7 ms·

A similarity between the CAP theorem and our heart

150 points by DVassallo 3y ago

mo_42 3y ago
I showed this text to a friend who works in internal medicine (so not a cardiologist but probably much closer than most commenters). Basic comment was that the person confuses and misunderstands many things. According to my friend, the range marked as "missed beat" contains a premature heart beat [1]. Some more comments: - Premature hear beats happen in us quite frequently - CT scans are a rather invasive diagnostic method and such be avoided So unless some more competent doctor comments otherwise, I take this as a nice story that resonates well in our layperson's minds. Not more. [1] https://en.wikipedia.org/wiki/Premature_heart_beat https://en.wikipedia.org/wiki/Premature_heart_beat
latchkey 3y ago
This is an absolutely fascinating read.
samspenc 3y ago
Science / health aside, I think this is the longest Twitter post I've read posted as a single tweet (instead of a thread). I knew that Twitter had relaxed some length limits but I didn't realize it was possible to post a (checks in text editor) 10,000 character or 1,800 word article in a single tweet these days.
- paws 3y ago
  I believe this is only available to paying members with a blue check. EDIT: "this" meaning posting
  - mparnisari 3y ago
    I'm not a paying member and I still see the entire thing
    - guessmyname 3y ago
      > I believe this is only available to paying members with a blue check. > I'm not a paying member and I still see the entire thing They meant paying members can post lengthly tweets.
      - mparnisari 3y ago
        Ohhhhh lol my bad
  - thomasahle 3y ago
    Blue check is not enough, I believe, this post is not just long, it has multiple images inserted in the middle of the text. Like a full length blog post. I think this comes with a "creator profile" while also is why the button says "Subscribe" at the top.
polishdude20 3y ago
I'm surprised an extra 30 mins per day of running for 6 weeks had enough of an impact to change the structure of the heart noticeably.
- DVassallo 3y ago
  Author here. I've been taking running seriously for 22 months, so maybe the past 6 weeks were just the last straw to trigger this arrhythmia. I also had covid at the end of July (very mild symptoms), which made me think there could be a link, but the tests seem to exclude any lingering inflammation or infection.
  - paws 3y ago
    > the heart is designed for max availability over consistency, so when in doubt, it triggers a beat. This is a great line, thanks! Going to share this with my distributed database reading group
  - vermilingua 3y ago
    Sorry if this is too much prying into your health, but what was the personal/medical verdict on whether to continue the running? You say that the symptoms disappear after a while without exercise, but if it’s benign will you keep it up?
    - DVassallo 3y ago
      I'm going to take it easy for a few weeks, just out of abundance of caution; just in case there's something else that got missed. I'm not into any competitions or races. I run for health purposes only, so I'm okay losing some fitness. If the symptoms disappear, I'll certainly ramp up again. If they don't, I'll play it by ear :) My understanding is that 35-50% of endurance athletes have what I have (including symptoms), and they continue to train without any harmful effects.
      - low_tech_punk 3y ago
        Thank you for sharing this! I'm into endurance cycling and had similar issues. I'm diagnosed with PVC as well and rely on medication to keep it from happening. I nearly fainted while driving a car, so it is not without "harmful effect". In my case, the PVC disappears during exercise and comes back when I take a rest after exercising. I just wonder if you had any comparisons between rest vs. elevated heart rate scenarios. Now I'm super curious how elevated heart rate might change the clock rates for those nodes.
tw1984 3y ago
amazing article! best read in 2023.
throwaway_15axd 3y ago
I'm not a cardiologist (so take my comment with a pinch of salt). But I was an avid runner (running average 10km a week for 2 years) but a few years later, I developed a form of Ventricular Tachycardia called RVOT. I went for a battery of tests similar to the OP. The results shows my heart is structurally OK. The doctor diagnosed that I had RVOT and recommended I do ablation. He says that this is a very very common procedure. I did the procedure. However, the symptoms started coming back again. After reading this article, I wonder if I should have just left my heart as is.
- low_tech_punk 3y ago
  Glad you mentioned this. I'm a avid biker and endurance runner. I'm diagnosed with PVC a few years ago. I went through two rounds of ablation, both failed. Now I take Flecanaide to keep the rhythm but I want seek second opinion now, thanks to this tweet.
  - rstuart4133 3y ago
    Maybe this helps: some anti depressants (like Zoloft) modify neurotransmitters, like serotonin. In my case at least, having a lot of unused serotonin laying around caused arrhythmia. Most doctors have never heard of the side effect (I'm not sure if it's even listed), but in my case stopping / starting Zoloft behaved as reliably as a light switch on my arrhythmia, albeit with cause and effect delayed by a few weeks. The sad thing is I took Zoloft for years, mostly because my doctor said it's not wise to stop. In my case it was bad advice, as arrhythmia is a self perpetuating condition that gets worse if you let it linger. I use Zoloft to get past a high stress few years in my life (running my own business). Once that was over I should have stopped taking it immediately.
