Haider Warraich

Family caregivers save the American health system $450 billion annually.

It’s care provided mostly by women. It consists of long hours, no pay, and high stress.

This is just one of the side-effects of medical advances that keep people alive much longer than they lived even a generation ago. And in many cases it keeps people alive in situations that are worse, even deplorable for sentient beings.

It leaves them in the alien surroundings of hospitals often without the authority to determine their own treatment, or desire to be left without treatment.

And it leaves doctors in an uncomfortable position having to negotiate conflict between family members, something they have no training in. And in many societies, doctors are the target of physical violence for who they are, for what they earn, and for sometimes just being in the wrong place at the wrong time.

And when the patient dies, the doctor often sees it as his or her fault.

In this book we learn that loneliness increases mortality by 50% although nobody knows why.

In the US there are now more than two million people who outlive all friends and relatives. The chief defence we have against nothingness is family and up until the end it holds up quite well, Dr. Warraich opines.

Still, modern medical science has created new challenges by keeping people technically alive when in fact they are dead. Has modern science done more to defer death than to extend meaningful life? It would seem so.

It is important for doctors to view their patients as people stuck in a place they’d rather not be.

“Death stealthily commands and controls every aspect of our lives.” This seems to hold true for the physician as for the patient.… (mehr)

More people die of heart disease than any other disease in the world

dogs have a bigger heart relative to the size of their bodies than any other mammal,

Left ventricular assist devices (LVADs) are
mechanical pumps that are surgically sewn into patients' hearts and take
over the pumping function of the heart.

Angina= Pressure feeling in chest represents a heart attack

Notes:

The Vena Amoris vein runs from the heart to ring finger

As the book reviews theology of the heart, a theorist named Ibna Al Nafis suggested that hearts primary function is the heat the body.

it is surrounded by a thin, double-walled fibrous sac called the pericardium. The pericardial sac contains about 30 milliliters of a transparent fluid called pericardial fluid. The pericardium does many things
-it lubricates the heart, allowing it to continue pumping while expending the least amount of excess energy. The pericardium also shields
the heart from infections that might occur in the tissues around the heart.

Blood flows from the right atrium, across the tricuspid valve, into the right ventricle.
The heart valves are meant to prevent blood from going in reverse gear and keep blood moving in the right direction. The right ventricle, much smaller than the left ventricle, is connected directly to a large artery called
the pulmonary artery that leads this venous blood to the lungs. As soon as the pulmonary artery emerges out of the right ventricle, pointed up toward the head, it splits into the right and left pulmonary arteries like a T.

Arteriosclerosis is plaque buildup in vessels which is root cause of M.I.

Kidneys use sodium to get a sense of how well hydrated the body is. Too much salt usually means that there is not enough water around to dilute it. This causes the kidneys to retain water.

Salt restriction = lower blood pressure

The first ace inhibitor was created by snack venom from the Brazilian pit viper.

Statins: Decreases cholesterol

LDL: Considered the bad cholesterol

Troponins: proteins found in heart muscle that can leak into the bloodstream if the heart muscle begins to die after its oxygen supply is interrupted

People who have more control are more likely to attend cardiologist appointments and rehab.

After a tragedy, one can experience stress cardiomyopathy.

People are 27% more likely to have a heart attack on their birthdays than any other day.

The chances of heart disease increases the longer the patients make it past their cancer diagnosis

Patients older than 65 with heart failure in US admitted to hospital live an average of 2 years

Once dependent on Initropes patients live on average of 6 months

Fluid in lungs = Diuretics or initropes

The author suggests that the best way to address heart failure is prevention.… (mehr)

I wasn't sure when I started this book that I wanted to finish it, but I got pulled in to Haider Warraich's story as a cardiologist. Heart disease is the biggest cause of death despite cancer. But the author does plumb the story of cancer and heat disease and some connections between the two. I appreciate that he talks knowingly and seems to be really devoted to his patients. But there are outliers. He also shows that women's experience with heart disease has a certain separation from that of men. One example is that of takotsubo cardiomyopathy, which does not come about through hypertension or elevated cholesterol, but the stresses of life in post-menopausal women. It is sometimes called broken heart syndrome. Another situation more typical of women is spontaneous coronary artery dissection (SCAD). This is a condition that can be over-treated.… (mehr)

The human heart is undergoing both scrutiny and transformation as it never has before. The steep learning curve is teaching us how hearts interact with other organs, how lifestyles and medicines affect it, and how the medical fraternity can mediate its weaknesses and failures. In State of the Heart, cardiologist Haider Warraich continues his documenting of the process.

