Articles

Don’t Be Scared of Your Heart

Fables about heart disease can do you more harm than the disease itself, says this specialist. This is the truth about tickers

PAUL D. WHITE, M.D. November 1 1949
Articles

Don’t Be Scared of Your Heart

Fables about heart disease can do you more harm than the disease itself, says this specialist. This is the truth about tickers

PAUL D. WHITE, M.D. November 1 1949

Don’t Be Scared of Your Heart

Fables about heart disease can do you more harm than the disease itself, says this specialist. This is the truth about tickers

PAUL D. WHITE, M.D.

AS TOLD TO JOHN E. PFEIFFER

ONE DAY a grim-faced patient walked into my Boston office and there was worry in his voice as he told his story. He was 53 years old, and ran a silver-fox and turkey farm on Prince Edward Island. A few months previously he had been suddenly stricken with a painful heart attack. Pale and faint and in a cold

sweat, he staggered t.o bed, and, although his symptoms subsided, he expected to die within a year. He explained that he’d come to Boston only at the urgent insistence of friends to find out if there could be any escape from this depressing verdict.

This Canadian had a coronary thrombosis, a clot in one of the heart’s main arteries that was cutting off its blood supply. But I didn’t share his beaten hopelessness. I knew that since he had spent a few weeks quietly in bed, under careful medical supervision, the odds were that nature had already accomplished two lifesaving miracles: the healing

of the heart muscle scar and the establishment of adequate “collateral circulation.” This latter process means that the blood, blocked by the clot in its path, had found reserve channels among the heart’s interlaced network of blood vessels and had detoured the barrier, thus establishing a new circulatory route for the regions of heart muscle depleted of their previous blood supply.

The days passed and the months and years. The patient regained his strength and suffered no further attacks a certain sign that these miracles had indeed occurred. He had expected that he’d have to stop working, and sit quietly awaiting death on the front porch while others took care of his silver foxes. I advised him to go back to work —adding that, if he didn’t, he’d lose some precious

years of active life.

As the patient left my office, he turned and said: “From now on. Dr. White, I’m going to send you a turkey every year as long as I live.” This man came into my office a quarter of a century ago —back in 1924, and he sent me 23 annual turkeys before his final illness and death (and not from heart disease) at the age of 715.

I have recalled this case for a very definite purpose. The American Heart Association is launching a drive to spike the host of groundless superstitions about heart disease—superstitions that are likely to cause more suffering among patients and their families than the actual ailments themselves. There is no worse disease than fear, and thousands of heart patients are living in needless terror because of old wives’ tales that doctors have discarded years ago.

The idea of leading an easy-chair life, which is what my Canadian patient originally planned to do, is a perfect example of such outmoded notions. Actually, exercise is good for any heart unless it is very weak with impending failure or subject to angina pectoris. General bodily health depends on good circulation and only an active heart can do a really adequate job of pumping blood supplies to vital organs. These facts should be enough to debunk the widespread dread of climbing stairs. Of course that doesn’t mean that heart patients should go leaping upstairs two at a time, but doing the thing at a decent pace is simply sensible living in the great majority of cases. Yet., to spare their strength, some persons have elevators installed in their homes, a practice which is often a sheer waste of money.

Golf is another good form of exercise. You’ve undoubtedly heard scare stories about players dropping dead on the eleventh green, the implication being that they should never have been out on the links in the first place. Just as likely as not, these men would have died 10 years earlier if they’d always stayed at home. Persons who worry about the golf myth should remember the sarcastic remark of another specialist: beds must be the most dangerous things in the world, because so many people die there.

Keep up the Good Life

HEART DISEASE should neither be feared —nor taken lightly. It would be dishonest to pretend that all patients can ignore their symptoms and lead 100' ; normal lives. Although there’s no avoiding the fact that the condition accounts for more deaths than any other sickness, it’s essentially a disease of middle-aged and elderly persons and, since the average lifespan has increased with advances in modern medicine, it often comes as a normal part of the ageing process.

