Selected Podcast
Would You Know If You Are Having a Heart Attack?
Discussion of how heart conditions, untreated, can contribute to a heart attack, i.e., atrial fibrillation, high blood pressure, valve disease.
Featuring:
Louis F Janeira, MD, FACC
Louis F Janeira, MD, FACC is a Cardiologist at Franciscan Health and Franciscan Physician Network. Transcription:
Scott Webb: We're all familiar with the movie or TV image of a man suddenly clutching his chest with a pained look on his face and we know he's having a heart attack. But in real life, the signs and symptoms of a heart attack are not always so dramatic and sometimes there are no signs at all. If you have family members who have had heart disease, heart attacks, heart surgery or stroke, you owe it to yourself to know the signs and symptoms of a possible heart attack.
And that's what we are discussing today, what they are, how they vary in men and women. And we'll also touch on the ways to reduce your risk of heart disease and its consequences. And joining me today to discuss heart attacks is Dr. Louis Janeira. He's a cardiologist at Franciscan Health and the Franciscan Physician Network.
This is the Franciscan Health Doc Pod. I'm Scott Webb. So doctor, thanks for your time today. We're discussing heart attacks, signs, symptoms, and so on. So let's start with, what are the general signs of a heart attack?
Dr. Louis Janeira: Heart attacks come in many different flavors as you can imagine. There are patients in fact that have heart attacks without any symptoms at all. We do some tests for this or that reason and find that there has been a heart attack sometime in the past and the patient has had no symptoms whatsoever. On the other side of the equation, we have people that have attacks and just basically die suddenly from very dangerous heart rhythms that are brought on by the heart attack.
But most people, the sort of symptoms they have is a pressure right in the middle of their chest. The pressure is often described as a pressure or heaviness, sometimes squeezing. It's particularly worrisome when the symptoms come with exercise or activity and relieved by rest. They're also bothersome if they're associated with nausea or a cold sweat or sometimes just feeling the heart racing, that would be very disturbing. If these symptoms occur, then we want people to call 911.
Scott Webb: And I guess I'm wondering are heart attack warning signs different for men and women?
Dr. Louis Janeira: They are. Women tend to have more of the unusual or, as we would call them, atypical signs or symptoms. They can have different types of pain. So instead of that pressure or heaviness, it could be pain that's described in other ways,
Scott Webb: Yeah. And as you say, they could manifest differently for men and women. And of course, we know from TV and movies, the classic, you know, sort of clutching of the chest is not always the case, right? It may be for some, but for others, they can be very subtle. So how are we to know? When the signs come and go, or if they're not classic heart attack symptoms, how do we know when it's time to go to the hospital? How do we know when it's time to call 911?
Dr. Louis Janeira: I would say any signs or symptoms that involve the chest or sometimes it's just a profound fatigue or weakness that sort of hits all of a sudden. But anything that's not easily explainable that doesn't have obvious causes would be perhaps time to go for patients that are in the risk factor, age, so, you know, 50s, 60s, 70s. If someone has pains in their teens or 20s or 30s, it becomes less likely that it's the heart.
But, for instance, a lot of times people will take an antacid and the pain goes away. Well, that gives us some clues that we're dealing with a stomach issue rather than the heart. But if there's no other explanation, it's always better to be safe than sorry. And I would always advise being very liberal with the decision to go when there's a concern or question in somebody's mind.
Scott Webb: Yeah. We're going to talk about the importance of calling 911 and getting treatment as soon as possible, because we know that time is heart, time is muscle. And every minute of delay, you know, can lead to worse outcomes for people and possibly death. And so when we talk about heart attacks, are they always a result of blocked arteries or are there other causes as well?
Dr. Louis Janeira: There are very rare causes that are not involving the traditional atherosclerosis or plaque buildup inside the arteries. But those are rare and often we find them when we go look and see that the arteries are normal or near normal, and then we find the other reason. Some would be for instance, spasm in the arteries. Others would be clots that sometimes travel inside the coronary arteries, which are the arteries that feed the heart muscle. Those spots can come and obstruct the blood vessels, just like the traditional plaque that builds over years could. And then there are just some other rare things, inflammation and the like.
Scott Webb: Yeah. So it does sound like blocked arteries are typically the cause, but there can be some outliers, there, some other explanations as well. And I want to have you talk about the importance of knowing our family history. You talked about risk factors, those that are in their 50, 60, 70s. But why is it so important that we know our family history when it comes to preventing sudden cardiac events, let's say?
