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State of the Heart: Exploring the History, Science, and Future of Cardiac Disease

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“Haider Warraich's elegant and poignant book takes us on an unforgettable journey. A caring and thoughtful doctor, he also writes beautifully.” —Siddhartha Mukherjee, New York Times bestselling author on Modern Death

In Heart of the Matter, Dr. Haider Warraich takes readers inside the ER, inside patients' rooms, and inside the history and technology of heart disease.

More people die of heart disease than any other disease in the world, including even cancer. In fact, deaths from heart disease are on the rise around the world and in the United States. When any heart disease becomes advanced enough, it results in the development of heart failure. In the United States, heart failure is the most common reason for admission to the hospital. Heart failure strikes both the abject and the affluent. And yet, even the most basic facts about heart failure remain known by few who don’t work in medicine for a living. Many patients develop heart failure without having any problems with their coronary arteries. Heart failure can affect anyone at any time: a child recovering from a viral infection, a woman who has just given birth, a cancer patient who received chemotherapy or anyone with any number of common conditions such as high blood pressure, diabetes, or sleep apnea.

Warraich's signature blend of lucid writing and compelling narrative explores the complex discussion about heart failure with accessibility and compassion.

352 pages, Hardcover

Published July 23, 2019

84 people are currently reading
600 people want to read

About the author

Haider Warraich

6 books64 followers
As a physician, writer, and clinical researcher, Haider Warraich wears many hats that have come together in his new book, State of the Heart - Exploring the History, Science and Future of Cardiac Disease, launched July 2019 by St Martin's Press/Macmillan.

He writes most frequently for the New York Times but also contributes to the Guardian, the Atlantic, the LA Times and the Boston Globe amongst others. He writes about all things that fall within the purview of healthcare, from health policy to the daily interactions between patients and their physicians.

Haider Warraich completed internal medicine and cardiology training at Harvard Medical School and Duke University and will be the Associate Director of Heart Failure at the Boston Veterans Affairs Hospital, Associate Physician at Brigham and Women’s Hospital and Instructor at Harvard Medical School in the Fall of 2019.

Dr Warraich is also an avid clinical researcher and has published in the New England Journal of Medicine and Journal of the American Medical Association amongst many others.

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Displaying 1 - 30 of 30 reviews
Profile Image for David Wineberg.
Author 2 books874 followers
May 24, 2019
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
Profile Image for Lynn.
3,386 reviews71 followers
September 19, 2020
A cardiologist, Haidas Warraich, who studied at Harvard and Duke, writes about his experiences as a cardiologist from young people who have heart attacks, people with heart problems and have undiagnosed cancer, defibrillators and devices that help hearts when heart transplants are unavailable. What causes heart problems and how they’re treated. But it’s mainly about his insights into heart diseases. He’s written about how modern medicine has changed death and fiction too. It’s interesting.
Profile Image for Jordan.
43 reviews2 followers
July 22, 2019
I am a Registered Nurse and I thought this book was very informative. I learned a lot that I can take back to my practice and share with my patients. I would definitely recommend this to friends, family, and patients suffering from heart disease. Thank you to NetGalley and St, Martins Press for the advanced copy. All opinions are my own.
11.4k reviews192 followers
July 13, 2019
Fascinating. This well written volume covers a lot of issues related to, well, the heart and it does it well. Divided into pointed chapters on individual topics, it's a good tour of a subject that is important to all of us and yet so often opaque because of the difficulty of conveying the information effectively to the lay audience. Warraich has wisely mixed up his text with anecdotes and variables that might make you go huh occasionally. Thanks to Netgalley for the ARC. A very good, accessible, and educational read.
Profile Image for Bonny.
1,013 reviews25 followers
June 25, 2019
I have a fairly strong family history of breast cancer, and I used to worry about it. My husband had been known to tell me "Don't be so concerned. You have a greater chance of dying of heart disease." That was never very reassuring and not exactly what I wanted to hear, but after reading State of the Heart, I can see that it might very well be the truth. But this book about the history, science, and future of cardiac disease is full of empowering information and knowledge, not scary statistics.

Dr. Warraich gives plenty of information and data, but it's all made more interesting with personal patient stories. I was especially interested in his explanations of atherosclerosis, the role of salt in blood pressure, and the role of hypertension in heart disease. The chapter on women, how heart disease affects them, and how their symptoms can differ markedly from men is something that I think almost every woman would benefit from reading. I found the book to be a wonderfully readable combination of research, data, and anecdotes. It was difficult to read at times as the reader is forced to face mortality, but a valuable and enjoyable read nonetheless.

