The Exquisite Machine

The New Science of the Heart

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Paperback
$24.95 US
On sale Feb 06, 2024 | 232 Pages | 978-0-262-54841-0
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. 
1 Introduction 1
2 Threats to the Heart: A Thousand Natural Shocks 9
3 The Science of the Really Small 29
4 Big Data--Many Hearts that Beat as One? 45
5 The Plastic Heart 69
6 The Responsive Heart--Emotion in Motion 83
7 Can You (Not) Die of a Broken Heart? 99
8 The Gendered Heart 119
9 The Mechanical Heart 135
10 Can Stem Cells Help Us Grow a New Heart? 151
11 When Will the Future be Here? 173
Acknowledgments 193
Notes 195
Index 215
EXTREME ATHLETES—TOO MUCH OF A GOOD THING?
Exercise is good for you, there is no doubt about it. But we humans are always taking things to extremes, and there is a point where even exercise can turn bad. Endurance athletes are a breed apart, performing feats of astonishing strength and stamina. The record at the time of writing is 59 successive days running a marathon, but no doubt this has been broken since. Interestingly, endurance cycling is one of the toughest sports for your heart, probably because of the combination of large leg muscles needing steady maximum blood flow and the intermittent peaks of intense work for the arms and upper body. Top blood pressures of 200 mgHg are common during rapid mountain climbs as in the Tour de France. The cyclists must also keep this up for long periods—up to five hours— compared to the two to three hours for a marathon.
Overall, endurance cyclists do well in general health, with mortality reduced by 41 percent and life extended by 17 percent.6 But a significant proportion do develop heart abnormalities, about 50 percent more than in the general population. These include a wide range of arrhythmia types including atrial fibrillation. A thick (or hypertrophied) heart wall is much more prone to rhythm abnormalities. When 46 athletes (37 cyclists) who had these abnormalities were followed up over five years in one study, 18 had a serious cardiac event. Nine of them (all cyclists) died within two years. We must always remember that evolution balances the increased risk of overstimulating the heart with the benefits for immediate survival in times of danger. Extreme exercise saves lives in an emergency but is risky as a modern lifestyle choice!

Chapter 5

6. D. W. T. Wundersitz, B. A. Gordon, C. J. Lavie, V. Nadurata, and M. I. C. Kingsley, “Impact of Endurance Exercise on the Heart of Cyclists: A Systematic Review and Meta-analysis,” Progress in Cardiovascular Diseases 63 (2020): 750–761.
Sian E. Harding, a recognized authority in cardiac science, is Emeritus Professor of Cardiac Pharmacology in the National Heart and Lung Institute at Imperial College London, where she led the Division of Cardiovascular Sciences and the BHF Centre for Cardiac Regeneration.

About

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. 

Table of Contents

1 Introduction 1
2 Threats to the Heart: A Thousand Natural Shocks 9
3 The Science of the Really Small 29
4 Big Data--Many Hearts that Beat as One? 45
5 The Plastic Heart 69
6 The Responsive Heart--Emotion in Motion 83
7 Can You (Not) Die of a Broken Heart? 99
8 The Gendered Heart 119
9 The Mechanical Heart 135
10 Can Stem Cells Help Us Grow a New Heart? 151
11 When Will the Future be Here? 173
Acknowledgments 193
Notes 195
Index 215

Excerpt

EXTREME ATHLETES—TOO MUCH OF A GOOD THING?
Exercise is good for you, there is no doubt about it. But we humans are always taking things to extremes, and there is a point where even exercise can turn bad. Endurance athletes are a breed apart, performing feats of astonishing strength and stamina. The record at the time of writing is 59 successive days running a marathon, but no doubt this has been broken since. Interestingly, endurance cycling is one of the toughest sports for your heart, probably because of the combination of large leg muscles needing steady maximum blood flow and the intermittent peaks of intense work for the arms and upper body. Top blood pressures of 200 mgHg are common during rapid mountain climbs as in the Tour de France. The cyclists must also keep this up for long periods—up to five hours— compared to the two to three hours for a marathon.
Overall, endurance cyclists do well in general health, with mortality reduced by 41 percent and life extended by 17 percent.6 But a significant proportion do develop heart abnormalities, about 50 percent more than in the general population. These include a wide range of arrhythmia types including atrial fibrillation. A thick (or hypertrophied) heart wall is much more prone to rhythm abnormalities. When 46 athletes (37 cyclists) who had these abnormalities were followed up over five years in one study, 18 had a serious cardiac event. Nine of them (all cyclists) died within two years. We must always remember that evolution balances the increased risk of overstimulating the heart with the benefits for immediate survival in times of danger. Extreme exercise saves lives in an emergency but is risky as a modern lifestyle choice!

Chapter 5

6. D. W. T. Wundersitz, B. A. Gordon, C. J. Lavie, V. Nadurata, and M. I. C. Kingsley, “Impact of Endurance Exercise on the Heart of Cyclists: A Systematic Review and Meta-analysis,” Progress in Cardiovascular Diseases 63 (2020): 750–761.

Author

Sian E. Harding, a recognized authority in cardiac science, is Emeritus Professor of Cardiac Pharmacology in the National Heart and Lung Institute at Imperial College London, where she led the Division of Cardiovascular Sciences and the BHF Centre for Cardiac Regeneration.

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