Naturally, heart patients have to modify their lives in certain respects. Complete rest may even be required for some persons, although they make up but a small proportion of the total. Depending on what specific condition a patient is suffering from and what the doctor orders, he may or may not have to cut down on smoking or stop entirely. Usually an occasional highball or two won’t affect the heart in the least, although heavy imbibers are quite rightly told to drink less (which advice, by the way, is just as sensible for persons without heart trouble). Moreover, all alcoholic drinks have calories which added to food calories may increase body weight unwisely.

As a general rule, heart disease calls for a change in food habits. Diseases of the arteries and high blood pressure may require eating less, especially if the patient is overweight. High blood pressure is often treated by low-salt diets. A new diet that seems to help in many cases, although doctors don’t yet know how it works, consists largely of rice and is the subject of continuing research. One Chinese patient who was suffering from high blood pressure came all the way to Boston for advice. He was surprised and amused to learn that his own national dish was to be the chief part of the prescribed diet.

New treatments are part of the brightening picture for persons who have heart disease and have learned that they can keep up their work and live useful, active lives. But what about the people who’ve never been properly diagnosed, feel certain they must have weak hearts and hide the suspicion from their doctors and friends? For every genuine heart patient there are a dozen physically healthy persons who think they’re already afflicted or feel “the first faint signs” coming on. The minds of such “amateur physicians” are crammed with misconceptions about supposedly sure-fire symptoms of the disease.

Perhaps the symptom most commonly believed to be associated with heart disease is pain in the chest. Yet more than 80% of the time it’s an indication of some other trouble, as it was in the case of another of my patients, Mary, a telephone switchboard operator. One morning after a very hectic two hours of work she felt an aching pain just over her heart along with sighing, shortness of breath and pounding palpitation and faintness.

Like many persons, she had read just enough misinformation about heart disease to give herself an on-the-spot diagnosis. Another attack two weeks biter convinced her but, instead of going to a doctor, she kept her secret and suffered mental tortures. It took two more attacks and hours of fruitless worrying to send her to my office. I was able to tell her that her heart was in perfect condition. She was actually suffering from a condition called neurocirculatory asthenia, which is a state of fatigue with nervous and circulatory symptoms in an oversensitive person. During the two world wars it has been called “soldier’s” heart although there is no heart disease to it. Mary recovered slowly when she changed her job to one that was less nerve-racking.

Other fairly common causes of pain in the front of the chest are pleurisy, shingles, strained or bruised chest muscles, “intercostal neuralgia,” indigestion due to stomach trouble and spasm of the esophagus or gullet which can produce a constriction under the breast which closely resembles angina pectoris (true coronary heart pain) except that it is not induced by exercise.

The Murmur Myth

What about shortness of breath? The odds are about nine to one that it’s a sign of mild arthritis, asthma, a lung disease or any one of half a dozen other conditions rather than heart trouble. One elderly businessman who wintered in Florida and prided himself as a first-class hiker began brooding when he found that even a short walk left him gasping for breath. As the result of a hasty medical checkup, he’d been taking digitalis for weeks before a more careful examination revealed that he was suffering from acute and chronic bronchitis; penicillin helped much more than the heart tonic did.

To illustrate an even more prevalent superstition, The Great Heart-Murmur Myth, let me tell you about the mother who brought her eight-year-old son to me from the Middle West. The child had “noises in his heart.” I found that, as in many persons with murmurs, there was nothing at all the matter

with the boy’s heart. The real patient in his case was the mother who, with the best intentions in the world, might well have given her son a lasting neurosis.

I took her aside for a brief heartto-heart chat. I explained that any doctor could produce a harmless murmur in any child simply by having him lie down and exhale completely. That causes one of the heart arteries (the pulmonary) to dilate, and whenever fluid rushes through a pipe of changing diameter the result is a blowing sound or “murmur.” I assured her that about 80% of all such sounds are meaningless. In this case the real diagnosis was maternal anxiety, not heart disease.

