

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Heart has a special place amongst all organs. While brain, blood, liver, skin and kidneys all work silently – heart is loud. It is the only one to beat, and to generate a perceptible pulse. Heart-beat and pulse are signs of life. Hence, dominant position of heart in all systems of medicine, should not come as a surprise. It is much more than an organ – it symbolises love, as well as life. Like most social systems, heart derives its power from the very organs it dominates over.

“Emotional” and “Anatomical” hearts in postage stamps

In popular culture, heart responds to emotions. This “emotional heart” is conical, with a pointed edge at the bottom, and a broad indented base at the top. Emotional heart, an expression of love has evolved from a pale cone to exuberant red. On the other hand “anatomical heart” is a simple fist-sized organ. It pumps blood from birth till death. Postage stamps are influenced by both emotional and anatomical depictions.

Your heart is your health: World health theme in 1972

Every year, World health organisation (WHO) announces a health-theme. Theme for 1972 was “your heart is your health”. By this time cardiology was already a well developed speciality. We had developed diagnostics such as chest X-rays and ECGs. We could also catheterise its chambers.

First phase of framingham heart study had just concluded, and we knew reasons behind heart attacks. Postage stamps celebrated the year with either anatomical or emotional hearts.

Flashbacks from the past

Ancient physicians knew about structure and functions of heart. Hippocrates had written detailed descriptions of cardiac diseases. Galen refined these views and correctly identified heart as a pump. Early physicians were however naive about circulation. Galen and his successors over next 1500 years believed that it pumps blood through veins, and air through the arteries. “Blood came from liver, and air from lungs. Tissues consumed both of these nutrients.”

In 1628, William Harvey described circulation. He correctly identified that arteries supply oxygenated blood, and veins collect it and return it back. His work was pathbreaking. Harvey was an international figure. He was born in England, studied in Italy, and could publish his work in Frankfurt.

Electrocardiography

Next major advance in cardiology was invention of electrocardiography or ECG. Pioneered by Einthoven in early 1900s, early instruments were big and cumbersome. In 1924, Einthoven recieved Nobel prize in medicine. By 1940s, scientists could make the device more portable. Early ECG recorders were electronic, followed by digital. Today we have ECGs even on watches and in home-based devices.

Submissive vessels

While heart dominates, vessels are submissive. Over the years, we considered blood-vessels as mere conduits, transporting wishes of its master. Flowing blood exerts pressure. In 1711 Stephen Hales could demonstrate this fact, but in a horse. First human blood pressure measurement in 1856 was possible in an amputated leg.

About four decades later Riva-Rocci, an Italian physician developed a simple mercury blood pressure machine. Initially physicians did not consider blood-pressure values of any use. It was a neurosurgeon, – Harvey Cushing who realised its importance. He discovered Cushing’s reflex – rise in blood pressure and fall in pulse, when pressure in brain is more. Soon neurosurgeons were measuring blood pressures, much before physicians realised its value.

Hypertension, Roosevelt, and Framingham

History of medicine is influenced by death of famous and powerful. Till 1945, hypertension was classified as benign (or asymptomatic) and malignant (symptomatic or with an end-organ damage). Doctors considered benign as a compensatory response, not to be treated. US president Roosevelt had many blood pressure measurements done from 1941-45. His blood pressure was steadily rising. However, it fell in benign category, and hence was never treated. Roosevelt died on 12th April 1945. His death was due to a much elevated blood pressure, leading to a stroke. This event was alarming. Three years later in 1948, CDC initiated Framingham study. In the following years, we had our first blood-pressure lowering medicines.

Blood-pressure targets

First hypertension control guidelines were published in 1977. World Health Organisation observed 1978 as a hypertension year and slogan was “down with high blood pressure”.

Over the years we have had eight revisions in hypertension guidelines. Levels above 135/85 need to be treated. Vessels are no-longer considered submissive. If pressures in them are high, it not only damages heart, but also eyes and kidneys.

Preventing and treating heart diseases

Most heart diseases today are a result of interruptions in its own blood supply. This realization is indeed a humbling moment for the dominating heart. Its blood vessels are tiny coronary arteries, that risk getting blocked. Today cardiac surgery can bypass blocked arteries. In 1978, we discovered streptokinase, a wonder drug that could dissolve clots. Over next years, we developed small stents that can be placed in the coronaries. But preventing these blocks altogether remains a task, larger than any of these.

Coronary blockages are due to smoking, cholesterol, obesity, diabetes, and high blood sugars. Simple measures such as being active, eating healthy, and controlling our blood sugars and blood pressure will keep heart healthy. Postage stamps in recent years have reinforced these behaviours.

Healthy-heart narrative dominates many chronic diseases. Its health depends on clean vessels, less body weight, controlled sugars, and reinforcement of healthy behaviours. In reality all organs need to work well to keep it healthy. So does heart really dominate ?