Q&A: Vincent M. Figueredo on The Curious History of the Heart

The heart. To some, it is a mere blood pump powered by the brain. To others a symbol of love and health—an important piece of cultural iconography. But to cardiologist Vincent M. Figueredo, the human heart is his life’s work. In The Curious History of the Heart: A Cultural and Scientific Journey he traces the evolution of our understanding of the heart from the dawn of civilization to the present. From daily life to cutting edge science, as well as ancient views, this book seeks to unveil our understanding of the heart through science and culture.

Q: What led you to write The Curious History of the Heart?

Vincent M. Figueredo: I have now spent the majority of my life studying and caring for hearts. In my college days, while filling in the blanks around my required premed courses, I found myself taking history, religion, and philosophy classes. I read a lot, mostly nonfiction. I love books that focus on the history of a single subject, such as Salt: A World History or The Emperor of All Maladies: A Biography of Cancer. This compelled me to research how the heart was viewed and understood by our ancient ancestors up to the present day. After creating a file of heart stories and facts starting almost twenty years ago, I decided to organize them into a book, completing the work over five years.

Q: Why did you call the book The Curious History of the Heart? What is curious about it?

Figueredo: I will start with—I have been a physician-scientist most of my life. So I am naturally curious. Early in my career I became fascinated with the remarkable and curious functioning of the heart. As I love books that focus on the history of a single subject, I decided I was going to study and write a history of the heart. In my research I found there has been a continuity of curiosity about the heart throughout human history. The role of the heart in human society and culture has taken many curious turns. For millennia, the heart was revered as the king of the organs and home of the soul. But by the Renaissance the heart lost its mystique, becoming nothing more than a blood pump. Curiously, about the same time, the symbolic heart took on the role of representing romantic love and the love of God. Soon the heart symbol went viral in art and literature.

So the title is an intentional double entendre. While the book is about human exploration and experimentation to understand the remarkable and curious workings of the heart, it’s also about the history of the curious obsession with the heart in the day-to-day lives of our ancestors and us today.

Q: What about the cover of the book?

Figueredo: I had to decide whether I wanted a symbolic cardioid shape or an anatomically correct heart on the book cover. One represents the cultural history of the heart; the other the medical and scientific history. I ended up choosing a cartoon model of the heart. A real heart would have been too much; a symbolic heart shape too little. Columbia University Press worked with me on the title fonts. We were pleased with the final cover.

Many have told me how much they like the cover. But I hope they do not just judge the book by its cover; there is a curious history inside.

Q: What is meant by the subtitle, “A Cultural and Scientific Journey?”

Figueredo: I want to let the reader know this is a book about two histories: a journey across human history that traces the evolution of our understanding of the heart; and what the heart has meant culturally, religiously, and artistically, from the dawn of civilization to the present.

Q: What will a reader learn about the heart when reading the book?

Figueredo: The Curious History of the Heart traces the evolution of our understanding of the heart from the dawn of civilization to the present. It explores the role and significance of the heart in art, culture, religion, philosophy, and science across human history.

There are sections on how the heart really works, its many meetings in our emotional and daily lives, and what cutting-edge science is teaching us about this remarkable organ. The book concludes with recent advancements in heart therapies and what the future may hold.

The book highlights the emerging field of neurocardiology, which has found evidence of a heart-brain connection in mental and physical health, suggesting ancient views of the heart hold more truth than we moderns believe.

Q: You write about some personal experiences in your career. Is there a particular incident that stands out to you?

Figueredo: I once held a living heart in my hand. Open cardiac massage is rarely performed, but is sometimes used when an emergency opening of the chest is required because of penetrating chest trauma or a cardiac arrest after the chest wall was just closed post–coronary bypass surgery. In my case, there was a patient crashing, having just come from the operating room after bypass surgery. The heart surgeon reopened the chest in the ICU, clearing clot from around the heart. As the medical resident in the ICU, I was told to start squeezing the heart, which was not moving. It felt like squeezing a tennis ball. The muscle was surprisingly strong. Suddenly this heart started beating again in my hand, slowly, at first, and quickening with increased force. Even this week heart felt so strong. I was in awe.

Q: What surprised you the most when writing your book?

Figueredo: The pervasiveness of the heart throughout society, both ancient and modern. Our ancestors elevated the heart to the role of king of the organs, home to emotions, reasoning, and memory. Their stories tell of the heart as the repository of the soul and the only way to connect with God.

Today we use heart emojis on texts and emails, we press a heart symbol if we like an Instagram or Twitter, we look for the heart-healthy options on the menu, and we check to see the number of lives, indicated by the number of hearts left, when playing video games. We give heartfelt thanks, memorize lines by heart, and give our heart up to God. The heart is pervasive in our music, literature, and art. We now dismiss the heart as nothing more than a blood pump, yet symbolically it is everywhere in our daily lives.

Q: Early civilizations were cardiocentric – seeing the heart as the seat of the soul, emotions, intellect, the life force. Today, we see it as a pump. Have we as human beings lost something valuable with the heart’s “demotion” to mere pump?

Figueredo: Yes, I believe so. We now physically dismiss the heart as a circulatory pump, devoid of feelings, memory, or our Self. Yet we metaphorically continue to use it for those very things. When seeing someone you love dearly, why do you cross your hands over your heart? Where do you point to on your body when you say “me”? Certainly not at your brain! Why do so many still believe that our love of family and God reside in our hearts?

We act as if our emotions and feelings our seated in our heart. But when asked what the heart’s purpose in our body is, we say it’s just a blood pump.

Q: Is there a story about the heart’s former central role in human well-being that’s particularly moving or striking for you?

