The Human Heart, with David Anderson

Our hearts are restless, says Saint Augustine, until they find their rest in God. The biological science and the spiritual metaphor are in agreement here. Over the course of billions of beats, our hearts never stop to rest.  Your magnificent heart exchanges or pumps your entire blood volume, just over a gallon, every single minute. (Athlete hearts can pump up to 10 gallons per minute!)

In this episode, Mark Labberton discusses matters of the heart with his close friend Dr. David Anderson, a cardiologist of four decades who trained at Johns Hopkins and helped launch one of the first interventional cardiology programs in San Francisco.

Anderson reflects on the medical science of cardiology, the profound life-saving medical advances over the past forty years, heart disease versus coronary artery disease, how the brain and the heart communicate, and what happens during a heart attack.

In the second half of their conversation, they move from physiology to spirituality of the heart: Pharaoh’s hardened heart, “out of the heart the mouth speaks,” and the human need to find somewhere to locate the self.

Anderson closes with what a cardiologist would tell anyone worried about their own heart, and with a case for medicine as a noble profession.

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Episode Highlights

• “When I first began in cardiology, if your heart was damaged, imagining that the heart could actually improve its function was like imagining someone could grow back a new arm.”
• “One of the distinctive things about the heart is unlike other muscles, it doesn’t have a time to rest. When it gets insufficient blood supply, it can’t just say, ‘Whoa, I’m gonna stop here.’ It asks you to slow down because it starts hurting.”
• “I think that’s part of the intrigue of the heart, that it is inside us … but in some ways it’s apart from us. It’s responding to environmental things that we’re not really even aware of. … I think it’s this sense of detachment of the heart from us—but yet its centrality—that has led people to posit the soul or the will or the passions or almost anything that you would think was the real you.
• “Atherosclerosis … I would describe as it’s like having a pimple inside your artery.”
• “First of all, know yourself. That is, it’s not a time to be fatalistic because your father had a heart attack in his fifties or your brother just had a heart attack. It’s a time to be proactive.”

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About David Anderson

David Anderson is a cardiologist who practiced for more than four decades before retiring. He studied at Stanford as an undergraduate and earned his medical degree at Johns Hopkins University School of Medicine. He stayed at Hopkins for residency, then trained in San Francisco at the dawn of interventional cardiology, helping to build an angioplasty program in the early 1980s.

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Helpful Links and Resources

• Alta Bates Summit Medical Center, Sutter Health, the Oakland hospital Anderson thanks by name: https://www.sutterhealth.org/about-us/our-hospitals/alta-bates-summit-medical-center
• DeWood et al., ”Prevalence of Total Coronary Occlusion during the Early Hours of Transmural Myocardial Infarction,” the 1980 study that identified clot as the cause of heart attack: https://www.nejm.org/doi/full/10.1056/NEJM198010163031601
• Waagstein et al., ”Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy,” the Swedish beta-blocker work behind the recovery he describes: https://pubmed.ncbi.nlm.nih.gov/1191416/
• What Is Atherosclerosis, National Heart, Lung, and Blood Institute: https://www.nhlbi.nih.gov/health/atherosclerosis
• Warning Signs of a Heart Attack, American Heart Association: https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack
• Angina (Chest Pain), American Heart Association, on the exertional pain he describes at the close: https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain

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Show Notes

• The impact of family gene pool, lifelong heart awareness
• How David Anderson got into medicine, and cardiology in particular
• A Hopkins autopsy elective, a teenager dead in a parking lot, a mentor who followed
• From internists interested in the heart to interventionists inside it
• Catheters, pressures, and the arrival of echocardiography
• Seeing a beating heart inside a living body for the first time, as a senior resident
• A colleague’s heart attack in 1979
• The 1980 angiography study that identified clot as the trigger
• Spring 1983: an artery occludes, the cath lab opens it, pain gone in fifteen minutes
• Bypass surgery before that: elective, scheduled, never mid-attack
• Prevention running under the technology: blood pressure, smoking, the lipid theory
• Fixing one artery and never having to fix another
• Coronary artery disease versus disease of the muscle itself
• Plasticity, not regeneration
• Adrenaline as an emergency system built for days, not decades
• Moving from technological advances to molecular-based understanding of heart problems
• Understanding of the pathophysiology of atherosclerosis and its prevention
• Beta blockers, ejection fraction, and hearts that came back
• The heart as a muscle with no rest
• The heart’s own electrical center, and the backup pacemakers below it
• Your heart doesn’t rely on you or your consciousness to beat
• Why the ancients may have located the self in the heart organ
• Jeremiah’s pounding heart, Pharaoh’s hardened one
• Pascal, the soul, and needing somewhere to put “the real you”
• Maintaining an appropriate degree of separation from the patient and their family in order to care properly and effectively
• The difficulty of delivering bad news to patients and their familes
• Digging for a shared history to call on in a crisis
• “Medicine is a noble profession.”
• Heart care advice from a cardiologist: First, know yourself.
• Heart health checklist: cholesterol, blood pressure, weight, knowing your own history
• The pain that warrants a phone call

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#Conversing #MarkLabberton #Cardiology #Heart #MedicalScience #HeartHealth #Biology #ChristianHumanism

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Production Credits

Conversing is produced and distributed in partnership with Comment magazine and Fuller Seminary.