The heart, often called the engine of life, has long been at the centre of medical debate and intervention. With age, it undergoes changes as natural as greying hair or dimming eyesight. Coronary artery disease (CAD) is one such transformation, in which the vessels supplying blood to the heart gradually develop blockages. Yet despite the familiarity of the term, CAD continues to surprise us with paradoxes and uncertainties that blur the boundaries of medical understanding.
It is not uncommon for a person with seemingly normal arteries to suffer a sudden heart attack. Equally puzzling, some with severely blocked arteries live well into their eighties without major complications. To make matters murkier, even the gold standard diagnostic tool—angiography—can be inconsistent. A single angiogram, interpreted by different cardiologists or even the same doctor at different times, often yields varying readings. This raises a troubling question: how precise is our understanding of cardiac risk?
One of the marvels of the human body is its adaptability. When arteries narrow, the heart sometimes creates natural bypasses—collateral vessels—that allow it to function without obvious symptoms. Surgical procedures, meanwhile, may dislodge plaque, with debris occasionally travelling elsewhere in the body and causing harm. The principle is not unlike waste management in a city: garbage is not destroyed but shifted elsewhere.
Interventions such as bypass surgery and angioplasty are often lifesaving, yet they come with caveats. Studies in journals like The New England Journal of Medicine suggest that every procedure releases microscopic debris into the bloodstream, leading to subtle brain damage in all patients. In more than half, this manifests as symptoms ranging from depression and memory lapses to, in rare cases, stroke.
Stents bring their own paradox. While arteries are designed to contract and expand rhythmically, stents lock them in place. This artificial rigidity, though often necessary, interferes with the vessel’s natural rhythm.
Even medical literature has admitted uncertainty. Harrison’s Principles of Internal Medicine itself notes that the precise benefit of bypass surgery remains unresolved. Possible explanations for perceived improvement include:
- Placebo effect: After investing lakhs of rupees—or selling heirlooms to pay for treatment—patients are naturally inclined to feel better.
- Sensory disruption: Surgery sometimes severs nerves, reducing pain perception though disease persists. Like closing one’s eyes on a sharp bend, the risk remains, but fear recedes.
- Infarction of diseased tissue: The damaged part of the heart may simply die, silencing the nerves that once cried out in pain.
Cardiac interventions are not as modern as people assume. Angiography dates back to the 1950s, bypass surgery followed soon after, and angioplasty in the 1960s. Yet the idea of bypass surgery itself was first floated in 1899—over a century ago. Despite decades of practice, many procedures still lack the full scientific certainty medicine strives for.
Drugs, too, are double-edged. Beta-blockers, ACE inhibitors, and calcium channel blockers all reduce the heart’s workload. But by dampening its force and frequency, they sometimes restrict its own nourishment. In trying to protect, they may paradoxically weaken.
Where then lies real protection? Again and again, the evidence points to basics: wholesome food, movement, stress management, and mindful living. Diets rich in fruits, vegetables, legumes, nuts, and whole grains build resilience. Cutting processed foods, excess salt, and trans fats protects both the heart and body. Omega-3s from flaxseed, walnuts, or oily fish further strengthen arteries.
Movement is equally vital. Brisk walking, swimming, yoga, or even frequent short strolls counteract the dangers of sedentary living. Stress, meanwhile, is a silent killer. Meditation, prayer, or simple breathing practices restore balance, while seven to eight hours of sound sleep lets the body repair. Add to this the timeless wisdom of avoiding tobacco and limiting alcohol, and one has a simple but powerful prescription.
Ultimately, the heart ages like the rest of the body. A diseased heart is not always a death sentence, nor is a healthy one a guarantee of immortality. What matters is acceptance, balance, and the refusal to let fear dictate choices.
As one doctor tells his patients, three simple mantras capture the truth:
- “Allah merman, toh insaan pahlwan”—with divine grace, humans can remain strong.
- “Ram rakhega, toh mujhe koi nahi chakhega”—protection lies in higher hands, not merely in medicine.
- “Ram chakhega, toh doktor ko bhi koi nahi rakhega”—when destiny calls, no intervention can stand in the way.
The science of the heart is layered with paradoxes. But amid uncertainties, a path of balance emerges—one that blends modern knowledge with timeless wisdom. By embracing wholesome living, managing stress, and accepting ageing as a natural process, we offer our hearts the greatest protection possible. Medicine has its place, but true healing often resides in the harmony of body, mind, and spirit.