Figueredo: I love the stories from our ancestors about the heart. A favorite is the ancient Indian Sanskrit epic Ramayana from around 600 BCE. It’s about the heart’s role in love and devotion. Lord Rama returned after fourteen years, having killed the evil mutiheaded demon king Ravana and his demon followers. He was crowned king of Ayodhya. A celebration took place where precious ornaments and gifts were distributed to everyone. Hanuman, Rama’s general and ardent devotee, was given a beautiful necklace of pearls by Rama’s wife Sita. Hanuman examined each and every pearl and then threw them away. All present were surprised by his behavior. When asked why he was throwing away the pearl necklace, he replied that he was looking for Rama in them. They carried no value to him, since anything in which there was no Rama was without worth. The guest mocked him and asked him if Lord Rama was in Hanuman himself. He tore his chest apart to reveal his heart. The images of Rama and Sita appeared on his heart. The guest present were now convinced of his genuine devotion.

Q: Why did humans for millennia believe the heart housed the soul?

Figueredo: Our ancient ancestors understood that a beating heart meant life—beating harder and faster with fear and love and beating no more upon death. As a dead body quickly cooled, surely the heart must act as a furnace to warm the body. The heart had to be the repository of emotions in our body, given its responses to love and joy, anger and fear. This hot beating organ in the middle of our body must be the home of consciousness, memory, and the soul. Surely the way to connect with God was through one’s heart. While some Greeks and Romans eventually began to argue that the brain, and not the heart, ruled the body, at least in Europe, the Church dictated the teachings of Aristotle and Galen to be sacrosanct. Thus, it was not until the Renaissance that the demystification of the heart began.

Q: Today, the heart and many of its components are replaceable, thanks to a tsunami of innovations in cardiology in the twentieth and twenty-first centuries. What are some major replacement parts that weren’t available a decade or two ago, and what do you see in the near future?

Figueredo: We can now repair and insert new heart valves via a catheter, instead of open-heart surgery. We can implant artificial heart-assist devices to bridge people with broken hearts to transplant or replace their heart with an artificial one completely. One recipient lived seven years.

I believe in the not-too-distant future we will be performing xenotransplantations – transplanting a heart from another animal, such as a pig, into humans. This will be needed given the chronic shortage of human donor hearts available. A recent recipient of a gene-modified pig heart survived two months.

We are growing new heart cells in damaged hearts. Unlike salamanders, humans cannot replace dead heart muscle with new cells. Gene research and stem cell studies look promising for rebuilding lost heart muscle.

Biological pacemakers, vaccines to prevent heart disease, and 3D printing technology, to create a perfect heart valve matched to a patient or even a whole new heart, are in our future.

Q: The brain has superseded the heart as the body’s recognized boss, but you end the book on a fascinating note – new research suggesting the heart can influence pain perception, concentration, and emotional processing in the brain. Are we returning to a fuller appreciation of the heart’s mysterious role in our health?

Figueredo: A new field, neurocardiology, is finding that there is a dynamic two-way dialogue between the heart and brain, continuously affecting the function of each organ. The heart has an intrinsic nervous system composed of over forty thousand neurons; a little brain that enables the heart to sense, regulate, and remember. The heart is sending as many signals to the brain as the brain is to the heart. Signals from the heart affect function in multiple parts of the brain, including the medulla, hypothalamus, and the emotion center in the brain, the amygdala. The heart also affects the brain through hormones such as the love hormone, oxytocin, the heart producing similar amounts as the brain. The heart also affects the brain through rhythmic electromagnetic energy. A negative example of this is arrhythmias, abnormal heart rhythms, which can cause anxiety and panic attacks. Positive examples include meditation, mindfulness, singing, and feelings like compassion and appreciation, which produce coherent, harmonious heart rhythms that affect brain processing of attention, motivation, pain centers, and emotion.

Our ancient ancestors believed the heart and mind were one, often using the same character in their language to represent both. Maybe they were not so wrong after all. It now appears the heart does play a role with the brain in our mental, spiritual, and physical health.

Q: Fatal heart disease rates are rising again in the U.S. after decades of progress and decline. What’s behind this turnaround and what should we be doing for our heart health that we’re skipping?

Figueredo: Several factors are contributing to this reversal of fatal heart disease rates that were down-trending since the 1960s. These include the aging of the population, diabetes and obesity epidemics, stress, depression, and the COVID pandemic. While the COVID virus itself may have played a role, it is likely that resulting physical inactivity, weight gain, decreased health-seeking behaviors, and mental stress were major factors contributing to increased fatal heart disease events.

I know this sounds so simple, but for most of us the answer to decreasing our risk of fatal heart disease is eat right, exercise, don’t smoke, and reduce stress in our lives. If only it were so easy. In the future, gene-informed therapy will create personalized, genetically modified RNA or cell infusions, or vaccine-like therapies to prevent individuals from having future heart events.

Q: How is this book different from other books about the heart? Who is this book meant for? Can someone with little medical knowledge enjoy your book?

Figueredo: Books on the history of the heart come in two flavors, those that mostly focus only on the medical and scientific history and those that focus on the author’s personal experiences with historical vignettes about past heart history. The Curious History of the Heart is meant to be, in the genre of books on the history of a single subject, a panoptic look at the meaning of the heart over the whole of human history. This book traces the evolution of our understanding of the heart from the dawn of civilization over fifteen thousand years ago to today. It examines how we humans have evolved our beliefs about the purpose of the heart to try to understand what life forces it contains. It explores the role and significance of the heart in culture, art, religion, philosophy and science. This book chronologically examines how the once “king” of the organs became dismissed as a mere mechanistic blood pump subservient to the brain, yet remains so central to our daily lives as a symbol of love and health.

This book is meant for any reader who loves books that focus on a single subject, like Salt: A World History or The Emperor of All Maladies: A Biography of Cancer. No prior medical knowledge is needed!

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