The Exquisite Machine: The New Science of the Heart

by Sian E. Harding

How science is opening up the mysteries of the heart, revealing the poetry in motion within the machine.

Your heart is a miracle in motion, a marvel of construction unsurpassed by any human-made creation. It beats 100,000 times every day—if you were to live to 100, that would be more than 3 billion beats across your lifespan. Despite decades of effort in labs all over the world, we have not yet been able to replicate the heart’s perfect engineering. But, as Sian Harding shows us in The Exquisite Machine , new scientific developments are opening up the mysteries of the heart. And this explosion of new science—ultrafast imaging, gene editing, stem cells, artificial intelligence, and advanced sub-light microscopy—has crucial, real-world consequences for health and well-being.

Harding—a world leader in cardiac research—explores the relation between the emotions and heart function, reporting that the heart not only responds to our emotions, it creates them as well. The condition known as Broken Heart Syndrome, for example, is a real disorder than can follow bereavement or stress. The Exquisite Machine describes the evolutionary forces that have shaped the heart’s response to damage, the astonishing rejuvenating power of stem cells, how we can avoid heart disease, and why it can be so hard to repair a damaged heart. It tells the stories of patients who have had the devastating experiences of a heart attack, chaotic heart rhythms, or stress-induced acute heart failure. And it describes how cutting-edge technologies are enabling experiments and clinical trials that will lead us to new solutions to the worldwide scourge of heart disease.

Genres: Science, Medicine, Nonfiction, Health, Medical, Biology, Audiobook

232 pages, Hardcover

First published September 20, 2022

Reviews

[Olive Fellows (abookolive) · Rating 4 out of 5]

An extremely thorough look at the most modern science related to the human heart. The author has a special interest in heart disease, so that's a particular focus of the book.

Click here to hear more of my thoughts on this book over on my Booktube channel, abookolive.

[Jazzy Lemon · Rating 4 out of 5]

How the heart works, and what may cause it to stop working.

[Gijs Limonard · Rating 4 out of 5]

Solid and entertaining science writing, bit too popular in style, lacking depth in places, but maybe that’s my professional bias; had expected some more extensive discussion of the heart from a cultural-historical angle but the emphasis is firmly on the latest hard-core medico-scientific developments.

[Katie Murphy · Rating 4 out of 5]

Thank you NetGalley for the eARC!

As a cardiac nurse I was immediately drawn to this book. I was prepared to be reading some pathophysiology and while it was that, it was so much more as well. The history of cardiac medicine is something I’ve never considered.. I knew we had made advancements but the research and explanations in this book made it so much more interesting. This book made me really think and consider the stressors our hearts go through not just physiologically but emotionally.

If you like biology or are in health care it’s definitely an intriguing read. There was a decent balance between medical terminology and lay terms

[Morgan Hamel · Rating 3 out of 5]

I feel that I’m not enough of an expert in this subject to critique this. I will say that the fun header titles and cartoonish visuals help this feel more accessible.

I received an ARC for free and am leaving this review voluntarily.

[Eianna · Rating 3 out of 5]

It was interesting enough sometimes (you can genuinely die of a broken heart how devastatingly poetic is that?) But also what was bro yapping on about.

There's a lot of big words and sometimes I'd zone out but read it at the same time, but like for a supercurricular book it's ok.

Not horrific (I will never rate a supercurricular book more than 3 stars)

[Nicole Simovski · Rating 4 out of 5]

Interesting short read on the latest science of the heart. Learned many new things about heart cells, and how various heart problems manifest and cause damage.

[Mari Annus · Rating 5 out of 5]

Kuulasin audioraamatuna.
Põnev populaarteaduslik teos südamest ja südameuuringutest. Mulle väga meeldisid lood teaduse arengust ja teaduslike meetodite arengust - kuidas me midagi oleme teada saanud? Kuidas mingit uut ravimeetodit arendatakse? Lisaks südame ehituse ja funktsiooni tutvustamisele, käsitles raamat ka mõnesid haigusi sügavamalt, nende ravivõimalusi ja mis suunas praegu teadus südame koha pealt liigub.
Raamat ei asenda kuidagi õpikut südamest või südamehaigustest, vaid on asjalik meelelahutuslik lisa. Teos on sobiva pikkusega, nii et ei hakka igav. Mõnus lugemiselamus.

[Tiffany Vaughan · Rating 3 out of 5]

Solid read for layperson. Felt some places were lacking depth and writing was a bit difficult to follow at times.