- dfc 3y ago
  10k a week is avid running?
  - appplication 3y ago
    It probably puts you in the 95th+ percentile in distance run per week
DrDroop 3y ago
CAP shows up in lots of places, my favourite is arrow's impossibility theorem.
- blurbleblurble 3y ago
  Share more?
  - DrDroop 3y ago
    Sorry don't have much time to explain, but in economics and other social sciences there are many situations where there needs to be made a tradeoff between three things, so called trilemmas. I already gave the example of voting in a democracy with arrows impossibility theorem but also it shows up at the central bank when they need to set the exchange rate and needs to to decide between savers, investors and the government tax revenue. This things are always difficult to explain with lots of trade of scenarios just like CAP. I suggest you google trilemma and economy and read more if you are interested.
    - blurbleblurble 3y ago
      Gotcha, I was wondering if there was a deeper or more concrete connection between these particular trilemmas. It'd be interesting if there was seeing as how both are related to coordination, though I'm not so sure there is one.
      - DrDroop 3y ago
        Yes, coordination is a common theme among them. Another way of looking at it is that these systems all have a partial ordering but no full ordering, like a game of rock paper scissors. This is something that shows up all around us, space time itself can have different ordering of events based on the observer so it is embedded in the very causal geometry we live in. I've tried in the past to have a more rigorous explanation for this all but I lack the time and honestly the intellect.
bluepizza 3y ago
If you have PVCs and find yourself worried, remember that the author is an endurance runner. Coffee and anxiety also cause PVCs, which are really harmless.
lgeorget 3y ago
The funny thing about all that "decentralization" and the fact that the heart doesn't need the central nervous system to work is that the pulmonary system does need it. So on the one hand, it's great, your heart can function on its own, on the other hand, you cannot breathe without a working brain. Time to finish that refactoring, evolution! One component is over-engineered with respect to the rest of the system.
- bheadmaster 3y ago
  Evolution: Well, our milleniums-long testing indicates that adding decentralization to pulmonary system is not the highest prority right now, as the blood already provides an oxygen cache - in case of pulmonary failure, we have a couple-minutes window to restart it before any permanent damage occurs. You can add it to the backlog, and we'll get to it when we have time.
  - matthewaveryusa 3y ago
    That's way too eloquent for evolution. More like: "Hey, let's try this" burp
    - nemonemo 3y ago
      For one individual, maybe your analogy might be closer to what evolution tries, but I suspect in a large group of individual in a species over a long period, a more eloquent description could be emerged.
      - distract8901 3y ago
        No, it's pretty much "hold my beer, I got this" billions of times until something works. Evolution isn't organized or eloquent. It's messy and random and non-optimized. Evolution results in many individuals who are not fit, any many evolved solutions are quite plainly bad. Any elegance or beauty in evolution is a construct humans apply to an incredibly abstract and obtuse concept because that's just what we do to things that are difficult to grok. Evolution is simply random mutations from various mechanisms, but the only guiding force is that of survival. Some random changes make some individuals more fit to survive, which makes the species more fit in time. There really isn't anything more to it. It's all just random chance averaged over a very, very long time.
workfromspace 3y ago
https://nitter.net/dvassallo/status/1716585205400756514 https://nitter.net/dvassallo/status/1716585205400756514 (original twitter URL requires JS to be enabled, nitter doesnt)
SirSegWit 3y ago
Came for the CAP theorem, stayed for the cardiology 101 course, lol. His approach to diagnosing himself is really admirable. Working with doctors but never fully trusting them w.r.t. completeness is unfortunately the way to go in these busy times, where doctors just assume the most likely diagnosis and move on. Luckily, we have almost the same information available as the doctors with studies and such that we can dig deeper ourselves.
- aneutron 3y ago
  I can't really blame them. The essence of it is "if you see hooves think horses not zebras". The human body is usualy one resilient bastard, so the ol' "tylenol and come back if it gets worse" is a good tactic for 95% of the cases. But detecting those 5% cases probably takes A LOT of dedicated bandwidth from the whole medical process, so unless there is some clear manifestation that it's not horses but something else, I think it is reasonable that some will not investigate further.
deleted 3y ago
[deleted]
poszlem 3y ago
PVCs are curious because many people have them and don't even realise. But for those who do notice, they sometimes become super aware of every beat. Feeling a PVC can make some people anxious, which boosts adrenaline, potentially leading to more PVCs. It's like a feedback loop where a "missed beat" gets linked with that adrenaline jolt. Most of the time, PVCs are no big deal. So, the best "fix" might just be learning to shrug them off, which often makes them happen less or go away (obviously after getting a green light from a cardiologist).

