The Man Who Touched His Own Heart

by Rob Dunn

  18. “The Glamorous Artificial Heart,” New York Times, January 15, 1983.

  19. In one recent study of 133 people given assist devices, the average time they stayed on those devices was 180 days, and 100 of the 133 patients eventually received heart transplants. Twenty-five of the remaining 33 died, but the hearts of a few individuals recovered enough for them to live without the support device. See L. W. Miller et al., “Use of a Continuous-Flow Device in Patients Awaiting Heart Transplantation,” New England Journal of Medicine 357 (2007): 885.

  9. Lighter than a Feather

  1. http://www.yare.org/essays/The%20Tomb%20of%20Queen%20Meryet.htm.

  2. A. R. David, A. Kershaw, and A. Heagerty, “Atherosclerosis and Diet in Ancient Egypt,” Lancet 5 (2010): 718–19.

  3. Among those likenesses that have been preserved is one that speaks to the heart’s link to emotion. An obelisk dedicated to Hatshepsut Karnak reads, “Now my heart turns this way and that, as I think what the people will say. Those who see my monuments in years to come, and who shall speak of what I have done.”

  4. H. E. Winlock, The Tomb of Queen Meryet-Amun at Thebes (New York: Metropolitan Museum of Art, 1932).

  5. The heart pounds with excitement because of exciting events, whether they be things that have happened (you were chased by a tiger) or things that might happen (you think you hear a tiger, and it seems prudent to be prepared). As part of its fight-or-flight response, the body releases endorphins, which speed up the heart in order to pump more blood and oxygen to the cells that will need them in the event that you need to (a) fight a tiger or (b) run.

  6. Winlock did not know it, but his original quarry, Queen Hatshepsut, had been found decades before, on the floor of a minor tomb in the Valley of the Kings alongside another woman and mummified geese, but she had never been studied because her body was so unadorned and unremarkable. Her son, who begrudged her her success, had had her body moved to this locale, hoping in this and other ways to erase her traces. He nearly did so, but one of her teeth had been collected when her tomb was first found, and the DNA in that tooth, when studied in 2005, revealed her true identity.

  7. Or was heavier than the goddess Maat, who was charged with assessing lawfulness, morality, good, and evil.

  8. W. B. Ober, “Weighing the Heart Against the Feather of Truth,” Bulletin of the New York Academy of Medicine 59 (1979): 636–51.

  9. Heart disease due to atherosclerosis is often called ischemic heart disease, where ischemic derives from the Greek word for “narrowing” or “restriction.”

  10. The name derives from the history of cholesterol’s discovery. It was originally discovered inside gallstones and so associated with bile.

  11. There was some earlier work, particularly that of Marc Ruffer, who found atherosclerosis in some mummies in the early 1900s, but comparing Ruffer’s older studies to our modern definitions of the symptoms of atherosclerosis was not simple. See M. A. Ruffer, “On Arterial Lesions Found in Egyptian Mummies,” Journal of Pathological Bacteriology 16 (1911): 453–62.

  12. See figure 2 in A. H. Allam et al., “CT Studies of the Cardiovascular System in Ancient Egyptian Mummies,” American Heart Hospital Journal 10 (2010): 10–13.

  13. A. H. Allam et al., “Atherosclerosis in Ancient Egyptian Mummies: The Horus Study,” Journal of the American College of Cardiology: Cardiovascular Imaging 4 (2011): 315–27.

  14. W. A. Murphy et al., “The Iceman: Discovery and Imaging,” Radiology 226 (2003): 614–29.

  15. R. C. Thompson et al., “Atherosclerosis Across 4,000 Years of Human History: The Horus Study of Four Ancient Populations,” Lancet 381 (2013): 1211–22.

  10. Mending the Broken Heart

  1. Favaloro once said in an interview (D. K. C. Cooper, Open Heart: The Radical Surgeons Who Revolutionized Medicine [New York: Kaplan Publishing, 2010]) that when he was in college, his professor told him that to be a great surgeon, one needed to become a great carpenter. Like many of the stories doctors tell about themselves, this one seems to mark Favaloro early as fated for the life he led, a life as a carpenter of the heart.

  2. Often, the first symptom of a permanently blocked coronary artery is a heart attack. Often, the second is death.

  3. In practice, it tended to leave patients with the original angina and, as a bonus, a complete and permanent lack of energy.

