Lillian Wilson

The Exquisite Machine by Sian E. Harding

'The Exquisite Machine' delves into the latest advancements in cardiac science to enhance heart health and extend longevity.

The Exquisite Machine

The book has received 4.11 ⭐️ on GoodReads.

The human heart beats with astounding precision, pulsating approximately 100,000 times every single day, propelling roughly 7,600 liters of blood throughout the body. It is a relentless performer, and its reliability is nothing short of remarkable. Due to the fact that an increasing number of individuals are expected to live beyond 100 years old, there is a growing need for cutting-edge scientific advancements in the field of heart rejuvenation.

In this review, we will explore the intricacies of this vital organ and its relationship with the ever-evolving landscape of scientific progress. Central to our discourse is the thought-provoking book ‘The Exquisite Machine’ penned by Sian E. Harding. Through her insightful work, Dr. Harding sheds light on the promising possibilities for enhancing heart health and longevity, offering a glimpse into the future of cardiac science.

Author’s background

Sian Harding currently holds the position of Professor of Cardiac Pharmacology at Imperial College London’s National Heart and Lung Institute.

Sian Harding (r)

Additionally, she serves as the Director of the Imperial Cardiac Regenerative Medicine Centre. Her academic journey includes earning a Ph.D. in Pharmacology from King’s College, London, in 1981. Throughout her career, her primary research focus has revolved around studying the functionality of cardiomyocytes in heart failure.

What is the book about?

In ‘The Exquisite Machine,’ Sian E. Harding delves into the awe-inspiring intricacies of the human heart. Despite years of research, scientists have been unable to replicate its flawless design. However, Harding highlights that recent scientific breakthroughs, such as ultrafast imaging, gene editing, stem cells, artificial intelligence, and advanced microscopy, are unravelling the heart’s mysteries and holding significant implications for our health.

Being a prominent authority in the field of cardiac research, Harding delves into the complex relationship between emotions and heart functionality. Her work sheds light on the heart’s dual role in both reacting to and influencing emotions. In her writing, she delves into medical conditions like Broken Heart Syndrome, a condition that can manifest following emotional stress or loss. Additionally, she includes personal anecdotes of people who have confronted heart-related difficulties in their lives.

The book emphasises how cutting-edge technologies are enabling experiments and clinical trials to address the global burden of heart disease. It underscores the paradigm shift in understanding the heart’s complexity, from cells communicating with each other to the regenerative potential of stem cells. For instance, it is now possible to create cardiac muscle in a lab dish from a few of your cells, offering personalised insights into heart health and drug response.

Overall, ‘The Exquisite Machine’ provides a captivating journey through the latest advancements in cardiac science. The author emphasises the need for cardiac scientists to become proficient engineers and mathematicians to unravel the complexities of heart health fully.

Table of contents

  • 1. Introduction
  • 2. Threats to the Heart: A Thousand Natural Shocks
  • 3. The Science of the Really Small
  • 4. Big Data-Many Hearts That Beat as One?
  • 5. The Plastic Heart
  • 6. The Responsive Heart Emotion in Motion
  • 7. Can You (Not) Die of a Broken Heart?
  • 8. The Gendered Heart
  • 9. The Mechanical Heart
  • 10. Can Stem Cells Help Us Grow a New Heart?
  • 11. When Will the Future Be Here?
  • Acknowledgments
  • Notes
  • Index

Three key takeaways from ‘The Exquisite Machine’

1The heart remains extremely resilient and plastic despite its limited ability to regenerate its muscles

In one of the initial chapters of the book, Dr. Harding explores the incredible resilience of the human heart in the face of various insults, both ancient and modern. Despite enduring numerous challenges, including the limited ability to regenerate its muscle cells, the heart continues to function admirably.

The book reveals how carbon dating, a technique typically associated with archaeology, provided essential insights into the heart’s regeneration capabilities. It was discovered that around half of the cardiomyocytes in a 75-year-old person’s heart had been present throughout their entire life, attesting to the heart’s remarkable endurance. Although there is a small degree of regeneration, especially in younger individuals, it falls short in cases of severe cardiac disease.

The book also draws parallels between cardiac and brain research, highlighting the brain’s adaptability through neuroplasticity. The author underscores the heart’s impressive capacity to adapt and change in size and function to meet the body’s demands, even without full regeneration.

2A ‘mini-brain’ in your heart can tell you how you feel

While we typically associate emotions with the brain, recent research reveals a complex interplay between the heart and the nervous system. Notably, there exists a ‘mini-brain’ within the heart, known as the intrinsic cardiac ganglionated plexus, where sensory neurons from the heart interact with autonomic neurons, influencing emotions like fear and anxiety. These interactions can be profound, as evidenced by instances where rapid or erratic heartbeats can trigger panic attacks. Conversely, preventing heart rate increases can mitigate feelings of fear.