150 points by DVassallo 3y ago

I showed this text to a friend who works in internal medicine (so not a cardiologist but probably much closer than most commenters). Basic comment was that the person confuses and misunderstands many things. According to my friend, the range marked as "missed beat" contains a premature heart beat [1]. Some more comments: - Premature hear beats happen in us quite frequently - CT scans are a rather invasive diagnostic method and such be avoided So unless some more competent doctor comments otherwise, I take this as a nice story that resonates well in our layperson's minds. Not more. [1] https://en.wikipedia.org/wiki/Premature_heart_beat https://en.wikipedia.org/wiki/Premature_heart_beat

latchkey 3y ago

This is an absolutely fascinating read.

samspenc 3y ago

Science / health aside, I think this is the longest Twitter post I've read posted as a single tweet (instead of a thread). I knew that Twitter had relaxed some length limits but I didn't realize it was possible to post a (checks in text editor) 10,000 character or 1,800 word article in a single tweet these days.

paws 3y ago
I believe this is only available to paying members with a blue check. EDIT: "this" meaning posting
- mparnisari 3y ago
  I'm not a paying member and I still see the entire thing
  - guessmyname 3y ago
    > I believe this is only available to paying members with a blue check. > I'm not a paying member and I still see the entire thing They meant paying members can post lengthly tweets.
    - mparnisari 3y ago
      Ohhhhh lol my bad
- thomasahle 3y ago
  Blue check is not enough, I believe, this post is not just long, it has multiple images inserted in the middle of the text. Like a full length blog post. I think this comes with a "creator profile" while also is why the button says "Subscribe" at the top.

polishdude20 3y ago

I'm surprised an extra 30 mins per day of running for 6 weeks had enough of an impact to change the structure of the heart noticeably.

DVassallo 3y ago
Author here. I've been taking running seriously for 22 months, so maybe the past 6 weeks were just the last straw to trigger this arrhythmia. I also had covid at the end of July (very mild symptoms), which made me think there could be a link, but the tests seem to exclude any lingering inflammation or infection.
- paws 3y ago
  > the heart is designed for max availability over consistency, so when in doubt, it triggers a beat. This is a great line, thanks! Going to share this with my distributed database reading group
- vermilingua 3y ago
  Sorry if this is too much prying into your health, but what was the personal/medical verdict on whether to continue the running? You say that the symptoms disappear after a while without exercise, but if it’s benign will you keep it up?
  - DVassallo 3y ago
    I'm going to take it easy for a few weeks, just out of abundance of caution; just in case there's something else that got missed. I'm not into any competitions or races. I run for health purposes only, so I'm okay losing some fitness. If the symptoms disappear, I'll certainly ramp up again. If they don't, I'll play it by ear :) My understanding is that 35-50% of endurance athletes have what I have (including symptoms), and they continue to train without any harmful effects.
    - low_tech_punk 3y ago
      Thank you for sharing this! I'm into endurance cycling and had similar issues. I'm diagnosed with PVC as well and rely on medication to keep it from happening. I nearly fainted while driving a car, so it is not without "harmful effect". In my case, the PVC disappears during exercise and comes back when I take a rest after exercising. I just wonder if you had any comparisons between rest vs. elevated heart rate scenarios. Now I'm super curious how elevated heart rate might change the clock rates for those nodes.

tw1984 3y ago

amazing article! best read in 2023.

throwaway_15axd 3y ago

I'm not a cardiologist (so take my comment with a pinch of salt). But I was an avid runner (running average 10km a week for 2 years) but a few years later, I developed a form of Ventricular Tachycardia called RVOT. I went for a battery of tests similar to the OP. The results shows my heart is structurally OK. The doctor diagnosed that I had RVOT and recommended I do ablation. He says that this is a very very common procedure. I did the procedure. However, the symptoms started coming back again. After reading this article, I wonder if I should have just left my heart as is.

low_tech_punk 3y ago
Glad you mentioned this. I'm a avid biker and endurance runner. I'm diagnosed with PVC a few years ago. I went through two rounds of ablation, both failed. Now I take Flecanaide to keep the rhythm but I want seek second opinion now, thanks to this tweet.
- rstuart4133 3y ago
  Maybe this helps: some anti depressants (like Zoloft) modify neurotransmitters, like serotonin. In my case at least, having a lot of unused serotonin laying around caused arrhythmia. Most doctors have never heard of the side effect (I'm not sure if it's even listed), but in my case stopping / starting Zoloft behaved as reliably as a light switch on my arrhythmia, albeit with cause and effect delayed by a few weeks. The sad thing is I took Zoloft for years, mostly because my doctor said it's not wise to stop. In my case it was bad advice, as arrhythmia is a self perpetuating condition that gets worse if you let it linger. I use Zoloft to get past a high stress few years in my life (running my own business). Once that was over I should have stopped taking it immediately.
dfc 3y ago
10k a week is avid running?
- appplication 3y ago
  It probably puts you in the 95th+ percentile in distance run per week