Dr. Louis Janeira: Yeah, it's always important to know one's risks for heart disease. And the family history is important because it speaks for a genetic basis for having heart disease and having atherosclerosis or plaque-forming at a younger age than expected. The statistics usually show that approximately one American per minute dies of heart disease. It gets worse. Half of those dying from heart disease was the first clue that there was a heart problem. So of course, waiting and seeing what happens is not a good strategy. A better strategy is to see your doctor and define your particular risk.
Part of that equation certainly is genetic, so what's your family history like. And there, we're looking for people that have had heart attacks or strokes before age 60 to 65. Other things will be of course the cholesterol, blood pressure, weight, that sort of thing. There's a test that I'm very fond of. I get it myself and I recommended wisely in people over 40 and that's what's called a promo heart scan or a calcium score. What this basically does is it helps us identify ahead of time if there are blockages in the arteries and to what degree. We now have a lot of scientific, very robust data that allows us to predict one's risk of a heart attack in the next 10 years based on that score plus the cholesterol levels, blood pressure, family history, and other things of that nature.
So if we come across a patient whose risk of a heart attack in 10 years is very low, 1%, 2%, 3%, then those patients, we would treat obviously very different than a patient whose risk of a heart attack in the next 10 years is a 100% as you can imagine. I unfortunately see a lot of those, but we can then start working on risk factor modification aggressively and thereby avert these very troubling issues that can arise.
Scott Webb: Yeah. And you mentioned risk factors. So I want to talk about smoking and why smoking is so hazardous to our health and can be so deadly for people, especially if they have other risk factors for heart attack.
Dr. Louis Janeira: Absolutely. You know, to tell you the truth, we really don't know exactly the mechanism as to why smoking is causing all the problems it does, the cancers, the COPD or the lung trouble smokers get, heart attacks, strokes, erectile dysfunction for the young man out there, wrinkly skin for the young ladies out there. But all of these things, we really aren't completely sure exactly what the mechanism is. Some postulated type things would be that sometimes cigarette smoking can cause spasm in the arteries that could go on to aggravate him and that sort of thing. But there is one thing that there is no question about, and that is that there is definitely an association between smoking, heart attacks, strokes, cancer, lung disease, and all the other ones.
Scott Webb: And it's so fascinating. It's sort of like you know that smoking is bad. We don't know exactly why it's bad. But we're just telling you, it's bad. It's bad on so many levels, especially as you say about stroke, heart attack and so on. So basically, the message is just don't smoke. Don't worry about why it's bad for you. We're just telling you it's bad. Just take our word for it, right, doctor?
Dr. Louis Janeira: Yeah. There's so much compelling data to speak to that, that it is in fact bad for you. Yeah, absolutely. You said it very well. I couldn't say it any better.
Scott Webb: Okay. So when we talk about treatment, I mentioned earlier, you know, time is heart, time is muscle. And when we talk about stroke, time is brain. So what does that mean exactly to you, doctor, as a cardiologist? Why is it so important? And what's the message to get across to people about get to the emergency department as quickly as you can? If it's an emergent thing that can't be explained and doesn't go away with Tums, go to the hospital. That's the message, right?
Dr. Louis Janeira: That is certainly a good message to send out to folks. The reason of course is number one, it could kill you suddenly. So that alone is a problem. But as you say, time is muscle or brain. Think of these arteries. I tell my patients, these arteries are just like fuel lines. So the fuel lines get crowded on the inside. Again, we call that atherosclerosis or plaque. These things grow with time, again with these risk factors. And if the artery gets to the point where it's not delivering enough blood flow downstream, if downstream is the heart, a heart attack; if the downstream is the brain, stroke; if the downstream is the leg, then you get into the situation where you sometimes have to amputate legs because of difficulty with blood flow down to the leg.
But either way, nothing good happens from having blocked arteries. And if the artery blocks completely, there is no blood flow downstream, whatever's downstream getting that fuel won't work and it'll die. The quicker one gets to the emergency room where these arteries can be opened up and allow for a restoration of blood flow, we're just killing cells, we're just killing tissue. And certainly the message of the sooner, the better is very important. Of course, the sooner would be 911 because you can get the fastest into the medical system that way.
