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Part of 15/23

 thought the causes of heart disease – and heart attacks in particular – were likely related to anxiety and stress hard work and low economic status. They also thought that use of the stimulant Benzedrine was a contributing factor. This drug is an amphetamine that was doled out to ease obesity treat low blood pressure and pain. The scientists’ ideas were in the ballpark but they’d also overlooked some other important factors. 
In that sense then the Framingham study was a success. It showed how lifestyle factors were responsible for heart disease. 
Thanks to the study the connection between high blood pressure hypertension (an arterial illness that raises blood pressure) cholesterol levels and heart disease could be clearly demonstrated. 
Now doctors knew that if they could identify methods for reducing blood pressure hypertension and cholesterol levels they could also treat heart disease. Something like diet was an obvious contender. 
The study also established a relationship between
Part of 13/23

ink – was medically impractical at the time. 
That same year Lillehei was ready to put his experimental cross-circulation surgery to the test. 
Lillehei’s first patient was a 13-month-old boy Gregory Glidden. Gregory’s circulatory system was connected to his father’s via the father’s femoral vein and artery. 
Once this was in order Lillehei tied off the inlets and outlets to the child’s heart. Gregory’s heart was now inactive. 
Lillehei then speedily zeroed in on the coin-sized aperture in Gregory’s ventricular septum and stitched it up. 
Both Gregory and his father survived the experimental procedure. Unfortunately a complication arose. Just ten days later Gregory developed a chest infection and died. 
Luckily Lillehei met with a better outcome two weeks later with his next patient. Pamela Schmidt was four years old and her 14-minute operation was a resounding success. 
In that year alone Lillehei went on to perform cross-circulation surgery on 44 more patients. 32 of them survived.
Part of 14/23

The tide was turning. 
In the 1950s lifestyle factors began to be understood as contributing to the risk of heart problems. 
The 32nd President of the United States Franklin D. Roosevelt was a titan in every sense of the word. But throughout much of his four-term presidency he suffered from heart complications ultimately dying of a massive heart attack in 1945. 
The death of such a prominent figure may well have stimulated the decision to establish a major study for a better understanding of heart disease in the 1950s. 
The name given to this effort was the Framingham Heart Study. It was conducted on 5 000 citizens between the ages of 30 and 60 in the small town of Framingham not far from Boston. 
The study’s participants agreed to be monitored over a 20-year period. Their lifestyles would be observed in detail. That way correlations could be detected between lifestyle choice and health particularly with respect to the increased risk of heart disease. 
Prior to the study scientists
Part of 11/23

imented on dogs. One dog would be anesthetized and its heart stopped. Lillehei then used a beer hose and milk pump to link this dog’s circulatory system to the circulatory system of a second dog. 
The blood was pumped from the first into the second dog and then returned to the first dog from one of the second dog’s arteries. 
It might sound crazy but it worked. Both dogs survived without any complications. 
Of course the next step was to develop this cross-circulation system for use in humans. We’ll look at that in the next blink. 
Congenital heart disease remained a major health problem until the advent of the first cross-circulation surgeries in the 1950s. 
All in all Lillehei performed his cross-circulation experiments on more than 200 dogs. Sure of his technique he was keen to find a human subject on whom to try the surgery. 
In 1954 Lillehei identified which group of patients would respond best to his method. He found that it was those with congenital heart disease that is whe
Part of 12/23

re the heart aorta or other large blood vessels were deformed from birth. It is also the most common form of major congenital disability found in newborns. 
At the time 50 000 American babies were diagnosed with congenital heart disease each year. These patients were also filling hospital wards across the country. A significant number had difficulty breathing and their life expectancy wasn’t even 20 years. 
The most commonly occurring congenital heart disease results in a coin-sized aperture which appears in the wall separating the upper chambers of the heart – the atria. The aperture may also occur in the wall between the lower chambers of the heart – the ventricles. 
These apertures cause leakage: oxygen-poor blood mixes with oxygen-rich blood. This can reduce the overall level of oxygen in the blood which can cause fainting fits and even result in death. 
Fixing these apertures requires stopping a patient’s heart for more than ten minutes something that – as we know from the last bl
Part of 10/23