Experiments have even demonstrated that emotional states can change within a single resting heartbeat, emphasising the heart’s role in shaping our emotional responses. For example, during heart contraction, fear responses are amplified, while during heart relaxation, they are dampened. Such findings shed light on how our bodies, bypassing conscious cognitive processes, can swiftly respond to perceived threats, offering a potential advantage in moments of danger. Interestingly, responses to images of faces expressing disgust, happiness, or neutrality vary, underscoring the heart’s unique influence on specific emotional reactions, especially in the face of potential threats.

3Can a broken heart kill?

Takotsubo syndrome, often referred to as ‘broken heart syndrome,’ is a peculiar heart condition characterised by the sudden onset of symptoms that mimic a heart attack, such as severe chest pain, ECG changes, and elevated blood markers, despite the absence of coronary artery blockages. This syndrome was first observed in Japan during a major earthquake and gained attention due to its distinctive features. It primarily affects women, with an overwhelming majority of patients being female, particularly those postmenopausal.

Remarkably, many Takotsubo patients recover fully, going from acute heart failure to leaving the hospital disease-free within days. The condition is often triggered by extreme stressors, including arguments, bereavement, and even sporting events, with men and women responding differently to such stressors. The precise causes and mechanisms of Takotsubo syndrome remain a subject of study, and its recognition has grown worldwide, thanks to advanced imaging techniques that help diagnose the condition.

Strengths and weaknesses, according to readers’ reviews


  • Provides valuable insights into the heart and the current state of treating heart disease, making it informative for readers interested in the subject.

  • Offers a balanced perspective by discussing both the successes and failures of research, providing an authentic portrayal of scientific inquiry.

  • Written in a conversational tone with elements of humour and personal anecdotes, making it an enjoyable and approachable read.


  • Lacks practical guidance for readers seeking a manual on addressing heart problems, as it does not sufficiently cover crucial aspects such as diet, exercise, sleep, stress management, and body weight, which are vital for preventing and treating heart issues.

Best quotes from ‘The Exquisite Machine’

“The fight-or-flight response is an emergency reaction and did not evolve to be turned on all the time. Adrenaline (and noradrenaline) can also cause actual damage to the heart muscle when they are present for too long, or when their concentration becomes too high. If the calcium overload of the cardiomyocyte is too extreme or too prolonged, it triggers death mechanisms in the cell. Long-term effects of adrenaline are large-scale or patchy alterations in the heart muscle producing turbulent patterns of electrical flow.”
“At first, the papers being published on Takotsubo syndrome described these kinds of triggering incidents linked to disaster and grief. Often, the triggers were very like those for SCD, such as bereavement and trauma.”
“The Framingham Heart Study started in 1948 and managed to recruit an impressive 5,209 of the town’s 10,000 adult citizens, with ages ranging from 28-62 years and, pleasingly, with almost equal numbers of men and women…The researchers drawing from its data were the first to show many things we now take for granted: that high blood pressure, smoking, diabetes, or high cholesterol increase heart disease; that there are differences in cardiovascular risk between men and women; that exercise, a moderate body weight, and healthy eating are beneficial.”

Final takeaway

‘The Exquisite Machine’ by Sian E. Harding is a remarkable exploration of the human heart, offering profound insights into its intricacies and the state of contemporary cardiac research. Harding delves into the heart’s extraordinary resilience despite its limited ability to regenerate muscle cells. The book highlights the heart’s capacity to adapt and change, underscoring its impressive ability to respond to the body’s demands, even without full regeneration. Readers are treated to a fascinating discussion on the heart’s role in influencing emotions, with the revelation of a ‘mini-brain’ within the heart.

It is a must-read for those fascinated by the complexities of the heart and the cutting-edge advancements in the field.

Where to buy

You may purchase ‘The Exquisite Machine’ on Amazon at the best price. It is available in paperback, hardcover, audio and Kindle versions, so you may choose an option that appeals to you the most.

Healthypedia FAQ

Dr. Harding's extensive academic background and expertise in the field of cardiac research lend credibility to the book's content. Additionally, the book is published by MIT Press, a reputable academic publisher known for producing high-quality, peer-reviewed works in various scientific fields.

Yes, the book is written in a clear and approachable manner, making it accessible to readers with varying levels of scientific knowledge.

Yes, the book includes personal anecdotes of individuals who have faced heart-related challenges. These stories humanise the scientific content and provide real-world context.

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