Scott Webb: Yeah, definitely. Call 911 if you're having symptoms. Don't err on the conservative side, because we're hearing during the pandemic that people are delaying care. You know that when they are not having the classic signs and symptoms that you described earlier and their signs and symptoms may come and go, they're delaying care because of a fear of going to the hospital because of COVID, but we don't want them doing that, right?
Dr. Louis Janeira: Yeah, fortunately COVID is getting a little bit to be in our backview mirror, which is so good, but yes, absolutely, even now, but certainly during the peaks that we had before, people were staying home because they were afraid of getting COVID or they were assuming their symptoms were related to COVID or that sort of business. But either way, if care is delayed, then there is a very high chance of getting into a lot of trouble. So absolutely, I would agree with what you just said.
Scott Webb: Yeah. So call 911, get to the hospital. It's the safest place. If you go to the grocery store, you can definitely go to the hospital and that's where the treatment is. And one of the things I want to talk to you as we get close to wrapping up here, doctor, is about sudden cardiac events and abnormal heart rhythms. And just this sort of idea that there are people walking around that are these sort of time bombs, if you will, these walking time bombs that they don't know that they have heart issues and they suffer an abnormal heart rhythm, and then that results in sudden cardiac deaths. So what do we do about that? What do we tell people?
Dr. Louis Janeira: It's one of these things that once that happens is a little bit too late and the chances of survival having a cardiac arrest at home are very low. So the best thing of course is again, as we discussed earlier for heart attacks, is know your risk, know what could happen and discuss with your doctor the best way to delay or prevent these awful things from happening.
But what we're talking about is the emergence of very dangerous, very rapid heartbeats that essentially cause the heart to stop functioning and the patient dies suddenly. A lot of this happens in the middle of the night while the patient's asleep. So unfortunately, we don't even know this is happening until the next morning when it's way too far, too late to do anything about it.
Fortunately, we do have a lot of things we can do to predict some of these things. Not always, of course, but in a lot of patients, we're able to predict these things. For patients that are at risk and we can't make that risk lowered with medications, for instance, we have these implantable defibrillators that are devices, like pacemakers that are implanted in the body. The devices monitor for these dangerous rhythms. And if they occur, the device would shock the heart from within and result in restoration of normal rhythm and the saving of the person's lives.
Scott Webb: Yeah. And that'd be outstanding if we could do that. And it just sounds to me in basically talking to you today that a lot of people have risk factors, but there is help available there's treatment available, there's technology, you know, that was unimaginable, let's say, when you became a doctor and you've been at this for decades. So as we wrap up here, what's the takeaway? What's the message you want everyone to know when it comes to heart conditions, caring for themselves, preventing heart attacks? What would you like everybody to know?
Dr. Louis Janeira: Of course, talking to their doctor about their risk of these things happening. But in general, you know, we want people to be physically active, to walk or run, to just move more. Obesity as a humongous problem in this country, certainly in our state. So working on the weight and, of course, it's hard to work on weight unless you exercise. So I think exercise is an amazing thing. And again, it could be as easy as walking for people that have a lot of hip problems or orthopedic problems. I tell my patients, you know, walk five minutes every hour while awake. At the end of the day, you'll get near a mile and near or even over an hour of exercise a day, which is not that bad. So even as little as five minutes of walking around the house could help for those with the really bad arthritis.
For those that are able to do more, of course more is best. I myself use my smartphone and I try to do 10,000 steps a day. I try to do a little bit of running with that, try to do some weights as well. But I'm pretty much always looking at my phone to make sure that I'm going to be able to do those 10,000 steps a day. Again, you don't go from zero to 10,000, but slowly little by a little, get up there. But I think physical activity is humongous. It very important in helping folks.
If you smoke, we talked about this already, but absolutely you have to quit. It's a must. And some people need help with that, some people can do it on their own, either way it's an important thing to do. Staying well-hydrated and making sure you get enough sleep. Making sure that you have a balanced nutrition is always a good idea to stay healthy overall and certainly heart-healthy as well.
Scott Webb: As you say, a little goes a long way. And when we talk about heart attacks and preventing them, we need to know our family history, know our risk factors, address those things, seek treatment when necessary. So doctor, thanks so much for your advice, your wisdom today and you stay well.
Dr. Louis Janeira: Thank you. You as well. It was a pleasure to do this.