simply too risky to perform. 
If you think about it it’s all a question of time. In heart surgery heart activity has to be paused. However with no pumping heart the brain and body cells no longer receive oxygen through the blood. 
Typically the body can only survive three to five minutes without an oxygen supply. This means that if the heart is stopped for any longer than that there will be irreversible damage. 
Now of course most heart surgery can’t be performed that quickly. Typically at least 10 minutes are needed and some surgeries can last much longer. 
Heart surgery therefore used to be impossible. That was until an American surgeon by the name of C. Walton Lillehei had a brain wave in the 1950s. 
Lillehei was inspired by babies in the womb who survive without a direct oxygen supply. Babies’ blood instead passes into their mothers’ blood circulation system where it is cleaned and oxygenated. 
So Lillehei set about designing a similar system for heart operations. For this he exper
Part of 8/23

ed the heart. 
Smeared with his own blood but unphased Forssmann kept pushing. Finally the catheter entered his heart's right atrium. 
Incredibly not only did Forssmann survive his experiment but he went on to repeat it several times. It was truly revolutionary; no one had come so close to touching the inside of a human heart before. 
That’s not to say Forssmann wasn’t laughed at for his eccentric self-probing. After all no one had the faintest idea as to what use the procedure could be put. 
But in the late 1930s two American cardiologists at Bellevue Hospital in New York City André Cournand and Dickinson Richards were inspired by Forssmann’s work to develop their own new techniques. 
Cournand and Richards set about designing tiny catheters. These were to be inserted in patients’ veins or arteries and used to monitor blood pressure and blood flow. This is information that is critical when treating patients with cardiac diseases such as congenital or rheumatic heart diseases. Richards
Part of 9/23

and Cournand’s work laid the foundation for later developments in cardiac operative procedures. For instance coronary angiography the detailed imaging technique for investigating the insides of the heart and blood vessels can be traced back to them. 
Thanks to their work developing techniques for diagnosing cardiac illnesses all three scientists – Cournand Richards and Forssmann – received the Nobel Prize in medicine in 1956. 
Open heart surgery was thought impossible before cross-circulation surgical procedures were invented. 
You surely already know this scene from the movies: one of the protagonists is suddenly struck by a heart attack and is hurried to the nearest hospital. There he is put on a gurney and wheeled away by medical staff. 
More often than not these fictional characters survive as do most people in real life these days. But for many years survival from such an attack was not even a possibility. That’s because open-heart surgery – the operation often required – was
Part of 6/23

accepted phenomenon. It even has a name: Takotsubo cardiomyopathy . “Takotsubo” is Japanese and refers to the octopus trapping pot that is wide at the base but narrow on top. 
It is precisely that shape that the heart takes when it is subjected to intense emotional stress. 
As a general rule it is women who are afflicted with Takotsubo cardiomyopathy. Break-ups or the deaths of loved ones result in the deformation and weakening of these women’s hearts. They then develop symptoms typically associated with impending cardiac arrest. Chest pain breathing difficulties and sudden collapse are all common. The patients often recover from these symptoms but there are cases where people literally die of grief. 
“Heart problems including sudden cardiac death have long been reported in individuals experiencing intense emotional disturbance.” 
A daring self-experiment by Werner Forssmann led to Nobel-prize winning breakthroughs in cardiology. 
The year is 1929. In Eberswalde a small town n
Part of 7/23

ear Berlin a medical intern by the name of Werner Forssmann convinces a nurse to get hold of an extra-long catheter tube. She thinks she’s about to be the first guinea pig in an experimental operation that Forssmann has devised and enters the operating theater tentatively handing over the catheter. 
But all was not as it seemed. Forssmann tied the nurse to the table but not because of what the nurse feared. 
In reality Forssmann planned to operate on himself. He was preventing the nurse from intervening or running off for assistance. 
Forssmann cut open the skin on the inside of his left elbow. He then used the blade to dissect through to the antecubital vein which runs along the upper arm. He opened it up and pushed the catheter into it. It slipped up through the vein and headed toward the heart. 
At this point Forssmann untied the protesting nurse and asked her to take him to the fluoroscopy room. He wanted an x-ray of his body. 
The scan showed that the catheter had not yet penetrat
Part of 5/23