Thank you to St. Martin's Press and NetGalley for providing me with a copy of the book.
Profile Image for Wally Hartshorn.
5 reviews2 followers
August 24, 2019
Science, history, education, and motivation

The author engagingly combines science and history, two of my favorite topics, to create a book that is educational, eye opening, and a great source of motivation to improve my eating habits and get more exercise. Along the way, he provides useful advice, sure, but he doesn’t just tell you to do something (e.g. reduce sodium to lower blood pressure); he explains why and how that is helpful (a high concentration of sodium fools the kidneys into thinking there is too little blood in the body, so it signals for more blood to be created to lower that concentration), and does so in a way that keeps me interested and and wanting to learn more. Furthermore, the book is very recent, featuring numerous examples of current studies that overturn what was believed just a few years ago.
240 reviews3 followers
July 23, 2019
Wow! Fascinating book! When I started it, I wondered how interesting a whole book about the heart, written by a cardiologist, could be. How much was there to say about the heart that ordinary people could understand, much less enjoy reading? Well, I couldn’t have been more wrong. I was engrossed in this from start to finish and felt disappointed when I realized it was ending.
I expected to have to skim over parts where it became too technical, or to find some parts dry, but this too was dead wrong. He was able to explain everything so clearly that it was easy to understand, and I have absolutely no medical background and am embarrassingly ignorant about human anatomy.

By telling vivid stories about a wide variety of unusual situations, he was able to keep me riveted. He starts with the history of cardiology, from the Pharoahs of Egypt and their treatments for heart disease, and on to the present day, with all the amazing medical advances of the recent years. He explains how the heart works, what heart failure is, what techniques are available or in development, how things go terribly wrong, or surprisingly right and what he foresees for the future.

He is from Pakistan and quite a good example of how immigrants enrich our country. He came here with very little, went to medical school, and through many years of hard work, developed skills that have saved thousands of lives. He has also written this educational and entertaining book, for which I thank him.

Very highly recommended.

Note: I received an advance copy of the ebook from the publisher in exchange for an honest review.
Profile Image for Riann.
533 reviews22 followers
June 21, 2019
A fascinating book which taught me a great deal about not only the inner workings of the heart but also the evolution of humanity's understanding of the heart. Through patient stories the author put a a human face to the complexities of heart disease. The advances in surgical techniques and advances in life saving devices have been staggering. I can only imagine what further advances there will be within the next decade and beyond.
Profile Image for Mamatha.
69 reviews
August 24, 2019
Loved this book about the heart. Particularly liked the insight into the history of various aspects of cardiology (The account of the first heart catheter placed by a medical student to his own heart was particularly fascinating). The author, who is a cardiologist, also gives a compelling description of cardiac procedures and the patient experience.
Profile Image for Sushil.
83 reviews5 followers
June 28, 2020
This is very informative book in cardiovascular diseases. Dr Haider has written very well and presented the key questions on cardiovascular health. This book should be read by all as heart disease are leading cause of death worldwide. This book can be life saver in many aspects. Thank you Dr Haider for writing this book.
Profile Image for Priyanka.
260 reviews3 followers
August 4, 2020
Beautifully written, informative, fascinating, eye-opening - completely put me in awe; I would recommend "State of the Heart" to everyone.
Profile Image for Ben.
426 reviews1 follower
March 27, 2021
Fantastic, informative read; very easy to comprehend. This book has certainly altered how I view cardiovascular care.
Profile Image for Kyle Vanderheide.
26 reviews
December 31, 2022
Takeaways:


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.
This entire review has been hidden because of spoilers.
Profile Image for Cathy.
1,184 reviews22 followers
September 20, 2019
Warraich gives readers an overview of how the heart and its functions were viewed in the distant and more recent past; how treatments have evolved, especially in the past century and most recent few decades; how much can be done with not just proven medications and interventions but with some of the latest treatments to extend lives (and improve quality of life even as patients live with a diagnosis of heart disease), and how there are still new advances around the corner. He uses very brief anecdotes about patients he has treated and doctors and researchers who have contributed to the science we now use regularly. I often felt that those anecdotes were too brief; he used the information to make his point and then moved along very quickly. The book is scholarly but still approachable and on a level that many readers can understand, but it might benefit from more fleshed-out stories of some of these many individuals who must live with heart disease in its various forms.

Last year, I read Heart: A History, which was similar in topic, obviously, but focused on different aspects of the medical treatment of the heart and how we can all do better to take care of our hearts. That was fascinating; State of the Heart wasn’t quite as engaging, but I still found it interesting and important reading. I have to say that, if nothing else, I was left with the conviction that when my doctor suggests I take a statin, I’ll agree to do so. I also heartily agreed with Warraich’s conclusions that doctors have to be able to connect better and build relationships with patients so that patients will trust their medical providers enough to follow their recommendations. I don’t know how much our current health care system will allow that to change in its current setup, but it’s certainly an important observation.

*I received an ARC of this book in exchange for my honest review.

Read my full review, including a rating for content, at RatedReads.com:
https://ratedreads.com/state-heart-ca...
110 reviews2 followers
March 22, 2021
Heart disease is one of many topics in life where you are familiar with the words relevant to the topic but if you had to define them you may be challenged. In this book such words as atherosclerosis, myocardial infarction, and cardiomyopathy become accessible topics for discussion. I read this book because my son will be born in 3 months with a heart defect and I'd like to have a solid knowledge about the heart in order to take care of him. While this book was not about heart defects it gave me sufficient knowledge about related heart conditions. It also provided some thought provoking nuggets I had never considered before.