The list of unfounded beliefs could be extended indefinitely, documented with dozens of similar case histories. Neither palpitation nor dizziness nor fainting are reliable heart symptoms; in fact, most patients who complain of all these conditions are almost certainly not suffering from heart disease. They’re usually victims of a littleunderstood psychomatic ailment called neurocirculatory asthenia or anxiety neurosis, such as affected Mary; this resembles heart trouble so closely that it’s often mistaken for the real thing. Not that you should pass off any of these symptoms lightly, because they may indicate a need for medical study. The main point is to see your doctor and find out definitely.

As a result of experience gained during the past 20 years specialists are convinced of one thing: the heart is

probably the strongest muscle in the body. Once, during a lecture to laymen at Harvard, a young lady interrupted me to ask, “Can you die of a broken heart?” When the audience’s laughter had subsided, I replied that I’d never seen or heard of such happening to a normal heart and doubted whether it could happen. No emotion, no matter how upsetting, can rupture a healthy muscle designed to beat nearly 38 million times a year and pump 1,050 pounds of blood an hour!

Furthermore, the heart combines strength with an amazing sensitivity to the condition of the body. When you’re asleep it’s beating only about 50 to 60 times a minute; the average sitting-up rate is 72. Colds and other fever-producing sicknesses make the heart throb faster (the pulse rate increases about 10 beats per minute for every one-degree Fahrenheit rise in body temperature), while more than 150 contractions per minute are not uncommon during heavy exercise, especially when the subject is not in good training. Practically everything you do, from smoking a cigarette to arguing about the cost of living, is reflected by a change in your heart rate.

Many unusual rates are not signs of serious illness. It used to be thought that a slow rate was a certain sign of heart block, a crippling disease in which the mechanism that regulates the contractions of the heart muscles is damaged beyond repair. But this is simply another fallacy, as indicated by the case of Leslie MacMitchell, the great miler of New York University’s prewar track team. Although he’d nearly broken a world’s record not very long before, MacMitchell’s physical status was questioned by U. S. Navy doctors because his heart beat was so slow, only 38 to 40 times a minute. The worried athlete went to a heart specialist, who —recalling that another star runner, Kansas’ Glenn Cunningham, had a pulse in the low 40’s—gave him a thorough checkup. MacMitchell, as any sports writer might have guessed, was in top condition, and the Navy finally commissioned him.

In cases of this sort a “normal” pulse rate may actually be a sign of poor health. During the war MacMitchell visited me when his cruiser was making a stopover in Boston and his heart rate had “soared” to 60. Knowing that the runner’s natural pulse was much lower, I suspected that he was not feeling so well. MacMitchell hadn’t been getting enough exercise, had put on some weight and felt generally run-down.

But when I saw the athlete about a year later, he was back in shape again. The Navy had obligingly taken account of MacMitchell’s unusual physical demands and had marked out a track on his cruiser. Daily jogs brought his pulse down to his healthy 38 to 40! Incidentally, although most runners don’t have below-average heart rates, it’s not uncommon among them and seems to be an advantage because the heart works more efficiently at a lower pumping speed.

The Racing Hearts

Another heart condition, this time at the other end of the pulse-rate scale, may cause a good deal of worry and trouble. It’s called tachycardia, the main symptom being “racing spells” during which the heart beats 170 or more times a minute. The cause may be highly strung nerves, indigestion, or too much smoking or drinking; it rarely indicates a major illness. Yet many uninformed persons have driven themselves half-crazy brooding about their palpitating hearts.

One of these victims of medical superstition was Mrs. Johnson, a 50year-old housewife. She didn’t dare rest when her attacks came because of fear of worrying her family. She stayed on her feet, trying bravely to clean the house and prepare meals as if nothing was the matter. As a result, the attacks, which lasted more than half

an hour or so if the patient promptly lay down, continued for three or four hours. Finally, her secret came out and her children made her go to a doctor. The diagnosis: nothing serious, perhaps too much coffee. Today Mrs. Johnson gets an occasional attack but. it lasts only about 20 minutes, and she’s as healthy as ever. In fact, she’s much better off, because her fear and especially her family’s fears are gone.