DrDroop 3y ago

CAP shows up in lots of places, my favourite is arrow's impossibility theorem.

blurbleblurble 3y ago
Share more?
- DrDroop 3y ago
  Sorry don't have much time to explain, but in economics and other social sciences there are many situations where there needs to be made a tradeoff between three things, so called trilemmas. I already gave the example of voting in a democracy with arrows impossibility theorem but also it shows up at the central bank when they need to set the exchange rate and needs to to decide between savers, investors and the government tax revenue. This things are always difficult to explain with lots of trade of scenarios just like CAP. I suggest you google trilemma and economy and read more if you are interested.
  - blurbleblurble 3y ago
    Gotcha, I was wondering if there was a deeper or more concrete connection between these particular trilemmas. It'd be interesting if there was seeing as how both are related to coordination, though I'm not so sure there is one.
    - DrDroop 3y ago
      Yes, coordination is a common theme among them. Another way of looking at it is that these systems all have a partial ordering but no full ordering, like a game of rock paper scissors. This is something that shows up all around us, space time itself can have different ordering of events based on the observer so it is embedded in the very causal geometry we live in. I've tried in the past to have a more rigorous explanation for this all but I lack the time and honestly the intellect.

bluepizza 3y ago

If you have PVCs and find yourself worried, remember that the author is an endurance runner. Coffee and anxiety also cause PVCs, which are really harmless.

lgeorget 3y ago

The funny thing about all that "decentralization" and the fact that the heart doesn't need the central nervous system to work is that the pulmonary system does need it. So on the one hand, it's great, your heart can function on its own, on the other hand, you cannot breathe without a working brain. Time to finish that refactoring, evolution! One component is over-engineered with respect to the rest of the system.

bheadmaster 3y ago
Evolution: Well, our milleniums-long testing indicates that adding decentralization to pulmonary system is not the highest prority right now, as the blood already provides an oxygen cache - in case of pulmonary failure, we have a couple-minutes window to restart it before any permanent damage occurs. You can add it to the backlog, and we'll get to it when we have time.
- matthewaveryusa 3y ago
  That's way too eloquent for evolution. More like: "Hey, let's try this" burp
  - nemonemo 3y ago
    For one individual, maybe your analogy might be closer to what evolution tries, but I suspect in a large group of individual in a species over a long period, a more eloquent description could be emerged.
    - distract8901 3y ago
      No, it's pretty much "hold my beer, I got this" billions of times until something works. Evolution isn't organized or eloquent. It's messy and random and non-optimized. Evolution results in many individuals who are not fit, any many evolved solutions are quite plainly bad. Any elegance or beauty in evolution is a construct humans apply to an incredibly abstract and obtuse concept because that's just what we do to things that are difficult to grok. Evolution is simply random mutations from various mechanisms, but the only guiding force is that of survival. Some random changes make some individuals more fit to survive, which makes the species more fit in time. There really isn't anything more to it. It's all just random chance averaged over a very, very long time.

workfromspace 3y ago

https://nitter.net/dvassallo/status/1716585205400756514 https://nitter.net/dvassallo/status/1716585205400756514 (original twitter URL requires JS to be enabled, nitter doesnt)

SirSegWit 3y ago

Came for the CAP theorem, stayed for the cardiology 101 course, lol. His approach to diagnosing himself is really admirable. Working with doctors but never fully trusting them w.r.t. completeness is unfortunately the way to go in these busy times, where doctors just assume the most likely diagnosis and move on. Luckily, we have almost the same information available as the doctors with studies and such that we can dig deeper ourselves.

aneutron 3y ago
I can't really blame them. The essence of it is "if you see hooves think horses not zebras". The human body is usualy one resilient bastard, so the ol' "tylenol and come back if it gets worse" is a good tactic for 95% of the cases. But detecting those 5% cases probably takes A LOT of dedicated bandwidth from the whole medical process, so unless there is some clear manifestation that it's not horses but something else, I think it is reasonable that some will not investigate further.

deleted 3y ago

[deleted]

poszlem 3y ago

PVCs are curious because many people have them and don't even realise. But for those who do notice, they sometimes become super aware of every beat. Feeling a PVC can make some people anxious, which boosts adrenaline, potentially leading to more PVCs. It's like a feedback loop where a "missed beat" gets linked with that adrenaline jolt. Most of the time, PVCs are no big deal. So, the best "fix" might just be learning to shrug them off, which often makes them happen less or go away (obviously after getting a green light from a cardiologist).