Heart Strings: As Understood by a Prosector and Romantic

I will never forget the first time I held a human heart.

Although it was stiff and strangely plastic due to the embalming process, it was unmistakably fragile. The heart protected within the cage of my own ribs was divided: it both fluttered with curiosity and ached with the gravity of mortality. I imagined the moments this heart had pumped through; the immense human suffering, unbridled joy of being alive and the fleeting moments of happiness before it stopped forever. I lost track of my own heartbeat.

How was a twenty year old supposed to comprehend the eighty-seven year old heart belonging to the deceased? It was an existential quandary in the midst of trying to grasp the responsibility of refurbishing this heart, transforming it into a learning aid. Heart in hand, I remembered myself after being met by a sea of sparkling eyes staring at me from behind surgical masks and shields. Well practiced in stoicism, I remembered that I had a job to do. The person who once animated the body in front of me had chosen to give this gift. The only way I could honour that decision was to do exactly what was asked of me; learn from the dead in order to serve the living.

I let my emotions float away as my analytical brain came online. Mentally dissecting every step prior to picking up my scalpel, my mind flipped though the countless notes and textbooks I had studied. I recalled the complexities of the machines engineered to temporarily replace a heart stopped for surgery, which after observing a triple bypass a few years prior, I now understood. There was no debating that a healthy human heart is the far superior machine. I started to see the heart in my hand as a collection of cells, tissues and systems. It was a challenge to avoid getting lost in the complexities and intricacies, as my mind zoomed in on the endless labyrinths within. My thoughts became efficiently reductionist. This heart was unique to every diagram or model that I had studied, but all the parts were present.

Dodging partially deflated coronary arteries and veins, I sliced a window into the left ventricle. The resistance my blade met was similar to that of well salted salmon flesh. Tenderly peeling back the dense muscles, I tried to minimize the Velcro like ripping of muscle fibers. Hiding from me under the junction between the atrium and ventricle were a collection of white fibers, desperately clinging to their blanket of muscle. A hidden smile spread under my mask. I whispered with great admiration, "chordae tendineae." The professor supervising the operation, no doubt familiar with my awe, encouraged me to pluck the little white tendons. Gingerly, with my gloved pinky finger, I strummed. "They feel like harp stings!" With knowing eyes well etched by laugh lines, the professor grinned, "well, you ARE pulling on their heart strings." In response to the worthy pun, our group let out an academic chuckle. It eased the tension like a puff of air from a pressure cooker. With my logical brain drunk on putting knowledge into practice and seeing the puzzle laid out in front of me, the remaining time in the lab soon evaporated.

It was not until a cold hand with freshly painted red nail polish slipped off the table and fell into mine that I was sobered by emotion. I continued to hold the hand as my thoughts stuttered to ask, Who? W-w-why?

My grandmother used to ask me to "quit pulling on her heart strings", right before she enveloped me in a hug. After realizing that I had actually tugged the heart strings of a body someone likely recognized as their grandmother, my head spun and I felt slightly nauseous. While my logic centres had been satiated, it was as if the low fuel light had illuminated my brain's dashboard with a chime. I became acutely aware that something was missing. My thoughts continued to loop back to the hours I had spent dissecting the heart. I spent many sleepless nights pondering heart strings: the anatomy, how they became an expression for evoking our deepest emotions and affections, and the role heart strings played in my own life. The tugging could not be ignored, heart strings beg to be explored.

Our hearts start beating when we are in the womb, at around six weeks old, and they will continue to beat until the day we die. CPR during cardiac arrest or a Cardiopulmonary Bypass Circuit during open heart surgery can be temporarily substituted for a heartbeat, but neither are permanent solutions. If oxygenated blood fails to reach and nourish the brain, it could take as little as five minutes before we are pronounced dead.

The four chambers of the heart, two ventricles and two atria, work collaboratively with a network of vasculature to ensure that blood meets the body's oxygen demands. This dependance on blood includes the heart itself which sips oxygenated blood from coronary arteries in order to keep pumping. The flow of blood relies on pressure differentials, where it cascades from a higher pressure to a lower pressure. The heart is like the initial elbow of a water fall, instigating the change in flow that the rest of the system is forced to obey.