  4. See the description in K. L. Greason et al., “Myocardial Revascularization by Coronary Arterial Bypass Graft: Past, Present, and Future,” Current Problems in Cardiology 36 (2011): 325–68.

  5. D. J. Fergusson et al., “Left Internal Mammary Artery Implant—Postoperative Assessment,” Circulation 37 (1968): 24–26.

  6. G. Murray et al., “Anastomosis of a Systemic Artery to the Coronary,” Canadian Medical Association Journal 71 (1954): 594–97.

  7. On May 2, 1960, Robert Goetz actually performed bypass surgery on a thirty-eight-year-old man. A coronary artery was replaced by a mammary artery that was held in position by an artificial ring. The surgery appears to have been successful, but the patient died a year later due to a heart attack and there was no autopsy to see how or whether the death was related to the original surgery. It is unclear if Favaloro knew of this surgery.

  8. H. E. Garrett, E. W. Dennis, and M. E. DeBakey, “Aortocoronary Bypass with Saphenous Vein Graft: Seven-Year Follow-Up,” Journal of the American Medical Association 223 (1973): 792–94.

  9. Blockage of the left coronary artery is more serious, serious enough that the blocked vessel is often described, in the dark humor of surgeons, as a widow maker.

  10. For example, mammary artery grafts now appear more successful than vein grafts and so have become the standard.

  11. All three men would receive many accolades. One in particular is worth mentioning for Sones. He was awarded the Galen Medal of the ancient Worshipful Society of Apothecaries of London. Upon being told of the award, he was asked if he knew who Galen was. He replied, “Oh yeah, Galen, I remember him. He was number sixty-two in my class in medical school, and I was number sixty-one.”

  12. Now referred to, oh so mundanely, as “plain old balloon angioplasty” (POBA).

  13. J. G. Motwani and E. J. Topol, “Aortocoronary Saphenous Vein Graft Disease: Pathogenesis, Predisposition, and Prevention,” Circulation 1998 (1998): 916–31.

  11. War and Fungus

  1. Of note, this is not high for Endo’s age. It is only high relative to a mean for all individuals of all ages and cultures.

  2. In the Akita region of Japan, there is a long history of gatherers. As recently as six hundred years ago, hunter-gatherer tribes roamed the forested hills of the area.

  3. This genus of fungus, Amanita, contains many of the most deadly mushrooms in the world, including the death cap.

  4. I have to remind myself that such interest is unusual. It is the sort of curious interest on which my field depends, an interest my colleagues and I all share, and the sort of interest that might tempt us to repeat this experiment in the kitchen down the hall from my lab at North Carolina State University. (We did.)

  5. A. Endo, “A Historical Perspective on the Discovery of Statins,” Proceedings of the Japan Academy, Series B, Physical and Biological Sciences 86 (2010): 484.

  6. It sucks being a lab rat.

  7. For more on the statin story, see J. J. Lie, Triumph of the Heart: The Story of Statins (New York: Oxford University Press, 2009).

  12. The Perfect Diet

  1. For more about the high-elevation work, see S. W. Tracy, “The Physiology of Extremes: Ancel Keys and the International High Altitude Expedition of 1935,” Bulletin of the History of Medicine 86 (2012): 627–60.

  2. Ancel Keys, “Notes on the Laboratory of Physiological Hygiene, University of Minnesota,” February 9, 1945, Ancel Keys Collection, University of Minnesota Archives, Minneapolis, 3.

  3. For more about this astonishing experiment and all of its ethical complexities, see T. Tucker, The Great Starvation Experiment (New York: Free Press, 2006)
.

  4. Heavy cholesterol (HDL—high-density lipoproteins) helps break down plaques in the blood and move light (LDL—low-density lipoproteins) cholesterol out of the way, carrying it back to the liver. LDL cholesterol, however, is the one with the predilection for getting stuck on artery walls and precipitating the reactions that lead to atherosclerosis.

  5. In light of Queen Meryet-Amun’s story, he was clearly wrong that high cholesterol and atherosclerosis were new. It is less clear whether or not he was right that there was a postwar boom in atherosclerosis and heart disease. The data before the war are too limited to inspire confidence, and while there was a peak in heart attacks and heart disease, part of this peak may be due to the waning of other diseases rather than the waxing of heart disease.

