STATE OF THE HEART

A deep immersion in the world of cardiac disease.

“More people die of heart disease than any other disease in the world, including even cancer,” writes Warraich (Modern Death: How Medicine Changed the End of Life, 2017, etc.), a fellow in cardiology at Duke University Medical Center. Given that it is also on the rise, the time is ripe to look at “the doctors and nurses who treat it, the patients and caregivers who live with it, and the stories they hold close to their chests.” It is those stories that carry the narrative. The author begins with a history of heart disease recognition by the ancient Egyptians and Greeks, through the four humors, to the religious impulse that overwhelmed the sciences during the Dark Ages, when the Arab civilization rose to the challenge of advancing scientific knowledge. Warraich does a yeoman’s job explaining the various physiological aspects of the heart and its many influences—the role of salt in blood pressure, the role of blood pressure in hypertension, the role of hypertension in heart disease, or the place of atherosclerosis as the root cause of heart attacks—but where he shines is in introducing anecdotal evidence and vivid stories to add color to the raw data. Not that the anecdotal material commands the whole stage. There is plenty of hard science to ponder, such as the shift in recognizing pain as “a natural and physiological sensation rather than a metaphysical instrument of justice and heavenly intervention” or the woeful state of research in women’s cardiac health, with abiding “hegemonic gender roles…preventing many women of caring for themselves rather than others.” Warraich occasionally brings a dark humor to the proceedings—“this infarcted tissue is no better than dead meat, and ‘dead meat don’t beat.’ ”—and only rarely, thankfully, turns overly casual: “Lydia was, of course, gonna have none of that.”

An expansive, well-tempered profile of our most metaphorical organ.