REVIEW: State of the Heart by Haider Warraich
In State of the Heart, Dr. Haider Warraich takes readers inside the ER, inside patients’ rooms, and inside the history and science of cardiac disease.
State of the Heart traces the entire arc of the heart, from the very first time it was depicted on stone tablets, to a future in which it may very well become redundant. While heart disease has been around for a while, the type of heart disease people have, why they have it, and how it’s treated is changing. Yet, the golden age of heart science is only just beginning. And with treatments of heart disease altering the very definitions of human life and death, there is no better time to look at the present and future of heart disease, the doctors and nurses who treat it, the patients and caregivers who live with it, and the stories they hold close to their chests.
More people die of heart disease than any other disease in the world and when any form of heart disease progresses, it can result in the development of heart failure. Heart failure affects millions and can affect anyone at anytime, a child recovering from a viral infection, a woman who has just given birth or a cancer patient receiving chemotherapy. Yet new technology to treat heart failure is fundamentally changing just what it means to be human. Mechanical pumps can be surgically sown into patients’ hearts and when patients with these pumps get really sick, sometimes they don’t need a doctor or a surgeon—they need a mechanic.
In State of the Heart, the journey to rid the world of heart disease is shown to be reflective of the journey of medical science at large. We are learning not only that women have as much heart disease as men, but that the type of heart disease women experience is diametrically different from that in men. We are learning that heart disease and cancer may have more in common than we could have imagined. And we are learning how human evolution itself may have led to the epidemic of heart disease. In understanding how our knowledge of the heart evolved, State of the Heart traces the twisting and turning road that science has taken—filled with potholes and blind turns—all the way back to its very origin.
The statistics are sobering, the outcomes can be grim and despite the fact that amazing advances in medical procedures and medicines have been made in the past 50 years, many of us will fall victim to heart disease. Dr. Warraich takes us through the history of the specialty from the days when doctors who treated pharaohs deduced that people who suddenly clutched their chests and complained of pain weren’t likely to have a good outcome to the days (not all that long ago) when cardiologists scoffed at the notion that high blood pressure was a bad thing.
Other chapters talk about the role of inflammation in forming the plaques that narrow blood vessels (which does turn into an ad for statins), the wonderful inventions such as ECG which give doctors an immediate “view” of what the heart is doing and LAVDs that allow people with weakened hearts to hang on while waiting for a transplant and the reality that sometimes all the gee-whiz gadgetry and interventions done during the last months of life only end up adding to a patient’s suffering. Chapter 8 which covers how heart disease is different in women ought to be read by every woman and every woman’s doctor.
There are some parts that drone on a little too much (the discussion of p values in research papers) and Dr. Warraich is passionate about statins and vaccines. The discussions of patient cases was the most interesting to me while the frequent discourses off the beaten path were informative but ultimately served only to distract me from those. But he manages to discuss just about everything in a way that is neither too medically elevated nor too dumbed down while adding twists of humor along the way. It’s not quite riveting but I’m glad I read it. B-
It is commonly said in cardiology that time is muscle, and with every additional second of ischemia, heart muscle dies off from lack of oxygen without any significant ability to come back to life. Ever. Without even the slightest hint of overstatement, it is almost certainly a matter of life or death.