So begins a book called, “Facts on the Heart,” by one of the best-known physicians in the United States. As its title implies, the book aims to present nothing that cannot be substantiatednothing but the facts. And the first fact on the first page is that most “heart disease” is imaginary.
There is no doubt about it. Ten per cent of the freshman class at Harvard university, when they appeared for routine physical examination, thought they had trouble with the heart: the hearts in all cases were sound. Fourteen out of 18 patients sent to a prominent heart specialist for supposed heart trouble had no disease of the heart whatever.
What is the matter with these people? What makes them or their doctors think they have heart disease?
The answer is to be found in the same book from which I have already quoted. And I cannot emphasize too strongly the importance of these words.
The commonest type is the “patient who has fainted or been dizzy, or had a little pain in the heart region, and whose physician has heard a (quite harmless) murmur somewhere over the region of the heart.”
Every part of that sentence should be read over and over again by people who are worried for fear they have heart disease. Especially does the reference to the quite harmless heart murmur need to be emphasized. We will devote an entire article to the quite harmless heart murmur below. And another to the symptoms of false heart disease.
What difference does it make, you ask? What difference does it make if a physician finds a heart murmur, or if a patient takes it easy after a fainting spell? Isn’t it better to be on the safe side? Isn’t it better to conserve a questionable heart, rather than do something which will break it down?
I answer again in the words of the book which I have already quoted:
“The needless sufferings and sacrifices of such patients are often very great. To my knowledge boys have given up their chosen life work, girls their prospect of marriage, business men their favorite projects because of a false diagnosis of heart disease. The fears, dis-appointments and ailments resulting from such a diagnosis may be enough to render a person’s life miserable. And all this one can sweep away by a clear and positive reassurance based on a thorough examination.”
HEART AS WORLD’S BEST MODEL OF TIRELESS INDUSTRY
“Go to the heart, thou sluggard.”
Of all things in the world it is the best example of tireless industry.
The laziest man On earth has one thing inside him which works harder than the busiest go-getter in the peppiest organization on earth. Not only is it a hustler, but the heart is one of the most ingenious and one of the shrewdest and wisest old parties imaginable.
Its ingenuity is what makes it so difficult to down when heart disease comes along. It can struggle along for years under difficulties that would simply floor any other organ. Its valves can leak, the pressure it has to work against can rise, clots can form all over its substance, but still it keeps on working. It sort of fills in here, and enlarges there, and bolsters up the weak places, and manages to get by.
You often see examples of that. “Poor Ira, he’s had heart disease since he was a young man, and he can’t be as active as other people.” But Ira goes right ahead on to 40 years, then to 50 years, then to 60. “Poor Ira,” you hear, “doctor told his wife that old heart of his was about given out. Had to go to bed for a few weeks.” Next time you see Ira he says: “I’m thinking of enlarging the stock down at my store and getting ready for a brisk fall trade. I b’lieve the depression is about over.”
In the course of time Ira and his heart outlive about five doctors, two wives and seven or eight jazzy grandchildren.
It really is true, as proved by statistics. We hear many warnings lately to the effect that, “At the present time, heart disease ranks as the leading cause of death.” Yes, but when? If you look up the figures you will find that heart disease is carrying these young hopefuls off in the greatest numbers from the ages of 55 to 75.
The heart’s shrewdness is seen in the way it controls its owner. If the owner goes on a spree of smoking or something else, the heart all of a sudden turns over about four times and raps on the side of the chest. The owner calls it palpitation. It really is the heart saying: “Lookit here, I can’t work my best when you shoot all that poison into me. Lay off awhile. Go easy on that stuff.”
And when some person gets so hysterical and excited that nervous impulses are sent like express trains to the heart, does it try to keep up with this state of excitement? No. It just stops. Quits entirely for a minute. The owner faints. While you’re fainting you’re unconscious and you can’t get hysterical. The heart gets a rest from all these nervous impulses.
People think that fainting and the heart turning over mean heart disease. What they really mean is that the heart has more sense than its owner.
How HEART CAN “COME BACK” MORE THAN ANY OTHER ORGAN
A newspaper article from the pen of Miss Carolyn Wells has been of great interest to me. She wrote of how it feels to face the final reality.
