From care to emotions: the long journey of the heart and how to protect it

It is the first organ to form and the last to stop: it beats about 100,000 times in a day pumping 7500 litres of blood, in an entire lifetime that's 2.5 billion beats, and the amount of blood pumped could fill 90 Olympic swimming pools. This evidence is enough to remind us that the heart is the real engine of our lives, not only biologically but also emotionally: who has never experienced the feeling of having one's 'heart in one's throat' when falling in love? This is why Massimo Massetti, a well-known heart surgeon at the Policlinico Gemelli in Rome with 6,000 surgeries behind him, and Alfonso Dell'Erario, a leading journalist in the world of economics and social issues, could not have found a more apt title - "Sua maestà il cuore" (Cairo editore) - for the book they have written together and which is now available in bookshops.

This book is not simply an essay, nor just a valuable vademecum with 'instructions for use' and various practical tips, but is above all a fascinating journey, almost a novel, between science, history and clinical experience to understand how the heart works, why it gets sick and how we can protect it. But also to discover something fundamental, namely that emotions are inextricably linked to our health and that happiness is a life-saving medicine.

That the heart was the most important organ of all was already clear - as the two authors tell us - to the most ancient civilisations: from the Egyptians to the Greeks and Romans right up to the Renaissance when Galen's theories began to be superseded and Leonardo depicted it in numerous drawings. Then in the last fifty years came the revolution: it started with heart attacks when 'for the first time, it was no longer the symptoms that were treated, but the cause', as with hypertension and heart failure where the breakthrough of new drugs arrived. But 'if the eighties of pharmacology were the triumph of chemistry,' the book says, 'the following decade saw the rise of physics and hydraulics applied to biology': here the turning point came with stents or techniques such as the Tavi (trans-catheter implantation of the aortic valve), which aimed at a real paradigm shift, namely that of 'repairing the engine without opening the bonnet'. Revolutions that are also changing the skin of the heart surgeon, who in the 1990s was seen as a 'demigod' capable of 'stopping the heart, opening it up, repairing it and restarting it', but is now being refined by entering the era of micro technology and robotic surgery. With the future pointing to an even more ambitious frontier: 'Don't repair the damage, but repair it genetically'. Because as this fine volume explains, the epic of cardiovascular medicine is also 'the story of men and women who have not yet accepted that the heart, the engine of life, was an untouchable mystery and decided to learn how to repair it while it continued to beat'.

This long and exciting story is also enriched by Massetti's special encounters with patients who changed his professional life when he was a young resident in France: from 27-year-old Ismail to 97-year-old Luisa. Experiences that have made the doctor reflect on the way of treating, in which the focus must shift from the individual disease to the person as a whole, also because taking care of the patient - and not only of the pathology - is the real key to overcoming the current crisis of the health service. Without ever forgetting the role of emotions and feelings because the heart grows old 'when one loses the ability to rejoice, laugh and live life to the full'.

"I put my own experience into this book. In forty years of experience and encounters with many patients, I have realised that if these people had known the few secrets of the heart before they became ill, they would most probably have avoided becoming ill. That is why I decided to write the story of this organ to which we owe the utmost respect because it is the organ of life,' warns Massetti, who also looks at the need for a new organisation of care. A point on which Dell'Erario also insists: 'If we want to save the SSN, which is such a precious heritage and a guardian of democracy, we must change the paradigm of care: the person and not the pathology must be taken care of. Today everything is focused on a single service and instead a pathway of care must be designed around the patient. It is a problem of organisation'.