Preventive Medicine: The body calls, and the heart answers – CT Insider

Every year in the U.S., well over 650,000 people succumb to heart disease, and many if not most of those deaths are premature, if anything more so than for COVID. And, like COVID, heart disease produces long haulers as or more often than it kills. Congestive heart failure, cardiomyopathy, and diastolic dysfunction are illustrative labels for hearts permanently damaged by our cultural contagion of lifestyle-induced chronic diseases.

The matter of lifestyle demands three particular reflections. First, the flagrant fact of outsized influence on heart disease by lifestyle: diet, physical activity, stress, toxic exposures, etc., is incontrovertibly established. Where lifestyle prevails as medicine, generally mediated more by cultural norms than extremes of personally responsible effort, heart disease is reduced to a rounding error of its mainstream prevalence. There is no rebuttal to the contention that at least 80 percent of all coronary disease could be eliminated with a simple suite of salutary lifestyle practices, and a general consensus the figure is much closer to 100 percent. Like smallpox and polio, coronary artery disease is potentially eradicable; lifestyle constitutes the requisite vaccine.

Second, even causes have causes. One cannot speak equitably of lifestyle practices without conceding that the playing field of opportunity is precipitously inclined. For some, environments all but preclude healthful food selection, safe outdoor recreation, or the avoidance of toxins including frequent duress. There are genetic undercurrents, too, but far more important to outcomes than ones genetic code is ones zip code. The choices we make are subordinate to the choices we have, and those in turn are bounded by social and spatial and built environments.

And then third, a crucial consideration along a departing tangent.

Consider that the heart is arguably the hardest working construct in the body. If we adopt the lower end of a normal heart rate, namely 60 beats per minute, and apply that across a lifespan of 80 years, that heart will beat 2,522,880,000 times. It will never rest, for it never can. It can be called upon for greater effort, but never lesser.

Like all working muscle, or any living tissue for that matter, the heart requires constant oxygen and nourishment across the thick expanse of its myocardium (i.e., cardiac muscle). How are these provided?

The heart is fed via coronary arteries. There is a left, and a right, and branches of each we neednt explore in detail here. The coronary arteries open directly from the aorta, the bodys great artery, just beyond the leaflets of the aortic valve. The cardiac choreography of life, every minute of it, is as follows: the right and left ventricles fill to capacity while relaxed, and that filling upon completion slams shut the doors leading into these chambers, the tricuspid and mitral valves, respectively. That is the famous lub. Then, the ventricles contract to express the blood that fills them, and once they empty to the requisite degree, the doors leading out slam shut in turn the pulmonic and aortic valves, respectively and that, of course, gives us dub.The span from lub to dub is systole. Diastole populates the expanse from each lub/dub cycle to the next.

That expanse shortens, potentially by a lot, when the body has cause to ask more of the heart. It has such cause every time we climb stairs; carry groceries; become alarmed. From the trivial activities of homely routines to the supreme feats of great athleticism, the body calls, and the heart answers.

The heart answers ever, and always, at its own expense. For when the body has greater need of oxygen, fuel, and the flow of blood that delivers these, so, too, does the heart. As we take the pulse of a passing year, I am inclined to find more meaning in our own. With our every exertion, hearts bequeath their very breath to service the greater bodys common cause.

Well we may lament the cost of this where preventable coronary atherosclerosis compounds the toll. We might simply marvel at it. Better, though, that we strive in some small measure to emulate it, and march to the primal beat of the drummer within.

Dr. David L. Katz is a board-certified specialist in Preventive Medicine/Public Health.

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Preventive Medicine: The body calls, and the heart answers - CT Insider