The human heart endures a lot in a lifetime. Sophisticated imaging can give insight into what it tolerates and what ails it, but the most direct information comes from an autopsy.

Photographer Angela Strass­heim spent days at an undisclosed morgue in 2000, capturing the organ moments after its removal. She left with a series of images that show hearts pierced by a gunshot wound, damaged by obesity, affected by cancer and weakened by a drug overdose. In the center is a child’s healthy heart. The photographs are being published here for the first time. 

Comparing the hearts of healthy and obese individuals demonstrates how the latter get remodeled in unhealthy ways. Michael Lauer of the National Heart, Lung, and Blood Institute says research suggests that fat exerts toxic effects not only on the coronary arteries but on the heart muscle itself. In the image, fat visibly surrounds the organ, and the muscle is enlarged. The effects of drugs and of cancer that spreads to the heart are less visible here; both conditions can alter valve function and blood flow.

Despite their importance for research, autopsies are on the decline. The U.S. Centers for Disease Control and Prevention report that rates dropped by more than 50 percent between 1972 and 2007 because of such factors as changes in state laws that govern which deaths can be investigated, as well as a lack of insurance coverage for the procedure.

Although there have been advances in postmortem imaging, the technology has failed to diagnose some instances of heart disease and cancer. In an Annals of Internal Medicine editorial earlier this year, Elizabeth Burton and Mahmud Mossa-Basha of Johns Hopkins University said that until imaging technologies improve, “autopsy remains the gold standard for determining the cause of death.”

This article was published in print as "Telltale Hearts."