ir fears and anxieties. 
That might sound odd but remember emotions and actions seriously impact the physical heart’s operation. 
For instance stress and anxiety can actually damage heart tissue. This occurs because the body responds to them by constricting blood vessels. This increases heart rate and blood pressure. The result of all this sustained pressure in the long run is damage to the heart. 
There’s also statistical evidence that the heart is highly sensitive to emotional stress. 
At the start of the twentieth century statistician Karl Pearson observed that spouses often died within a year of their partner. In many cases the cause of death was a heart-related illness. 
Simply put then broken hearts can cause heart failure. Jauhar has seen a related phenomenon at his own practice. He’s of the opinion that loveless marriages can contribute to heart disease. 
You might think that the notion of emotional stress causing heart disease sounds far-fetched but in medical circles it’s an
Part of 3/23

as symbols of loyalty and bravery. The very word “courage” is derived from the Latin word for heart “cor.”  
The logical consequence of this metaphor is that people with small hearts lack courage and strength. This might result in them admitting defeat early on when beginning difficult tasks. 
Interestingly this metaphor stretches much further than the cultures of Europe. Take Jauhar’s grandmother as an example. She used to regularly chastise her family telling them to "take heart” when she felt they were about to give up on a venture. 
Most famously of course the heart is a metaphor for love. It’s been that way since the Middle Ages. In fact the connection between heart and love is so strong that if you ask people what image they associate most with love they’ll likely visualize a valentine heart. 
There’s even a scientific name for this shape. It’s called a cardioid and you see it everywhere in nature – certain leaves flowers and seeds all occur as cardioids. 
One such example is the
Part of 4/23

 silphium plant. Its heart-shaped seeds were used throughout the Middle Ages as a natural contraceptive. 
It may be because of this usage that this particular heart shape became so linked with courtship and sexual behavior. 
The heart shape found its way into courtship paintings of the era and from then on the cardioid heart has become the symbol of romance in the West. 
“Today we know that emotions do not reside in the heart per se but we nevertheless continue to subscribe to the heart’s symbolic connotations.” 
Emotions affect the heart even leading to emotional heart damage. 
Despite Jauhar’s failed youthful exploits he nonetheless realized that medical practice would be his career. He trained to become a cardiologist and eventually started working in New York. 
He soon discovered that his work consisted of much more than recommending healthier diets and exercise or performing surgery when required. Often he would help patients by talking about emotional matters such as the
Part of 0/23

Heart (2018) examines an organ that has baffled humanity for centuries. Be delving into the history of the heart both from a biological and a cultural perspective it explains why the heart plays such an important role in human history.
Part of 1/23

What’s in it for me? Get intimate with the workings of the heart. 
The heart one of our most important organs has long been a symbol of life love and emotions. In fact   the heart was seen as so important that the ancient Greeks maintained a cardiocentric view of the body; they held the heart responsible not just for emotions but for the very process of critical thought. 
These blinks will give you a peek into the curious history of the heart as an organ that sustains lives but also as a symbol that has inspired cultures the world over.  
A short warning before we begin: The following blinks contain graphic descriptions of surgeries and experiments using animals. 
In these blinks you’ll learn 
what a Japanese octopus pot has to do with heart disease; 
how one eccentric young surgeon decided self-surgery was the way to advance science; and 
why the problem of fatty plaque in the arteries just vanished with a puff. 
The heart has been a symbol of human emotions ever since the
Part of 2/23