[Healthypedia · Rating 4 out of 5]

'The Exquisite Machine' delves into the latest advancements in cardiac science to enhance heart health and extend longevity.

The human heart beats with astounding precision, pulsating approximately 100,000 times every single day, propelling roughly 7,600 liters of blood throughout the body. It is a relentless performer, and its reliability is nothing short of remarkable. Due to the fact that an increasing number of individuals are expected to live beyond 100 years old, there is a growing need for cutting-edge scientific advancements in the field of heart rejuvenation.

In this review, we will explore the intricacies of this vital organ and its relationship with the ever-evolving landscape of scientific progress. Central to our discourse is the thought-provoking book ‘The Exquisite Machine’ penned by Sian E. Harding. Through her insightful work, Dr. Harding sheds light on the promising possibilities for enhancing heart health and longevity, offering a glimpse into the future of cardiac science.


Author’s background

Sian E. Harding currently holds the position of Professor of Cardiac Pharmacology at Imperial College London’s National Heart and Lung Institute.

Additionally, she serves as the Director of the Imperial Cardiac Regenerative Medicine Centre. Her academic journey includes earning a Ph.D. in Pharmacology from King’s College, London, in 1981. Throughout her career, her primary research focus has revolved around studying the functionality of cardiomyocytes in heart failure.


What is the book about?

In ‘The Exquisite Machine,’ Sian E. Harding delves into the awe-inspiring intricacies of the human heart. Despite years of research, scientists have been unable to replicate its flawless design. However, Harding highlights that recent scientific breakthroughs, such as ultrafast imaging, gene editing, stem cells, artificial intelligence, and advanced microscopy, are unravelling the heart’s mysteries and holding significant implications for our health.

Being a prominent authority in the field of cardiac research, Harding delves into the complex relationship between emotions and heart functionality. Her work sheds light on the heart’s dual role in both reacting to and influencing emotions. In her writing, she delves into medical conditions like Broken Heart Syndrome, a condition that can manifest following emotional stress or loss. Additionally, she includes personal anecdotes of people who have confronted heart-related difficulties in their lives.

The book emphasises how cutting-edge technologies are enabling experiments and clinical trials to address the global burden of heart disease. It underscores the paradigm shift in understanding the heart’s complexity, from cells communicating with each other to the regenerative potential of stem cells. For instance, it is now possible to create cardiac muscle in a lab dish from a few of your cells, offering personalised insights into heart health and drug response.

Overall, ‘The Exquisite Machine’ provides a captivating journey through the latest advancements in cardiac science. The author emphasises the need for cardiac scientists to become proficient engineers and mathematicians to unravel the complexities of heart health fully.


Three key takeaways from ‘The Exquisite Machine’

1. The heart remains extremely resilient and plastic despite its limited ability to regenerate its muscles

In one of the initial chapters of the book, Dr. Harding explores the incredible resilience of the human heart in the face of various insults, both ancient and modern. Despite enduring numerous challenges, including the limited ability to regenerate its muscle cells, the heart continues to function admirably.

The book reveals how carbon dating, a technique typically associated with archaeology, provided essential insights into the heart’s regeneration capabilities. It was discovered that around half of the cardiomyocytes in a 75-year-old person’s heart had been present throughout their entire life, attesting to the heart’s remarkable endurance. Although there is a small degree of regeneration, especially in younger individuals, it falls short in cases of severe cardiac disease.

The book also draws parallels between cardiac and brain research, highlighting the brain’s adaptability through neuroplasticity. The author underscores the heart’s impressive capacity to adapt and change in size and function to meet the body’s demands, even without full regeneration.

2. A ‘mini-brain’ in your heart can tell you how you feel

While we typically associate emotions with the brain, recent research reveals a complex interplay between the heart and the nervous system. Notably, there exists a ‘mini-brain’ within the heart, known as the intrinsic cardiac ganglionated plexus, where sensory neurons from the heart interact with autonomic neurons, influencing emotions like fear and anxiety. These interactions can be profound, as evidenced by instances where rapid or erratic heartbeats can trigger panic attacks. Conversely, preventing heart rate increases can mitigate feelings of fear.