The heart being in charge of traffic, employs two electrical conductors: the SA node and the AV node. The SA node sits on the roof of the right atrium and signals when the muscles in atrium should contract. When the atrium does contract, it pushes out the trickle of spent blood to the right ventricle, which was initially delivered to the atrium by the lazy river of veins. The message to contract eventually reaches the AV node, where the signal is slowed and causes the denser ventricles to contract. When the ventricles contract, the blood is launched towards the lungs and the rest of the body through bullet train arteries. Just like during a concert, the VIPs sitting closet to the stage are rewarded faster and more intensely than the majority of fans in the cheap seats.

The mechanical ability of the heart to pump relies on structures that ensure the flow remains moving in one direction; from atria to ventricles to arteries. In the fibrous junction between the atria and ventricle, on both sides of the heart, sit valves. The tricuspid valve is on the right and the bicuspid (mitral) valve is on the left. Connecting these valves to the populous muscles of the ventricles, are the chordae tendineae. In many diagrams chordae tendineae often look like the cables of a parachute that allow the fabric to catch air and ascend towards the sky. When the ventricles are prepared to eject the blood to the rest of the body, they contract and pull on the chordae tendineae. The chordae tendineae allow the valves to inflate which prevents a tsunami of ventricular blood from breaching the valves and pushing blood backwards into the atria. Our heart strings keep our blood moving forward in the right direction. Our chordae tendineae are robust and trustworthy parachutes. Our heartstrings are our life lines.

Lub - The ventricles contract and the valves reinforced by taut heartstrings barricading the atria, clash with angry blood. Dub - The blood pushed from the ventricles are locked out of the heart and forced to move on to the network of arteries awaiting. There is so much drama and finesse in the allegretto tempo of a heartbeat.

A reference to heart strings conveys something so intimate and personal that it often evades greater explanation. However odd it might sound, after experiencing it for yourself, the idiom resonates. That feeling lives in the moments when we acknowledge everything we stand to lose, to be met with a crushing feeling in our chest that reminds us that we are increasingly mortal with each passing beat. When you become painfully aware of your own heartbeat, reality assaults you. However uncomfortable, there is something paradoxically addictive and sobering about being reminded of the preciousness of life and the people we get to walk it with. The feeling of plucked heart strings is undeniably visceral.

The term heart string first originated in the 15th century, when medical professionals struggled to name the nerve they believed to allow the brain to act as the heart's puppet master. Drawing inspiration from other previously named anatomy, such as the hamstring, they adopted "string" as a suffix to "heart". String was also applied to name other groups of tendons throughout the body. In some dialects this trend extended to the heel string, which we more commonly know as our Achilles heel. The relation between hearts and heels is fitting, since many view them as our weaknesses.

We can appreciate the many variations on the word string: a ball of string, a string of thoughts, guitar strings, or a string of events. The word string is always underlined by connection. Our existence depends on the countless connections our heart makes within our own bodies, as well as the connections it makes to external life. One connection is more physical while the other is more emotional, yet both are equally important to the creation and maintenance of our lives.

Some have hypothesized that if we were to dissect the smallest building blocks of life, molecules, atoms, nuclei, neutrons and quarks, we would eventually come across tiny vibrating string-like filaments. This theory, known as the String Theory, essentially suggests that everything we know to exist, is merely a collection of strings vibrating in slightly different patterns. Thus, at the true core of matter, are a dancing symphony of cosmic strings masquerading as solid objects on our scale. Essentially, everything that ever was, is and will be, is made up of strings. We may never truly understand these incomprehensibly small string filaments, but we have plenty of tools at our disposal to explore the connectedness of life. Perhaps the best place to start is by examining the functional chaos within ourselves that we often claim to have a degree of control over; the connection between mind and body.

The most glaring example of this connection might be Broken-Heart Syndrome, also known as Takotsubo Cardiomyopathy. Dying from heart break is a medically confirmed possibility. Even more surprising though, the shape of a broken heart resembles an octopus trap! First discovered in Japan in 1990, Takotsubo Cardiomyopathy's name was based on the heart's unconventional and pathological shape. This syndrome mimics a heart attack with chest pain, shortness of breath and electrical abnormalities of the heart. Harvard Medical School predicts that at least 5% of women suspected of having a heart attack are actually suffering from heartbreak. Unlike a heart attack that is usually caused by a blockage in a coronary artery, there are no obstructions in Takotsubo Cardiomyopathy. A surge of emotions and stress hormones causes the ballooning and abnormal movement of the left ventricle. The stressors associated with this disorder vary significantly but it can happen after domestic violence, an unexpected loss, a fierce argument and severe pain. There is no standard treatment for a broken heart, in most cases it just needs time; about one month, according to experts.

