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Week 9. HF = heart failure

Starling's Law: the healthy heart can handle precisely the volume of blood brought to it by veins. The greater the volume and fiber length, the more Romeo-and-Juliet-like actin and myosin behave, and the heart pulses as hard and fast as necessary to pump all of one's blood through the body once in one minute.

In the failing heart, Starling's law breaks down. In 40 minutes, death from pulmonary congestion can occur. (Some online instructor, long ago, thought it funny to include a picture of a tombstone in green grass on this particular PowerPoint slide. Incidentally, the Chinese call marriage the dirt grave of love.)

Do people still believe in love? Surely, some do, because there's such a thing as broken heart syndrome. Sadness -> stress hormones -> vascular constriction -> chest pain, shortness of breath, hypotension, arrhythmia, possible heart failure. It is literally possible to feel one's heart break, over and over, years apart, especially since humans rarely mate for life.


Neither do starlings, highly social, beady-eyed birds that lay perfect blue or white eggs. A puffed-up ball of feathers looks approximately heart-shaped, aorta and all. A flock of starlings is called a murmuration.

A heart murmur can be innocent or pathologic. Listen to heart valves with the cold diaphragm of a stethoscope pressed against the warm mound of skin, flesh and bone protecting a patient's heart from the cruel world.

A doctor can prescribe alpha, beta, calcium channel blockers to dilate blood vessels; diuretics to reduce blood volume; and ACE inhibitors and angiotensin receptor blockers to do both. But what can heal a broken heart? Stars in the night sky, turning seasons, over-the-counter time.

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