  6. Ideally, he would have chosen people who were similar genetically and then prescribed each of those people one of a series of diets that varied in the number of calories; percentage of fats, proteins, and carbohydrates; and composition of other dietary particulars—fish oils, olive oils, nuts, vegetables, and fruits. He would need enough people to have some individuals in each treatment who would suffer from heart attacks. If no one had a heart attack, there would be nothing to compare. If Keys were to experiment with, let’s say, fifteen diets, he might need as many as fifteen hundred people to be part of the experiment. He would also have to convince people to stick with an experimental diet their entire lives. What was more, the experiment would work only if those people did not have the chance to choose which diet they would consume for the rest of their lives! No one has done such an experiment. No one ever will. Therefore, all studies that link diet, lifestyle, genetic background, and health outcomes are, at best, suggestive.

  7. At about this same time, Christiaan Barnard, in his book Heart Attack, described Keys as one of the most outstanding nutritionists and epidemiologists of modern times.

  8. One of the very few diets no one seems to advocate is a diet engineered by science. In 1940, it seemed clear that technology would produce the perfect diet, supplemented with each thing it needed. This no longer appears to be held as a truth except in the military and in attempts to deal with starvation. We now seem to believe that technology cannot solve the problems of diet; we believe this even as we, each year, consume more and more technologically processed foods.

  9. R. Estruch et al., “Primary Prevention of Cardiovascular Disease with a Mediterranean Diet,” New England Journal of Medicine 368 (2013): 1279–90.

  10. Though moving did not solve all of their problems. As the Keyses aged, they ultimately had to leave Italy. They were not Italian, so they had no family there to care for them. A new culture is no substitute for family.

  13. The Beetle and the Cigarette

  1. Cardio comes from the Greek for “heart,” -ologist is someone who studies. One might then imagine that the term cardiologists would be reserved for those who study the heart. It is not. In practice, cardiologists are physicians who mend hearts without using open-heart surgery. They are ever more common. Cardiac surgeons, by contrast, that bloody-handed and dexterous clan, are ever more rare.

  2. Christiaan Barnard even derisively referred to those who used statistics to evaluate the relative benefits of different treatments as “number boys.” He, like many surgeons, had much more confidence in his own intuition than in data.

  3. European Coronary Surgery Study Group, “Long-Term Results of Prospective Randomised Study of Coronary Artery Bypass Surgery in Stable Angina Pectoris,” Lancet 316 (1982): 1173–80.

  4. In other words, patients in the study had randomly, like guinea pigs, been assigned to one treatment arm or another. The advantage of such an approach is that it removes any preexisting differences in terms of who gets one treatment and who gets another.

  5. Here it is worth noting that because the effect of these pollutants is due purely to their size, it does not much matter what they are. So long as they are small, they will cause problems.

  6. T. Takano, K. Nakamura, and M. Watanabe, “Urban Residential Environments and Senior Citizens’ Longevity in Megacity Areas: The Importance of Walkable Green Spaces,” Journal of Epidemiology and Community Health 56 (2002): 913–18.

  7. D. J. Nowak, D. E. Crane, and J. C. Stevens, “Air Pollution Removal by Urban Trees and Shrubs in the U.S.,” Urban Forestry and Urban Greening 4 (2006): 115–23.

  14. The Book of Broken Hearts

  1. In 1976, still without so much as an undergraduate degree, Thomas was appointed as an instructor in surgery at Johns Hopkins.

  2. It was Osler who wrote that the tragedies of life are largely arterial, and he should know; he might have specified adult life, though. The tragedies of children are of a different nature.

  3. Despite these and many other successes, Abbott was never promoted beyond the role of assistant professor. In addition, she was (against her wishes) removed from all of her teaching responsibilities in 1923, before she wrote her great book. After death, she would receive more praise. The museum where she worked is now called the Maude Abbott Medical Museum.

  4. W. N. Evans, “Helen Brooke Taussig and Edwards Albert Park: The Early Years (1927–1930),” Cardiology in the Young 20 (2010): 387.

  5. As told by Taussig’s friend and student Charlotte Ferencz after Taussig’s death. See D. G. McNamara (who trained with Taussig and later worked in Texas with both Cooley and DeBakey) et al., “Helen Brooke Taussig: 1898 to 1986,” Journal of the American College of Cardiology 10 (1987): 662–71.