Further, by measuring the time between our heartbeats, we can get a better understanding of our mental well being and psychiatric resilience. This measurement is called Heart Rate Variability (HRV). The key player in HRV is the part of our nervous system which controls our body without conscious thought. We don't have to think about controlling our heart rate, blood pressure, breathing, and digestion for our bodies to automatically regulate them.

This part of our nervous system is called the Autonomic Nervous System (ANS), and it is divided into sympathetic and parasympathetic branches. The sympathetic branch is known for producing a fight-or-flight response that ramps up heart rate and breathing rate, dilates our pupils, and inhibits our non-emergency functions (such as digestion). Our Parasympathetic branch allows balance by promoting the complete opposite. It is understood as a rest and digest response that allows bodily functions necessary for long term survival. Together, these two branches work to control our responses to stress.

In day to day life, we all encounter stressors like traffic or a disgruntled co-worker, and it is completely normal for our heart rate to increase as a result. The measure of health comes into play by considering how long it takes our bodies to recover from the stress and return to a state of relaxation. Individuals who are able to jump between feeling stressed and feeling calm quickly and frequently, have a high heart rate variability. However, those who take a long time to recover from stress and hold on to feelings of threat and panic are said to have a low heart rate variability. Research has shown that there is a link between low HRV and worsening depression or anxiety. Also, a low HRV is associated with an increased risk of death and cardiovascular disease.

Heart rate variability can track how our nervous system is reacting to the environment, as well as to our emotions, thoughts, and feelings. Conversely, our instinctual hearts may have the ability to influence our conscious thoughts while impacting the health of our brains and bodies. Obviously, our hearts are far more than just a pump.

When I think of instinctual and embodied emotion, I think of the way music affects those living with Alzheimer's. There are no shortage of viral videos where unresponsive people with Alzheimer's suddenly "come to life" when they hear the music they used to listen to when they were young. Music has a way of connecting them to who they were through singing, dancing or tapping their feet. No one can deny the emotional experience of a good song. I am sure we can all relate to the nostalgic joy of hearing the song we worshipped in high school. I also know that I can't be the only one who has cried tears alone in her car after hearing what used to be "our song" post-breakup. The emotional quality of music can trigger powerful memories and even bring unconscious ones to the surface. We can tailor our playlists to reflect our mood and encourage everything from motivation to relaxation. Orchestrated instruments and vocals can help us tune up the connection between our heart and our brain.

Alzheimer's disease is a progressive brain disorder where neurofibrillary plaques and tangles interfere with the brain cells' lines of communication. This can lead to a variety of different outcomes for a patient depending on where and how many obstructions there are. Since music activates so many different parts of the brain simultaneously, music manages to find the remaining parts that are still healthy. Music therapy has been shown to improve both cognition and motor function, all while doling out a healthy serving of "feel-good" brain chemicals. Maybe we are just programmed for rhythm and music. After all, we do have a steady metronome in our chest always keeping time.

In exploring these questions of the heart, I have come to understand that while anatomy is a fascinating exercise in understanding how our cogs fit together to create a functioning human being, it discounts our humanity. Unlike machines, we are more than a collection of working parts. We are sentient beings, gifted with the potential to feel, create and grow. Western medicine has encouraged our vessel to fit into constructed categories of disorders and dysfunctions, and is repeatedly surprised when evidence shows that our minds and bodies are connected; as with Broken-Heart Syndrome, Heart Rate Variability and Music Therapy.

I suppose this would be unsurprising to any spectator removed from our capitalistic culture. The allure of productivity is chased by asking humans to be more like robots. Many education systems designed to produce professionals capable of healing humans, encourage students to dissect bodies and understand them as a collection of mechanical parts, but rarely as a whole.

I can never deny the importance of listening to one's heart. Engaging in life in a way that pulls at my heart strings has allowed me to fall in love with the feeling of being alive. I think I have also gained some closure with the questions I had asked as I held that hand with red nail polish. Who? Everyone. Why? We are all connected.

We may just be a manifestation of vibrating strings, but choosing to play our strings no matter how unpracticed, might allow us to learn to sing and dance along to the rhythm of life. Embracing the vulnerability of our heartstrings might strike a tender chord.