Experiments have even demonstrated that emotional states can change within a single resting heartbeat, emphasising the heart’s role in shaping our emotional responses. For example, during heart contraction, fear responses are amplified, while during heart relaxation, they are dampened. Such findings shed light on how our bodies, bypassing conscious cognitive processes, can swiftly respond to perceived threats, offering a potential advantage in moments of danger. Interestingly, responses to images of faces expressing disgust, happiness, or neutrality vary, underscoring the heart’s unique influence on specific emotional reactions, especially in the face of potential threats.

3. Can a broken heart kill?

Takotsubo syndrome, often referred to as ‘broken heart syndrome,’ is a peculiar heart condition characterised by the sudden onset of symptoms that mimic a heart attack, such as severe chest pain, ECG changes, and elevated blood markers, despite the absence of coronary artery blockages. This syndrome was first observed in Japan during a major earthquake and gained attention due to its distinctive features. It primarily affects women, with an overwhelming majority of patients being female, particularly those postmenopausal.

Remarkably, many Takotsubo patients recover fully, going from acute heart failure to leaving the hospital disease-free within days. The condition is often triggered by extreme stressors, including arguments, bereavement, and even sporting events, with men and women responding differently to such stressors. The precise causes and mechanisms of Takotsubo syndrome remain a subject of study, and its recognition has grown worldwide, thanks to advanced imaging techniques that help diagnose the condition.


Strengths and weaknesses, according to readers’ reviews

Strengths:
• Provides valuable insights into the heart and the current state of treating heart disease, making it informative for readers interested in the subject.
• Offers a balanced perspective by discussing both the successes and failures of research, providing an authentic portrayal of scientific inquiry.
• Written in a conversational tone with elements of humour and personal anecdotes, making it an enjoyable and approachable read.

Weaknesses:
• Lacks practical guidance for readers seeking a manual on addressing heart problems, as it does not sufficiently cover crucial aspects such as diet, exercise, sleep, stress management, and body weight, which are vital for preventing and treating heart issues.


Best quotes from ‘The Exquisite Machine’

“The fight-or-flight response is an emergency reaction and did not evolve to be turned on all the time. Adrenaline (and noradrenaline) can also cause actual damage to the heart muscle when they are present for too long, or when their concentration becomes too high. If the calcium overload of the cardiomyocyte is too extreme or too prolonged, it triggers death mechanisms in the cell. Long-term effects of adrenaline are large-scale or patchy alterations in the heart muscle producing turbulent patterns of electrical flow.”

“At first, the papers being published on Takotsubo syndrome described these kinds of triggering incidents linked to disaster and grief. Often, the triggers were very like those for SCD, such as bereavement and trauma.”

“The Framingham Heart Study started in 1948 and managed to recruit an impressive 5,209 of the town’s 10,000 adult citizens, with ages ranging from 28-62 years and, pleasingly, with almost equal numbers of men and women…The researchers drawing from its data were the first to show many things we now take for granted: that high blood pressure, smoking, diabetes, or high cholesterol increase heart disease; that there are differences in cardiovascular risk between men and women; that exercise, a moderate body weight, and healthy eating are beneficial.”


Final takeaway

‘The Exquisite Machine’ by Sian E. Harding is a remarkable exploration of the human heart, offering profound insights into its intricacies and the state of contemporary cardiac research. Harding delves into the heart’s extraordinary resilience despite its limited ability to regenerate muscle cells. The book highlights the heart’s capacity to adapt and change, underscoring its impressive ability to respond to the body’s demands, even without full regeneration. Readers are treated to a fascinating discussion on the heart’s role in influencing emotions, with the revelation of a ‘mini-brain’ within the heart.

It is a must-read for those fascinated by the complexities of the heart and the cutting-edge advancements in the field.

[Mia · Rating 3 out of 5]

This is a very fascinating read, if you are interested in the heart and the current scientific developments surrounding it.

I'll say that it was a bit of a slow start, but the later chapters were incredibly interesting, especially everything about Takotsubo (Broken Heart) syndrome, the gendered heart and - my personal fave - stem cells and gene editing. You can tell the author is very passionate about her work and it translates to the page, in particular when she talks about the experiments in her lab.

The book is a potpourri of many different topics and while all of them are great to read about, I found them to be a bit unstructured at times (the later chapters less so).

I know this book is supposed to be for a non-academic audience (and I definitely appreciated the figures), but often I was wanting for more background information and more detail about certain concepts. There is a detailed notes section attached and I'll definitely be giving those citations a read. That said, there is much information packed in about 200 pages and I learned a bunch of new information.

Overall it was a solid read about one of our most famous organs.

