Dubai: It can go dark during despair, feel heavy under stress, beat like a drum when angry, sink like a stone in grief and nearly stop under shock. In fact, sometimes, it does stop due to shock. The heart stops beating and the person dies. This otherwise indefatigable human organ, the most breathtaking clockwork mechanism in the human body, can just as suddenly give up its beat due to grief, stress, loneliness or shock as it would to scaled-up levels of cholesterol, LDL, and triglycerides. And yet, there is an overwhelming emphasis on acknowledging the latter - and gearing up the entire heart disease management apparatus to address it - to the near exclusion of the former in the field of cardiology.
But one cardiologist is out to make a difference. At the heart of his push for a change in the way cardiologists manage their patients is the need to consider the impact of emotions on the heart.
Dr Sandeep Jauhar, a US-based cardiologist and author of Heart: A History, believes it is time cardiologists devoted more attention to the emotional make-up of patients. What’s their personal history? Are they in an unhappy relationship? Are they lonely? Are they inordinately stressed due to work, finances?
The heart was transferred medically into [being viewed as a] machine; we need to return to the emotional [mode].
His book intersects emotional health and heart health, delving into the history of cardiovascular medicine and its remarkable technological advances, from open-heart surgery to the artificial heart. The mechanistsic approach to treating heart diseases has helped CVD (Cardiovascular diseases) mortality drop significantly over the last century, he believes. “There have been great success stories,” said Dr Jauhar, speaking to Gulf News from New York.
But we must look beyond the mechanistic progress, he says.
“If we are to continue with that kind of progress, we have to view the heart not just as a machine but also as an organ [that needs] a more nuanced approach,” he says. “The heart was transferred medically into a [being viewed as a] machine and we need to return to the emotional [mode].” The heart, says Dr Jauhar, has been considered an emotional organ for most of history.
The reason cardiologists shy away from tackling the emotional aspect, he says, is because it is difficult to handle. “There is no one prescription [to treat] emotional response to stress. Each individual is different.” But the point is to at least raise the issue of emotional stress with heart patients, he says. “Patients listen to their cardiologist. Of course, I am not equipped to treat it, it’s not me doing the therapy.”
Has his book raised awareness on the issue? “Definitely,” he says. There has been “tremendous appreciation and it has opened a new door.”
But it’s hard to say if things will move in this direction soon enough. “Everything moves very slowly.”
The heart is also the seat of fear
Jauhar’s interest in this subject stems from his family’s history with heart disease. As a young boy, he heard stories about his paternal grandfather, who died suddenly at age 57 when a frightening encounter with a black cobra in India caused him to have a heart attack. He became fascinated with the heart but also terrified of it.
After medical school, he did a cardiology fellowship and became director of the heart failure program at Long Island Jewish Medical Center, as well as a contributing opinion writer for The New York Times. At age 45, Jauhar had his own brush with heart disease. Despite exercising regularly and leading a healthy lifestyle, an elective procedure called a CT angiogram revealed that he had blockages in his coronary arteries. As he reviewed the radiographic images of his heart, Jauhar came to a startling realisation.
“Sitting numbly in that dark room,” he writes, “I felt as if I were getting a glimpse of how I was probably going to die.”
Since writing the book, Jauhar has a newfound appreciation for letting patients talk about the things that are bothering them so he can better understand their emotional lives. He has also tried his hand at new habits to help reduce stress, like yoga and meditation. He exercises daily now, spends more time with his children, and is better able to relate to his patients since discovering his own heart disease.
“I used to be so wrapped up in the rat race that I was probably putting an inordinate amount of stress on myself,” he said. “Now I think about how to live a little more healthfully, to live in a more relaxed way. I have also bonded more with my patients and their fears about their own hearts.”
- Washington Post
THE LANDMARK FRAMINGHAM HEART STUDY: THE ‘WHAT IF’ FACTOR
Dr Sandeep Jauhar believes heart disease management and treatment would have been a different story had the famous US Framingham Heart Study, started in 1948, and which followed thousands of Americans and identified important cardiovascular risk factors like cholesterol, blood pressure and smoking had also taken into account the emotional factors. The Framingham investigators initially considered looking at psychosocial determinants of heart disease as well, but ultimately decided to focus on things that were more easily measured.
“What came out of it were the risk factors that we now know and treat,” Jauhar said. “What was eliminated were things like emotional dysfunction and marital health.” That, according to him, was a mistake.