If your heart’s in perfect working order, what can you do to keep it that way? Healthy persons can co-operate with their doctors to try to reduce their chances of getting one of the three major forms of heart sickness—high blood pressure, rheumatic fever, and coronary artery disease (thickening of the walls of vital blood vessels that supply the heart). Together these conditions account for more than 90% of all heart cases, but the statistics are likely some day to lie less impressive when we learn to take care of people before they get sick.

Watch the Midriff

Point No. 1 is a matter of proper diet. All the evidence indicates that overweight, while it may not injure the heart directly, certainly has a deleterious effect on longevity. Overweight people may lose as much as four or five years of normal life expectancy. Among the worst offenders apparently are the muscular males who ate like horses during their football and hockey days, and still call for large portions even though they’re working behind desks and exercising too little.

Recent biochemical research has revealed that even if your weight is just right, it may not be wise to eat too much of certain kinds of fatty foods (the so-called cholesterol fats, found richly in butter, cream and egg yolk). When fats are introduced into or manufactured in the body, they enter the bloodstream. The lack of adequate fat metabolism may result in the deposition of fat in the inner walls of certain of the arteries, especially the coronaries, eventually forming calcified layers that not only make the blood vessels more brittle but narrow them and restrict normal circulation. However, much more research is needed to prove whether or not foods rich in cholesterol should be limited. Quite possibly they do no harm if the total caloric intake is not high enough to gain weight.

Exercise is as important for healthy persons as it is for most heart patients. On the other hand, it’s smart to take it easy nervously and mentally. The fast pace of modern living has long been suspected as an important factor behind high blood pressure and some forms of heart failure. Furthermore, high-power business often breeds a type of person who can’t relax even on his days off and week ends.

There’s also the matter of vacations. To most of us that means warm summer days in the lake among the mountains, or at the seashore, but —from a strictly medical standpoint —summer is the time you need a vacation least. Hot weather usually brings a natural slowdown in bodily activity anyway. Just before the war doctors at the Mayo Clinic in Rochester, Minnesota, made a special study of the health of more than 200 executives, sales managers, and advertising men, and found that “strokes” and heart failure occur most commonly in December, January and February. Because the strain of business activity hits a peak during these winter months, that may be the best time to take a vacation.

Long Life with a Bad Heart

Also, vacations were meant for relaxation. People who don’t get much exercise and fresh air during the rest of the year shouldn’t try to catch up by following a heavy, all-day schedule of sports, hiking and swimming. It may be a good idea to split your vacation into one-week periods instead of using it up all at once. I myself have tried to take one week off every three months; although that system may not be as convenient as the usual type of vacation, it may keep you healthy longer.

Having regular medical examinations is another obvious but frequently ne-

glected way of keeping tabs on your heart. Better and earlier diagnosis is possible nowadays because of instruments such as the X-ray machine and the electrocardiograph which records the electrical currents in the heart muscle.

Perhaps the most depressing and erroneous idea of all is that once a person has heart trouble, he’s got only a little while to live. This widespread notion simply doesn’t check with the facts. I have seen more than 30,000 patients since I started studying heart disease some 30 years ago, and during that period actual case records have steadily pushed life-expectancy estimates upward. F'or example, the future is much brighter than used to be thought for sufferers from acute coronary thrombosis, which was what the Canadian silver-fox farmer had, or from angina pectoris which consists of intense chest oppression resulting from narrowing of heart arteries with consequent insufficient blood supply to the heart.

In heart disease, as in many other illnesses, one of the doctor’s biggest enemies is the homemade “M.D.,” the person who’s picked up a variety of handy misinformation and is always ready to share his half-baked advice with worried friends. The only way to learn about the normal and abnormal workings of the heart is by painstaking research; such research is going on in hospitals and laboratories throughout the world. Meanwhile, there are enough facts right now to explode the large collection of myths about heart trouble, which cause hours of futile mental anguish. When the myths go, a great deal of the suffering will go, too. -k