The Heart Healers Read Online Free Page A

proved futile. When the knot extended to beneath her breastbone, she began to imagine more fanciful explanations. Could the moist salt air and the morning auto exhaust wafting over from Pacific Coast Highway cause chest pain? Could her discomfort be psychological, precipitated by her worry about a bully at Benjamin’s school? No, it wasn’t just in her mind, because the knot was now a small insolent fist, more insistent and more menacing with each run. It was time to see a doctor.
    Greta and Tyler’s drive to my office took her east on Sunset Boulevard past colossal mansions worth tens of millions of dollars. Turning south in a few minutes, a massive eight-story, two-square-block, granite-brown building rose to dominate their view. Its central segment, crowned with a Star of David, stood astride the corner of Gracie Allen Drive and George Burns Road. The unusual street names bespoke a subtle reminder of the prodigious financial support given to Cedars-Sinai Medical Center by the tiny city that surrounds it. Walking the corridors to my fifth floor office, Greta and Tyler would discover that every public corridor is a museum of contemporary art, where huge Rauschenbergs compete with Warhol prints.
    Greta made a gallant effort to smile brightly as she stood to greet me in my office, but the smile had already vanished before she spoke. As she sat she brushed a nonexistent hair from her forehead, then clasped her hands tightly in her lap. Greta was shouting fear and anxiety without speaking. So instead of talking about her symptoms, I started with family. I talked about my years coaching Little League, and moved on to ocean sports. Her son, Ben, was starting Little League and her husband Tyler was a surfer, she said, with a big smile. Now we were ready to talk about walks along the ocean and jogs in the hills.
    I started with her history. Greta didn’t smoke, was still menstruating, and had no history of high blood pressure or diabetes. She had never had her blood lipids checked. Her father had died suddenly at age fifty-seven from a heart attack in the past year. Her mother was in good health; she had no siblings.
    In diagnosing the cause of chest pain we begin with uncertainty. At one end of the spectrum Greta’s pain could be related to a psychological stress, such as her worry over her son. Or perhaps her father’s recent death from heart attack had caused her to obsess over her own risk. At the other end of the spectrum, coronary artery disease (CAD) might be the cause of her symptoms. I knew from large databases like the famous Framingham, Massachusetts, study that a thirtysomething-year-old woman with Greta’s demographics has less than 1% probability of having CAD. This woman also had chest pain, which increased the probability of disease, but by how much? In cardiology on most days, I find myself standing at the intersection of science and art, where objective probability meets subjective uncertainty.
    I asked Greta about her chest pain. Angina, the pain caused by CAD, has three principal characteristics. Greta had all three. Her pain was located behind the sternum, brought on by exercise, and rapidly relieved by rest. The probability of CAD increases with the number of characteristics, and since she had all three, Greta had “typical angina.” If we examine all people with typical angina, 90% have coronary disease. For a young woman who begins with a less than 1% probability of disease, typical angina and a positive family history raises her probability of having coronary disease to about 50%.
    I reached toward her and said, “Come, I’ll examine your heart.”
    The hospital is elegant; the examining rooms are not. Greta glanced around the tiny six-by-eight-foot room with its spare undecorated white walls, resting her eyes on the narrow, lumpy three-piece examining table, with a step stool at its base. Her anxiety again filled the room as she sat with her legs dangling uncomfortably from the examining table. I