It is a collection of anecdotes and rants, peppered with dips into history and controversy. He loves teasing a term or a fact, coming back to explain it only further down the page. There is a lot of detective work, with someone’s life at stake for a wrong deduction. Many, many times, Warraich explains that no one had ever seen this before, be it a symptom, a reading or a reaction. The experiences he relates are mostly his own. In one case, the patient died, but his artificial pump kept his blood circulating until Warraich called tech support and learned how to shut it off.

The life of a cardiologist is the other side of this:
“Being sick is like being given a new job that you didn’t ask for, didn’t want anything to do with, in fact. And now you are stuck with it. The moment you wake up, you swipe in until you fall asleep and you swipe out. There are no days off. Being sick is even worse when you have a chronic disease, like when you develop heart failure, because there is almost no chance you will get to have retirement party and ride off into the sunset. If anything, as you get older, chronic disease just gives you more work to do: more medications to take, more visits to the hospital, more limitations on your daily life, with a diminishing chance of a return to normalcy.”

The chapters are neatly divided into issues. They include history, cholesterol, meds, surgery, devices, women, cancer’s relation to cardio, transplants, and end of life. The meds chapter focuses not on benefits of individual drugs, but testing, placebos and studies. The chapter on devices tells the history of catheters, balloon angioplasty, stents and electronic implants. The stories include serendipity, dumb luck, pure accident, and arrogant persistence. Warraich goes into the failings and weaknesses of these devices, and the anatomy lesson they entail is most valuable.

Of particular interest to me was the chapter on women. Women manifest heart ailments differently than men. Their hormones protect them, but taking hormone replacements does no good whatsoever. Pregnancy and birth are stressful and traumatic, and the effects can linger for life. Doctors have long dismissed women’s cardiac issues, calling them cardiac neuroses. Male doctors tend not to believe their female patients. Instead, they believe their own misogynist stories that women don’t get heart attacks as much as men (they get more). They also suffer more depression and anxiety, the feeding grounds for heart ailments. Women are bigger deniers than men, postponing diagnosis and treatment due to family responsibilities, guilt, altruism and even vanity (I hadn’t even brushed my teeth – ugh – is a real excuse he cites). Cardiac issues kill far more women than breast cancer ever has. This chapter alone needs to be read out loud for all to hear.

At the other extreme is the chapter on cholesterol. Warraich explains it well enough, but the chapter turns into a commercial for statins. He finds nothing whatever to keep anyone from taking them for life. He presses this point continuously. He doesn’t address the scoring system, where good and bad cholesterol are lumped together and the total is always bad. Doesn’t matter if you have a great balance between HDL and LDL, the sum total is too high for the medical establishment. He doesn’t even say what good numbers would look like. The fact is the drugmakers are continually pushing to lower that threshold, so that essentially everyone in the world has too high a score all the time and should therefore take prescription statins every day for life. There is no medical basis for it, other than the current thinking is lower-is-better. We don’t really understand why the body produces LDL at all or what the optimum level might be. This is a major gap in the chapter, and makes me wonder what he has left out elsewhere.

Less newsworthy are the deleterious effects of modern life. Constant stress shows up in the heart. Bad food, lack of exercise and relaxation are life enders. People are 27% more likely to have a heart attack on their birthday than any other day. Stress is a major driver of obesity and overeating, major factors in heart disease. The human body has not evolved to keep up with constant stress. It still focuses on infection, and its solution to everything is inflammation. Inflammation means heart ailment, blocked circulation, weakened hearts and hearts out of control. ”I am here to tell you that inflammation is the central mechanism of atherosclerosis and that how we have evolved has led to more inflammation afflicting more people than any other disease in our times,” he says. Our labor-saving devices necessitate the invention of heart-saving devices. It may not be a great bargain.

The thing about cardiac death is that it is usually sudden, silent and painless. Warraich shows that heart interventions near death can prolong suffering and add extra, extreme pain. For example, electric assists (LVADs) are programmed to massively shock the heart if it falters, even if death is near. It is the equivalent of being dropkicked in the chest by a horse, Warraich says. Yet doctors rarely, if ever, inform patients they can have the device turned off. Some doctors don’t even know this themselves. Technology, as in so many areas, has taken off in its own direction, and left humanity behind.

State of the Heart is intense and both inspiring and massively uncomfortable. It could not be otherwise.

David Wineberg… (mehr)