She was told that she would live two years at the most. And she has outlived them and is better than ever. But the phrase which caught my attention was that she acknowledged with a heart irregular and jumpy as hers it did seem reasonable that it could not last. So I found out it was heart disease which was going to do for her, and which failed to come up to the doctor’s gloomy predictions.
That drama has been repeated so often in the history of the world that it is a good enough lesson for anybody. The term “heart disease” seems serious enough. The heart is the very center of life. When it is crippled it would seem as if there were no hope.
But on the contrary, the heart has more power of “come back” than nearly any other organ in the body. With just a little chance to rest and recuperate, its muscular walls become strong again, and, if no great strain is re-imposed on it, may go on indefinitely. Every physician knows hundreds of patients whose hearts have seemed to be inevitably damaged, who go on for years, engaging, it is true, in a somewhat limited activity, but still comfortable and completely happy. And the number of applicants for life insurance who have been turned down on account of the heart, and who have outlived the expectations of the proposed policy, is legion.
As to irregularities of the heart, there are two kinds. The one which is the least serious is the one which bothers and frightens the people who have it the most. They feel as if the heart is turning over, or has stopped beating. I once had a patient come to me with this sensation, and before he would let me examine him he made me promise, with tears in his eyes, that I would not tell his wife he had heart disease. I was able to persuade him, but only after a long argument, that there wasn’t anything serious the matter with him.
The other form of irregularity is not so frequently noticed by the owner of the heart. And while it indicates a more serious form of breakdown, it also can be controlled by treatment. The great heart medicine, digitalis, is the support of the heart here. As in the case of Miss Wells (and all devotees of the detective stories she writes so interestingly will rejoice in her experience), the heart carries on for many years, merrily ticking away to the discomfiture of gloomy prognosticators.
“SKIPPING HEART” SYMPTOM ThAT ALARMS MANY PEOPLE
People with real heart disease seldom know it. In most instances it produces no symptoms.
But the symptoms which people interpret as being due to heart disease are legion.
The skipping heart beat is one of the commonest. Sometimes it takes the form of the heart “turning over,” or stopping and then beating very strongly. The patient can feel this occur. And I can testify from personal experience that it is very alarming. It usually occurs in the middle of the night, when everything seems worse. And it has a way of occurring after middle age, when you have a pretty fair suspicion that your heart is not as good as it used to be.
The sensation of the heart dropping a beat or turning over is a fairly accurate suggestion of exactly what does happen. The condition technically is known as “extra-systoles.” Actually, they are not so much extra-systoles, or beats, but premature beats. They indicate a state of irritability on the part of the heart muscle : it throws in an extra beat out of turn. The long pause and the strong beats which follow are what make themselves known to the patient and scare him.
The commonest cause of the extra irritability is tobacco. But few people over the age of 40 live very long from that date without experiencing a premature heart beat once in a while, no matter whether they use tobacco or not.
The knowledge of the significance of skipping heart beats we owe to the work of one of the greatest physicians of the twentieth century, the late James MacKenzie. When Doctor MacKenzie started in practice he tells us that all the heart consultants regarded these irregular pulses as of very serious import. They put the patients to bed and offered very little hope.
But Doctor MacKenzie began to notice, as time went on in his practice, that the patients who had this trouble did not die, did not develop any heart symptoms and did not suffer any serious consequences from their “skipping hearts.” He finally made up his mind that the condition had no serious significance whatever. Every physician of experience now agrees with him.
He used to tell the story of a man aged 63, who consulted him and who had this form of irregular pulse. The man told him it had first been noticed when he was 27, and that a London heart specialist had given him a very serious prognosis. On the basis of this opinion he had given up a project to go to India in a very favorable and profitable enterprise and had settled down in London to die. He was still waiting, at 63, to die from his irregular heart. In other words, that London heart specialist’s opinion had wrecked his life.
There is really a great deal to be said for the patient who was told by his doctor that his x-ray showed he had tuberculosis.
Instead of getting hysterical he said, “Well, that’s only one man’s opinion.”