Readings

Today, patients with heart failure can be kept alive by an artificial heart while they await a heart transplant. These modern artificial hearts, or left ventricular assist devices (LVADs), remove the patient’s discernible pulse while still maintaining life. This technology contradicts physiological, historical and sociocultural understandings of the pulse as central to human life. In this essay, we consider the ramifications of this contrast between the historical and cultural importance placed on the pulse (especially in relation to our sense of self) and living with a pulseless LVAD. We argue that the pulse’s relationship to individual identity can be rescripted by examining its representation in formative cultural texts like the works of William Shakespeare. Through an integration of historical, literary and biomedical engineering perspectives on the pulse, this paper expands interpretations of pulselessness and advocates for the importance of cultural—as well as biomedical—knowledge to support patients with LVADs and those around them. In reconsidering figurative and literal representations of the heartbeat in the context of technology which removes the need for a pulse, this essay argues that narrative and metaphor can be used to reconceptualise the relationship between the heartbeat and identity.

Hansen, Claire, & Stevens, Michael Charles. “Be still, my beating heart: reading pulselessness from Shakespeare to the artificial heart.” Medical Humanities, vol. 47,no. 3, pp. 2021344–353. https://doi.org/10.1136/medhum-2020-011962

https://mh.bmj.com/content/47/3/344 

Heart rate has natural fluctuations that are typically ascribed to autonomic function. Recent evidence suggests that conscious processing can affect the timing of the heartbeat. We hypothesized that heart rate is modulated by conscious processing and therefore dependent on attentional focus. To test this, we leverage the observation that neural processes synchronize between subjects by presenting an identical narrative stimulus. As predicted, we find significant inter-subject correlation of heart rate (ISC-HR) when subjects are presented with an auditory or audiovisual narrative. Consistent with our hypothesis, we find that ISC-HR is reduced when subjects are distracted from the narrative, and higher ISC-HR predicts better recall of the narrative. Finally, patients with disorders of consciousness have lower ISC-HR, as compared to healthy individuals. We conclude that heart rate fluctuations are partially driven by conscious processing, depend on attentional state, and may represent a simple metric to assess conscious state in unresponsive patients. 

Pérez, Pauline, Madsen, Jens, Banellis, Leah,  Türker, Bașak,  Raimondo, Federico, Perlbarg, Vincent, Valente, Melanie, Niérat, Marie-Cécile, Puybasset, Louis,  Naccache, Lionel, Similowski, Thomas,  Cruse, Damian,  Parra, Lucas C,  Sitt, Jacobo D. “Conscious processing of narrative stimuli synchronizes heart rate between individuals.” Cell Reports (Cambridge), vol. 36, no. 11, 2021, pp. 109692–109692, 

https://doi.org/10.1016/j.celrep.2021.109692 

When actress Debbie Reynolds died a day after her beloved daughter, Carrie Fisher, the world diagnosed it as 'heartbreak'. But what's the evidence? Does emotional upheaval affect the heart? Can love, or chocolate, really heal our heart problems? And why do we know so much about heart attacks in men, when they are more fatal in women?

Heart and lung surgeon Dr Nikki Stamp takes us into the operating theatre, explaining what she sees in patients with heart complications and how a life-saving transplant works. Stamp fell in the love with the heart as a child and continues to be fascinated by its workings and the whole-of-life experiences that affect it. Rich with anecdotes, and insights for maintaining heart health, Can You Die of a Broken Heart? is a blockbuster from a uniquely positioned young specialist.

Stamp, Nikki. Can You Die of a Broken Heart? A heart surgeon's insight into what makes us tick. Murdoch Books, 2018.

Background: Patients with mechanical circulatory support devices regularly experience positive and negative emotions which are reinforced through interactions with their device. We explored emotional relationships between patients and their MCS devices through the names they assign to those devices.

Objectives: We sought to characterise device naming and suggest future developments which might capitalise on the naming phenomenon to improve patient wellbeing.

Methods: Qualitative online ethnography extracted comments on device names and emotions from a social media group. Thematic analysis grouped the comments according to their explicit or implied emotions, and their potential consequences for designing future MCS treatment.

Results: Thematic analysis identified 28 codes to characterise the names, from which we inferred 4 main themes for proposed emotional relationships. They centred on humour, coping, improving acceptance for family and friends, and reclaiming agency.

Conclusion: We suggest that by deliberately considering these factors in future research and development, clinicians and device manufacturers have scope to improve patient wellbeing.

Wrigley, Prof. Cara, et al. “Patient names for mechanical circulatory support devices: developing emotional insights.” Heart & Lung, vol. 50, no. 6, Elsevier Inc, 2021, pp. 953–67, https://doi:10.1016/j.hrtlng.2021.08.003 . 

The heart is an iconic symbol in the medieval and early modern European world. In addition to being a physical organ, it is a key conceptual device related to emotions, cognition, the self and identity, and the body. The heart is read as a metaphor for human desire and will, and situated in opposition to or alongside reason and cognition. In medieval and early modern Europe, the "feeling heart" - the heart as the site of emotion and emotional practices - informed a broad range of art, literature, music, heraldry, medical texts, and devotional and ritual practices. This multidisciplinary collection brings together art historians, literary scholars, historians, theologians, and musicologists to highlight the range of meanings attached to the symbol of the heart, the relationship between physical and metaphorical representations of the heart, and the uses of the heart in the production of identities and communities in medieval and early modern Europe.

Barclay, Katie, and Bronwyn Kate Reddan. The feeling heart in medieval and early modern Europe : meaning, embodiment, and making . De Gruyter, 2019.