  6. L. Malloy, “Helen Brooke Taussig (1898–1986),” in J. Bart, ed., Women Succeeding in the Sciences: Theories and Practices Across Disciplines (West Lafayette, IN: Purdue University Press, 2000).

  7. The chronically ill children were housed in the Harriet Lane Home for Invalid Children, named for and funded by Harriet Lane, the niece of President Buchanan, whose two children both died of rheumatic fever, the disease whose successful treatment with antibiotics would result in it no longer leading to chronic illness.

  8. Gross was an excellent and creative surgeon, but a complex human. By some accounts he was manic-depressive, disappearing for long weeks without explanation from both his wife and his work, and then reappearing as though nothing had happened. On the one hand, Taussig was not the only person whose career Gross failed to support. On the other hand, some (though they appear to have been few) who worked with Gross swore by both his genius and his supportiveness. For more on Gross, see D. K. C. Cooper, Open Heart: The Radical Surgeons Who Revolutionized Medicine (New York: Kaplan Publishing, 2010).

  9. See the original paper describing the first three surgeries: A. Blalock and H. B. Taussig, “The Surgical Treatment of Malformations of the Heart in Which There Is Pulmonary Stenosis or Pulmonary Atresia,” Journal of the American Medical Association 128 (1945): 189–202.

  10. “First Blue Baby Operation Tried Two Years Ago Today,” Miami News, November 29, 1946.

  11. Letter from Lord Brock to Mark Ravitch (September 1965), cited in R. Hurt, The History of Cardiothoracic Surgery: From Early Times (New York: Parthenon, 1996).

  12. This accomplishment is all the more important in light of its context. In the 1960s and 1970s, about two or three out of every thousand cardiothoracic surgeons in the United States were women. In the 1980s, the number began to increase, but modestly. It remains around 2 or 3 percent. See S. Roberts, A. F. Kells, and D. M. Cosgrove, “Collective Contributions of Women to Cardiothoracic Surgery: A Perspective Review,” Annals of Thoracic Surgery 71 (2001): 19–21.

  13. In addition to her work on the heart, Taussig also played a key role in calling attention to the dangers of thalidomide. Her testimony before Congress prevented its being approved in the United States.

  15. The Evolution of Broken Hearts

  1. L. K. Altman, “Dr. Helen Taussig, 87, Dies; Led in Blue Baby Operation,” New York Times, May 22, 1986. For more details about Taussig’s life and death, see D. G. McNamara et al., “Helen Brooke Taussig: 1898 to 1986,” Journal of the American Co
llege of Cardiology 10 (1987): 662–71.

  2. This is the same sort of challenge human societies face. When one or a few individuals live together, no roads are necessary. Everything needed can be gathered close to hand (and disposed of there as well). But as societies grow, roads and plumbing became necessary: roads to reach faraway resources and plumbing to take away the waste these resources created.

  3. For more on the evolution of the heart, see Carl Zimmer’s excellent “The Hidden Unity of Hearts” in the April 2000 issue of Natural History Magazine.

  4. Colleen Farmer at the University of Utah thinks she understands this mystery of the lungfish story. She thinks lungfish succeeded and diversified for hundreds of millions of years, but then they met up with real monsters. The descendants of the lungfish that crawled onto land, terrestrial vertebrates, had evolved and diversified. By 220 million years ago, they had even begun, in the form of pterosaurs, to fly. The jaws of some pterosaurs suggest they evolved to eat fish at the surface of the water. It would have been easiest for them to catch lungfish, those fish that had to keep coming up for air. Once flying predators evolved, lungfish had fewer advantages in the sea. They could swim faster, sure, but they had to keep surfacing, and when they did, they were eaten by some of the most ferocious flying beasts ever to have lived. When they did, lungfish began to go extinct or to rely less on their lungs. Modern fish are a lineage of lungfish that lost their lungs entirely.

  5. Here, I am focusing on just the big extant (living) lineages of land vertebrates. The full evolutionary tree of land vertebrates includes many stories of the heart, but most of those stories are very difficult to study because they played out inside the bodies of organisms, such as dinosaurs, that are extinct and in which the soft tissue of the heart was not preserved.