Middle Ages. 
Children love exploring the world around them and figuring out how it works. The author Sandeep Jauhar was no different. As a teenager he once decided that for a school science project he would measure the electrical signals emanating from a frog’s heart. To do this he’d have to dissect one. Unfortunately all he ended up doing was causing the frog a tremendous amount of pain. 
It was at that moment the Jauhar’s mother found him weeping at what he’d done to the poor creature. 
She tenderly explained to him that his heart was too small to take on a task that required such developed empathy: a small heart wouldn’t yet be courageous enough. 
Jauhar’s mother was tapping into a well-worn metaphor but that doesn’t make it any less potent – for centuries the heart has been associated with feelings such as courage. 
It was in Renaissance Europe that the heart first began to be seen as the seat of human courage. Consequently depictions of hearts found their way onto coats of arms
                    Catch and Kill
Part of 32/33

 threat of exposure during Farrow’s investigation.  
The precise extent to which this influenced executives’ decisions is open to debate. It’s easy to believe however that they acted on an old proverb: those who live in glass houses shouldn’t throw stones.  
“This precarious culture of secrecy made NBC more vulnerable to Weinstein’s intimidation and enticement.” 
Final summary 
The key message in these blinks: 
In late 2016 Ronan Farrow began work on an investigative series for NBC about undercover stories in Hollywood. One name kept coming up in his calls – Harvey Weinstein. When an actress alleged that the studio head had raped her Farrow decided to look into the case. Over the following year he spoke to Weinstein’s many victims and gathered compelling evidence of his predatory sexual behavior. As he moved to publish his findings however NBC attempted to kill the story. After publishing it in the New Yorker Farrow discovered a compelling explanation: the network had its own
                    Catch and Kill
Part of 33/33

culture of complicity.   
Got feedback? 
We’d sure love to hear what you think about our content! Just drop an email to remember@blinkist.com with the title of this book as the subject line and share your thoughts! 
What to read next: She Said by Jodi Kantor and Megan Twohey 
Farrow wasn’t the only reporter looking into Weinstein. Five days before his article appeared in the New Yorker Jodi Kantor and Megan Twohey published their own account of Weinstein in the New York Times . Just as Farrow’s story led to discoveries of wrongdoing at NBC the Times piece opened a Pandora’s box. 
Over the next 12 months Kantor and Twohey documented dozens of cases of sexual harassment and abuse. One case stood out: Christine Blasey-Ford the woman who came forward to testify that US Supreme Court nominee Brett Kavanaugh had assaulted her decades earlier. What happened next? Check out our blinks to She Said to find out.  
                    Catch and Kill
Part of 30/33

gue detailing his inappropriate advances toward her.  
The network’s executives stated that they were shocked and emphasized that this was the first they’d heard of Lauer’s behavior. NBC’s employees weren’t nearly as surprised as their managers claimed to be. As everyone who worked with Lauer knew the host had been behaving inappropriately for years. He had given coworkers sex toys as presents played “fuck/marry/kill” on open mics during commercial breaks and constantly hit on female coworkers.  
There was also talk of more serious wrongdoing. As producer Rich McHugh said in a meeting after Lauer’s dismissal “Prior to Monday a lot of us have heard rumors of stuff about Matt – let’s just say that.” Rattled by the Weinstein affair NBC staffers pressed management. Was NBC aware of these rumors?  
Kim Harris gave a careful answer. No she said there were no formal records of any complaints. That wasn’t the question though. What NBC’s employees were asking was whether management knew about t
                    Catch and Kill
Part of 31/33

hem not whether they’d recorded them. Had NBC ever paid women to sign nondisclosure agreements? Harris didn’t seem sure. “Umm ” she said “no.” 
In fact NBC brokered no fewer than seven nondisclosure agreements after 2011. Among the signees was a woman who alleged that Lauer had coerced her into sex in his office in 2001. When she passed out she claimed Lauer’s PA took her to a nurse. Another woman alleged that Lauer had raped her during her time reporting on the 2014 Sochi Winter Olympics.  
After an internal investigation headed up by Harris reaffirmed management’s claims not to have known about any of this one of the investigators – William Arkin – reached out to Farrow. He was troubled. During the investigation two sources informed him that Weinstein had said he was aware of Lauer’s behavior and capable of making it public.  
NBC denies that this threat was ever communicated but there is no doubt that the allegations against Lauer and NBC’s use of nondisclosure agreements came under