Scott Webb: For more information, visit FranciscanHealth.org/heartcare. And we hope you found this podcast to be helpful and informative. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well and we'll talk again next time.
Scott Webb: We're all familiar with the movie or TV image of a man suddenly clutching his chest with a pained look on his face and we know he's having a heart attack. But in real life, the signs and symptoms of a heart attack are not always so dramatic and sometimes there are no signs at all. If you have family members who have had heart disease, heart attacks, heart surgery or stroke, you owe it to yourself to know the signs and symptoms of a possible heart attack.
And that's what we are discussing today, what they are, how they vary in men and women. And we'll also touch on the ways to reduce your risk of heart disease and its consequences. And joining me today to discuss heart attacks is Dr. Louis Janeira. He's a cardiologist at Franciscan Health and the Franciscan Physician Network.
This is the Franciscan Health Doc Pod. I'm Scott Webb. So doctor, thanks for your time today. We're discussing heart attacks, signs, symptoms, and so on. So let's start with, what are the general signs of a heart attack?
Dr. Louis Janeira: Heart attacks come in many different flavors as you can imagine. There are patients in fact that have heart attacks without any symptoms at all. We do some tests for this or that reason and find that there has been a heart attack sometime in the past and the patient has had no symptoms whatsoever. On the other side of the equation, we have people that have attacks and just basically die suddenly from very dangerous heart rhythms that are brought on by the heart attack.
But most people, the sort of symptoms they have is a pressure right in the middle of their chest. The pressure is often described as a pressure or heaviness, sometimes squeezing. It's particularly worrisome when the symptoms come with exercise or activity and relieved by rest. They're also bothersome if they're associated with nausea or a cold sweat or sometimes just feeling the heart racing, that would be very disturbing. If these symptoms occur, then we want people to call 911.
Scott Webb: And I guess I'm wondering are heart attack warning signs different for men and women?
Dr. Louis Janeira: They are. Women tend to have more of the unusual or, as we would call them, atypical signs or symptoms. They can have different types of pain. So instead of that pressure or heaviness, it could be pain that's described in other ways,
Scott Webb: Yeah. And as you say, they could manifest differently for men and women. And of course, we know from TV and movies, the classic, you know, sort of clutching of the chest is not always the case, right? It may be for some, but for others, they can be very subtle. So how are we to know? When the signs come and go, or if they're not classic heart attack symptoms, how do we know when it's time to go to the hospital? How do we know when it's time to call 911?
Dr. Louis Janeira: I would say any signs or symptoms that involve the chest or sometimes it's just a profound fatigue or weakness that sort of hits all of a sudden. But anything that's not easily explainable that doesn't have obvious causes would be perhaps time to go for patients that are in the risk factor, age, so, you know, 50s, 60s, 70s. If someone has pains in their teens or 20s or 30s, it becomes less likely that it's the heart.
But, for instance, a lot of times people will take an antacid and the pain goes away. Well, that gives us some clues that we're dealing with a stomach issue rather than the heart. But if there's no other explanation, it's always better to be safe than sorry. And I would always advise being very liberal with the decision to go when there's a concern or question in somebody's mind.
Scott Webb: Yeah. We're going to talk about the importance of calling 911 and getting treatment as soon as possible, because we know that time is heart, time is muscle. And every minute of delay, you know, can lead to worse outcomes for people and possibly death. And so when we talk about heart attacks, are they always a result of blocked arteries or are there other causes as well?
Dr. Louis Janeira: There are very rare causes that are not involving the traditional atherosclerosis or plaque buildup inside the arteries. But those are rare and often we find them when we go look and see that the arteries are normal or near normal, and then we find the other reason. Some would be for instance, spasm in the arteries. Others would be clots that sometimes travel inside the coronary arteries, which are the arteries that feed the heart muscle. Those spots can come and obstruct the blood vessels, just like the traditional plaque that builds over years could. And then there are just some other rare things, inflammation and the like.
Scott Webb: Yeah. So it does sound like blocked arteries are typically the cause, but there can be some outliers, there, some other explanations as well. And I want to have you talk about the importance of knowing our family history. You talked about risk factors, those that are in their 50, 60, 70s. But why is it so important that we know our family history when it comes to preventing sudden cardiac events, let's say?