THE TAKUTSUBO CARDIOMYOPATHY SYNDROME
Studies show that stress and despair can significantly influence health, especially that of the heart. One of the most striking examples is a condition known as Takotsubo cardiomyopathy, or broken-heart syndrome, in which the death of a spouse, financial worries or some other high-pressure emotional event severely weakens the heart, causing symptoms that mimic a heart attack. This emotional burden transforms the heart into a shape that resembles a traditional Japanese pot called a Takotsubo, which has a narrow neck and a wide bottom.
“It’s well described in cardiology,” says Dr Jauhar. “It often affects women after an episode of situational grief. Most cardiologists are aware of this syndrome.”
Are you at high risk for CVD? A simple blood test is all it takes
Dr Abdulla Shehab, chairman of the Emirates Cardiac Society, says: “Now it is possible to identify those at high risk for CVD based on certain novel biomarkers which a simple blood test can reveal. These are certain proteins, enzymes and hormones that get elevated with the onset of poor heart health.”
The typical novel biomarkers Dr Shehab outlines are:
1) “NT-ProBNP, BNP are widely used but other markers such as the myocardial tissue biomarker Cardiac Troponin [some fatty acids binding the cardiac tissue], certain inflammatory markers such as C-reactive Protein, high uric acid, and fibrinogen, are not so widely used.
2) Pregnancy-associated plasma protein A, myeloperoxidase, and matrix metalloproteinases predict the risk of acute coronary syndrome. 3) Lipoprotein-associated phospholipase A2 and secretory phospholipase A2 predict incident and recurrent cardiovascular events.
4) Finally, elevated natriuretic peptides, ST2, endothelin-1, mid-regional-pro-adrenomedullin, co-peptin, and galectin-3 can easily predict fatality due to heart failure.
More and more hospitals are providing screening for heart disease with tests for such bio markers and people must go in for these tests.”
Dr Shehab added: “A simple blood test can reveal if these are elevated and can help us prevent acute cardiac complications. Biomarker detection can really save time, money and of course, lives. These play a very important role in screening, diagnosis and prognosis of heart disease and thes tests are available in all hospitals. [These tests] help predict if an individual is at risk of developing full-blown CVD, so they can make the lifestyle and dietary changes in time.”
(- Suchitra Bajpai Chaudhary, Senior Reporter)
WHAT PEOPLE SAY:
Fazal Maeen, Pakistani expatriate. Physical trainer who suffered a heart attack at the age of 31.
I had a heart attack at 31: “On the eve of my 31st birthday on June 12 this year, I had a heart attack. It was shocking as I have been a very health-conscious person all along. I work as a corporate executive but am also a freelance physical fitness trainer.’
I am very particular about my health: My friends laugh at me because I am so particular about my diet: salads, steamed vegetables, stick of fish and white meat. I regualrly exercise. Having said that, I have a family history of heart disease. My mother and uncle passed away owing to CVD. So I was always very careful.”
My medical history: My blood tests showed perfect lipids, cholesterol. I do not have diabetes or hypertension. Yet the fear and stress of getting CVD owing to my family history was the major pressure. The day I got my heart attack, I was feeling uneasy, dizzy and nauseous. Never once did I think it was a heart attack and when my friends revived me, I actually drove back home. When the pain continued, I walked to the Aster clinic at Dragon Mart and before I could say anything, collapsed at their reception. They rushed me to Aster Hospital Mankhool where investigations revealed that four out of five arteries were blocked and I was taken in straight for surgery. The surgeon attributed my condition to stress, lack of sleep, my fears [of getting a heart attack] and genetic factors. I am thankful I reached the hospital in time.”
Dr Walid Abdul Hamid, Medical Director and Consultant Psychiatrist at Priory Wellbeing Centre, Dubai:
“Negative life events such as grief, loss, separation and trauma – with the associated emotions of fear, sadness, anger, discontent and frustration - can trigger stress, which has been described as a ‘silent killer’.
“We find a lot of such stress in the workplace. According to the Whitehall study in UK, this is a significant contributor to death resulting from heart disease. Work stress and ‘burn-out’ gradually causes us to perceive work tasks, people and situations as threats and this can trigger what we call in psychology the ‘fight-flight’ reaction. This reaction results in the secretion of stress hormones Noradrenalin and Cortisol which not only cause hyper-arousal with associated anxiety, sleep disturbance, startled reactions and emotional outbursts, but will over time, also cause damaging effects on the cardiovascular system, such as increased blood pressure, diabetes and ischemic heart diseases.”
(Suchitra Bajpai Chaudhary, Senior Reporter)