Dr. Warraich does a good job of incorporating relevant patient cases to illustrate his points. Additional he weaves in useful bits of history to help provide context around how cardiac medicine has advanced over the years. For instance, it was interesting to hear that as recently as 1920 some doctors felt high blood pressure and high cholesterol were necessary. Through well documented research science has been able to demonstrate that is not the case, though Warraich reveals how some loyalists had a hard time giving up the traditional viewpoints in favor of what the new evidence supported.

Beyond facts and history, Warraich also takes some jabs at today's "fake news" culture and social media's role in disseminating ignorance and misinformation. He cites big business's as holding too much power over prescription drugs and medical devices. It's not overly political, it's nice to hear a qualified professional standing up for reason and calling out the problems that stand in the way of health and medical advancement.
Profile Image for Sabrina.
381 reviews9 followers
October 2, 2019
Learned a lot about that life giving pump.

Atherosclerosis.

“The heart, that muscular organ beating in your chest as you read, sending pulsations throughout your body, is perhaps a part of the body most associated with life at both ends of human existence.”

“If there is a pulse, there is life.”

1% CHD = 40,000 babies per year
1/4 of that 25% 10,000 babies have critical CHD

Hearts are wild creatures, that’s why our ribs are cages.
—Elalusz


Low density lipoprotein LDL-takes cholesterol from liver to rest of body
High DENSITY LIPOPROTEIN HDL-does opposite & brings cholesterol back from body to liver expelled from body after converted to bile in gallbladder and excreted in intestines

“The Cath Lab teaches us that the time to act as not when there are no consequences but when no action is the greatest consequence itself.”

“The heart, you can actually see it working. Unlike the brain, the liver, or kidneys, which perform complex task with bureaucratic invisibility, the heart is an incessant striver, whose every action is felt and heard in every body that it beats in. It is visceral and charismatic in a way no other part of the human body is.”
—Denton Cooley
Profile Image for Marty.
6 reviews2 followers
May 29, 2020
A tale of the science and scientific history of heart disease, which, as far as non-academic science books go, does a much-more-than-adequate job of keeping the reader engrossed throughout, very possibly because the subject is one to which nearly everybody, unfortunately, can relate. Maybe a few too many personal/medical anecdotes, though through them I have to admit that Warraich shows himself to be the antithesis of the [often unjustly depicted] stereotypical, arrogant medical specialist. I'm always amazed at and secretly envious with those who so deftly straddle the often separate poles of science and language-arts. I've got a hunch he might next tackle the story of COVID-19 in a similarly engaging way, and I'd definitely read that too.
3.5 stars
Profile Image for Shixiao Yu.
42 reviews1 follower
March 10, 2024
Very good. The writing is engaging with its examples and analogies (I will, however, forever clown "These organs suck out oxygen from the blood like you would the last bit of Slurpee with a spiral straw."). The inclusion of Warriach's own experiences provides a personal insight, although I found his usage of his wife's experiences with cutting down sodium to be somewhat sketchy due to potential bias.

The information itself is deeply important, revealing a glimpse into how the heart itself works and what affects it. Warriach does a good enough job explaining that I rarely found myself wondering how he got from point A to point B.

Overall, very insightful book on heart disease and the heart itself written in laypeople's language.
10 reviews
February 15, 2025
I thought this was a well written book about not only what is happening in the world of cardiology and patient treatment. I enjoyed reading about the history of the heart. There were some shocking comments made about the medical system. Unfortunately, it seems where humans are involved decisions that affect others are sometimes not made with the receiver in mind. I will read his first book at a later time.
Profile Image for Brandi D'Angelo.
522 reviews25 followers
January 24, 2023
This book is a collection of stories rather than a plan of action. If you are looking for succinct advice on heart health, this might not be the best source. But if you have the time to immerse yourself in some interesting stories, you'll learn quite a bit about the history of heart health and make your own list of advice.
1,420 reviews8 followers
August 14, 2022
This was a terrific book that beautifully weaved its way through the function and dysfunction of the heart, as well as the historical and up to date scientific breakthroughs. Warraich discusses what he hopes/expects from future scientific advances.
71 reviews1 follower
November 16, 2019
Very interesting book about heart diseases. Many new information about the oldest and the biggest threat to our health. I recommend this book to everyone who has an interest in heart and health.
4 reviews
December 18, 2019
Good overview of the history of cardiology and what the current thinking is of heart health and treatment.
Profile Image for Ashley Aguilar.
8 reviews10 followers
January 8, 2020
Must read for people in the field of cardiology and anyone who has a heart!
280 reviews
February 26, 2020
I learned a lot from this book. It was interesting to see a doctor's perspective on cardiac disease.
Profile Image for Alicia Drake.
2 reviews
March 19, 2022
Kind of a dry book for someone who knows a thing or two about the heart and heart disease…
Profile Image for Ayana B.
65 reviews1 follower
September 9, 2022
-pg 158
not done yet but I've got to return it to the library before I get a fine lol. Will finish over the summer!

update: finished in August- this book is so so good. Will definitely be reading Modern Death soon.
1,265 reviews28 followers
May 1, 2019
State of the Heart is a extremely interesting book. The author has done a lot of research and the book is easy to understand. Too many people due of cardiac disease and this book gives a lot of good information.
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