Thank you to #Netgalley and the publisher for providing an eARC in exchange for an honest review.

[Bernie Gourley · Rating 5 out of 5]

In this book, a renowned heart researcher presents an overview of what we know (and don’t know) about the human heart: i.e. what can go wrong with it and why, how [and to what degree] it fixes itself, and what modern medicine can do to treat or replace a damaged heart. I learned the most from the middle of the book – i.e. chapters five through seven. Chapter five explores plasticity in the heart, plasticity is a concept that most people associate with the brain and its ability to rewire itself to contend with damage or changing needs. The other two chapter look at how the heart can be damaged, specifically as a result of emotional experience. A “broken heart” isn’t necessarily a misnomer.

Chapter four is also intriguing but takes the win for “which one of these things is not like the others.” It deals with big data, though not in a general sense but rather as it applies to gaining a better understanding of the heart. This chapter discusses a common challenge of medical research: that it’s hard to come up with large enough study groups of patients with close enough to the same problem to draw solid conclusions. Four also discusses the potential of the vast amount of data that exists, e.g. Fitbit heart rate figures.

The last couple chapters deal largely with the future of heart repair through genetic / biological means (as opposed to via mechanical hearts and technologies, which are dealt with in Chapter nine.) This is where the book gets to be a challenging read for a readership of non-experts. It gets technical and jargon- / acronym-heavy.

The heart is an astounding entity, relentlessly at work, rarely giving up despite regularly being subjected to intense shocks, an organ tied to our whole being in a way that humans have always felt – if only just begun to understand. If you’re interested in learning more about this magnificent organ, check this book out.

[Konstantinos Tzortzis · Rating 5 out of 5]

A remarkable book from a renowned professor and scientist in Cardiovascular sciences. I had the chance to work with Prof. Sian Harding indirectly involved to projects of her lab - I was based in a neighboring lab while working on my PhD. This book brought back fond memories of my days in the lab, the whole team’s agony to achieve targets, work until late or over the weekend for the success of experiments and Prof Harding’s dedication to solve cardiac problems and understand those mechanisms described in the book. I feel that I was lucky enough to be part of the broader team working hard to ultimately offer a better life to patients.

The Exquisite Machine presents a nice overview of the complexity of this organ and the race of humans (and scientists more precisely) to understand it and tackle the serious public health issues related to the heart. The language is not complicated and appropriate for the general public, even though some basic biology background would be recommended.

I would recommend this book to everyone who would like to get an overview of this field, people who want to get inspired by a successful scientist and professor, anyone who wants to better understand why we haven’t managed yet to win the battle with the nature and such an intellectual and advanced organ, like the heart. The book ends with the hope that humans will manage to win this battle at some point in the future through hard work, persistence, patience and team work, even though “we’ve still got a bit of catching up to do”.

[Francis Tapon · Rating 5 out of 5]

The Exquisite Machine is perfect for anyone interested in the human heart.

The author helped discover cardiomyocytes, the heart's building blocks. They execute the synchronized pumping.
She devotes a chapter about stem cells being able to grow a new heart.

Chapter 4 discusses Big Data.

She observes that cancer and heart disease are inversely correlated. When oncologists cure cancer, heart disease often followers - and vice versa.

She talks about epigenetics. A generation or two after a starving generation, you're likely to get obese offspring. This bodes poorly for Africa.

Have you heard of mesenchymal stem cells (MSCs)?
Neither had I.
We don't know if MSCs can help with heart disease like bone marrow cells.
Sadly, they don't achieve the holy grail: creating more cardiomyocytes.

iPSC-cardiomyocyte therapy is promising.
But the immune system thwarts us.
It takes months to grow a personalized heart & that's too long for a patient on a stretcher.

We may combine CRISPR with iPSC to solve the heart problem.

It's only 200 pages, but it's packed with fascinating information for anyone with a heart.

[Sevim · Rating 5 out of 5]

Growing up with a mother who was a heart patient all her life and having many relatives coping with different heart conditions, I was somewhat familiar with some of the general heart conditions in our society. I’m sure, everyone knows someone with a heart problem. So, if you want to understand how the heart works and what “brakes” it, you should read this book.

Did you, for instance, know that heart cells don’t divide? Heart cells don’t regenerate.

An eye-opening read about how the heart can fail and what is done today to remedy the possible heart failure, along with today’s up-to-date, new technology therapies. Written by a world-known cardiac scientist, the book is packed with interesting facts and jaw-dropping statistics, and it then leads to the future state of heart treatments.

