During a recent dinner at a friend’s home I was introduced to a young lady as a heart surgeon. After a few pleasantries, I was asked a stock question. Can you mend broken hearts? I resisted the temptation to reply with my stock answer. In a slightly more intimate situation I would have said ‘only on the rebound’.

In our poetry all sorts of things can happen to the heart. It can burn, it can burst into a thousand pieces it can beat fast, it can stop beating and it can break. It can also be given away or even lost.

During much of human civilisation the heart has been thought of as the centre for most human emotions. Urdu poetry is replete with references to the heart both in sorrow and happiness. During my lectures to final year MBBS students on cardiac surgery I often quoted a verse from Mirza Ghalib to illustrate one of the risk factors for heart problems.

Without going into a literary discourse, Ghalib’s verse suggests that constant sadness created a ‘black spot’ on his heart. This black spot could well be compared to what we see in a heart after a heart attack. The point is that any form of extreme stress including sorrow, sadness, anger, fear and a host of other such feelings can induce a heart attack. Clearly stress comes in many different forms and shapes.

It has been difficult to prove that long standing ‘stress’ can lead to blockages of heart arteries that lead to a heart attack. Here it is important to explain what exactly a heart attack is. An artery supplying blood to a part of the heart muscle becomes narrowed decreasing the amount of blood going through it.

The first ‘symptom’ of such a narrowing is usually chest pain or discomfort associated with exercise. The pain occurs because exercise increases the need for blood but the narrowing of the artery prevents that from happening. When heart muscle does not get enough blood, it sort of cries out in pain.

That pain is called angina of exertion and usually stops when the exertion stops. However sudden and extreme stress can make the narrowed artery close down completely and cut off blood supply to a part of the heart. If this loss of blood is not treated it can lead to permanent damage to the heart muscle. That is a heart attack.

Stress comes in many forms and produces certain changes in the body. Sudden stress produces what is often referred to as the ‘fight or flight’ response. All of us have gone through such a response. The sudden noise, the almost car accident, or any other form of perceived danger makes our heart beat faster, our blood pressure goes up and a host of other changes occur. These changes are due to release of stress hormones that essentially prepare our bodies to fight or run away from the source of danger as efficiently as possible.

Once the danger or threat is over, the body calms down and things revert to the normal. Here it is important to emphasise that this response is instinctive and cannot be suppressed entirely. If the danger persists then changes will occur that can eventually damage the body.

The reason why all this came to mind was the recent public protests in response to a decision by the Supreme Court of Pakistan. The Honourable Chief Justice of Pakistan (CJP) presided over the bench that passed the verdict. A few days after that decision the CJP underwent an angioplasty at a local hospital.

Here a little bit of explanation. Virtually nobody ever gets just an angioplasty any more. This procedure that is used to open up a blocked heart artery is almost always combined with a stent placement. The stent is a medicated metal mesh tube that when expanded keeps the artery open.

Based upon the timing of the procedure we can speculate that what happened after the decision might have created the ‘stressful’ situation that necessitated the ‘angioplasty’. However it is important to point out that the blockage in the heart artery was definitely present before the court passed its judgment. It is also important to point out that having a response to a stressful situation is a normal biological reaction and does not in any way suggest any personal weakness.

We don’t know the details of the CJP’s medical history and what exactly happened that led him to seek medical attention. But it was most likely some form of chest pain that could be part of what is now referred to as an Acute Coronary Syndrome or even the beginning of a major heart attack (myocardial infarction). Whatever it was, the CJP was treated in a timely fashion and by God’s grace is evidently doing fine now.

The health of the CJP is a matter of great concern to many of us considering the important initiatives he has taken upon himself and the relatively short time left in his tenure. Any serious medical problem lasting longer than a few days would have been problematic.

My point is that the health of our leaders both in the public as well as the private sector is important and proper medical care including screening for preventable and treatable medical problems should be done to assure their continued good health.

I realise that it is a person’s right to accept or reject medical treatment. But public officials have an obligation to assure as far as is possible that they are physically well enough to fulfill their professional obligations. In this connection I have previously discussed the importance of the state of health of our political leaders.

Here again I must admit that I have no personal knowledge about the past and the present state of health of the CJP. But I do hope that he has been taking good care of his health and has had the basic screening tests done that any male of his age should go through depending on lifestyle choices and family history.

As a physician, I will suggest that in general most men should by the time they hit the sixty year age and in certain cases even earlier undergo a ‘full’ physical examination and a basic set of tests. These include blood pressure measurement, an ECG, chest X-Ray, blood tests for cholesterol levels and for blood sugar levels. Also a test for Hepatitis C is advisable for those that might have received a blood transfusion.

Concerning heart disease involving heart artery blockages, I have seen too many people in Pakistan that seem to have no obvious ‘risk factors’ but still develop heart problems. So, I suggest to most people that some form of an assessment of the state of heart arteries should be done for most men and importantly also women in their sixties.

And finally, back to the broken hearts. Indeed one of the complications of a major heart attack is the rupture of heart muscle. These are the real broken hearts and rarely do such people survive the heart break to even make it to a hospital.