[Lennette Daniels · Rating 4 out of 5]

This was an amazing book! The cover is beautiful, and the writing is very clear. My favorite quote was, "The heart is our companion in grief and joy." I learned quite a lot about the heart. It is an amazing organ, especially compared to the skin, which is our largest organ. The skin is shed and recreated constantly. Even the liver can regenerate. But a cardiomyocyte can work for 85 years. The book also highlights the need to treat the whole person instead of all the symptoms. It touches on poverty as an increase in heart-related death, as well. Overall, this was a well-written and very clear explanation of the heart.

[Rebecca M · Rating 4 out of 5]

I work in the cardiology field and have a child with CHD, so this book was right up my alley. The author does a great job of explaining scientific terms at the cellular level, (fascinating) cardiac research, the relationship between the nervous system and the heart, heart disease, etc effectively, I don't think the reader needs to have a science background to understand and appreciate the content. Looking forward to purchasing a hardcopy!

Thank you, MIT Press and #NetGalley for the eARC.

[Ethan J · Rating 4 out of 5]

Quite an interesting read. Author was very knowledgeable about heart, and talked about the structures of heart. This book led me to wonder basic questions like, why do we have heart beats? Why do we need to send oxygens to every part of the body? It truly makes you appreciate more about human body.

It is interesting that as an engineer, if I spend my lifetime, any system I build won’t be as complicated yet as beautiful as the human body.

[David · Rating 5 out of 5]

Find out the latest research on the heart.

This book covers the following:
1. Threats to cardiovascular health
2. Cardiomyocytes - the single heart-muscle cell
3. Conclusions and challenges of big data studies
4. Heart plasticity
5. How the heart feels "emotion"
6. Takotsubo syndrome - dying of a broken heart
7. Gender issues
8. Artificial hearts
9. Stem cells
10. The future of heart health - drugs, gene therapy etc.

[Darla Baker · Rating 5 out of 5]

If you are fascinated by the absolute miracle of the human body this should be on your Want To Read list. Of course I am particularly taken with hearts as I had open heart surgery at Mayo Clinic when I was five. I’m still here and so is my inexhaustible desire to learn more. I am sending shouts of acclamation to scientists and doctors out there who have a dream and don’t give up.

[Rebecca · Rating 5 out of 5]

I enjoyed reading about the heart - I did not realize there was so much to learn and know! I appreciate my own heart (and your heart too) to such a greater degree after reading this book!

The heart is an amazing engineering wonder, unmatched by any human innovation. And is the perfect example of Resiliency! I love you, Heart!

[Jeanice Harring · Rating 4 out of 5]

I definitely would recommend this book to anyone who wants to learn about one of our most important organs, the heart. The author is a cardiac researcher from London who takes a challenging medical vocabulary and brings it as much as she can to something most of us can understand. I enjoyed my time reading this book.

[Gary Shea · Rating 4 out of 5]

For me, this was an essential read. The author knows her field. I found this work to be 90+% comprehendible. Note to self - reread chapter 3! I must also note that I got used to Harding's occasional but always pointed use of exclamation points.

[Hassan Abdulrazzak · Rating 5 out of 5]

Fantastic book

A great book that not only explains the science of the heart but delves into new techniques that have broader implications. This book is of interest to both specialists and non specialists alike.

[Caleb Hintze · Rating 4 out of 5]

Read for the Orem book challenge. Fascinating stuff here. The author took a few chapters to get used to. She wrote for a non-academic audience, but the science was still hard to follow, with names, acronyms, methods, theories, doctors, etc.

[Mary Mojica · Rating 5 out of 5]

Lovely book! An exciting portrayal of science behind the heart and its future. Well-written, the chapters explore different aspects of cardiovascular clinical research and its impact on humanity. As a researcher in cardiovascular imaging, I found it quite entertaining.

[M. · Rating 5 out of 5]

It was a good read.

[Meilech · Rating 3 out of 5]

A nice overview of the history as well as where the latest technology of heart repair stands.

[Cherisevanegten · Rating 4 out of 5]

An interesting look at the modern medical field, with in particular, the heart. Different factors and effects on the heart explained, in a somewhat difficult but understandable way.

[Margaret M Sullivan]

This was a good readable (by the layperson) book but not very comprehensive. I was particularly looking for information on heart valves and there was little to none.