Dr. Louis Janeira: Yeah, it's always important to know one's risks for heart disease. And the family history is important because it speaks for a genetic basis for having heart disease and having atherosclerosis or plaque-forming at a younger age than expected. The statistics usually show that approximately one American per minute dies of heart disease. It gets worse. Half of those dying from heart disease was the first clue that there was a heart problem. So of course, waiting and seeing what happens is not a good strategy. A better strategy is to see your doctor and define your particular risk.
Part of that equation certainly is genetic, so what's your family history like. And there, we're looking for people that have had heart attacks or strokes before age 60 to 65. Other things will be of course the cholesterol, blood pressure, weight, that sort of thing. There's a test that I'm very fond of. I get it myself and I recommended wisely in people over 40 and that's what's called a promo heart scan or a calcium score. What this basically does is it helps us identify ahead of time if there are blockages in the arteries and to what degree. We now have a lot of scientific, very robust data that allows us to predict one's risk of a heart attack in the next 10 years based on that score plus the cholesterol levels, blood pressure, family history, and other things of that nature.
So if we come across a patient whose risk of a heart attack in 10 years is very low, 1%, 2%, 3%, then those patients, we would treat obviously very different than a patient whose risk of a heart attack in the next 10 years is a 100% as you can imagine. I unfortunately see a lot of those, but we can then start working on risk factor modification aggressively and thereby avert these very troubling issues that can arise.
Scott Webb: Yeah. And you mentioned risk factors. So I want to talk about smoking and why smoking is so hazardous to our health and can be so deadly for people, especially if they have other risk factors for heart attack.
Dr. Louis Janeira: Absolutely. You know, to tell you the truth, we really don't know exactly the mechanism as to why smoking is causing all the problems it does, the cancers, the COPD or the lung trouble smokers get, heart attacks, strokes, erectile dysfunction for the young man out there, wrinkly skin for the young ladies out there. But all of these things, we really aren't completely sure exactly what the mechanism is. Some postulated type things would be that sometimes cigarette smoking can cause spasm in the arteries that could go on to aggravate him and that sort of thing. But there is one thing that there is no question about, and that is that there is definitely an association between smoking, heart attacks, strokes, cancer, lung disease, and all the other ones.
Scott Webb: And it's so fascinating. It's sort of like you know that smoking is bad. We don't know exactly why it's bad. But we're just telling you, it's bad. It's bad on so many levels, especially as you say about stroke, heart attack and so on. So basically, the message is just don't smoke. Don't worry about why it's bad for you. We're just telling you it's bad. Just take our word for it, right, doctor?
Dr. Louis Janeira: Yeah. There's so much compelling data to speak to that, that it is in fact bad for you. Yeah, absolutely. You said it very well. I couldn't say it any better.
Scott Webb: Okay. So when we talk about treatment, I mentioned earlier, you know, time is heart, time is muscle. And when we talk about stroke, time is brain. So what does that mean exactly to you, doctor, as a cardiologist? Why is it so important? And what's the message to get across to people about get to the emergency department as quickly as you can? If it's an emergent thing that can't be explained and doesn't go away with Tums, go to the hospital. That's the message, right?
Dr. Louis Janeira: That is certainly a good message to send out to folks. The reason of course is number one, it could kill you suddenly. So that alone is a problem. But as you say, time is muscle or brain. Think of these arteries. I tell my patients, these arteries are just like fuel lines. So the fuel lines get crowded on the inside. Again, we call that atherosclerosis or plaque. These things grow with time, again with these risk factors. And if the artery gets to the point where it's not delivering enough blood flow downstream, if downstream is the heart, a heart attack; if the downstream is the brain, stroke; if the downstream is the leg, then you get into the situation where you sometimes have to amputate legs because of difficulty with blood flow down to the leg.
But either way, nothing good happens from having blocked arteries. And if the artery blocks completely, there is no blood flow downstream, whatever's downstream getting that fuel won't work and it'll die. The quicker one gets to the emergency room where these arteries can be opened up and allow for a restoration of blood flow, we're just killing cells, we're just killing tissue. And certainly the message of the sooner, the better is very important. Of course, the sooner would be 911 because you can get the fastest into the medical system that way.
Scott Webb: Yeah, definitely. Call 911 if you're having symptoms. Don't err on the conservative side, because we're hearing during the pandemic that people are delaying care. You know that when they are not having the classic signs and symptoms that you described earlier and their signs and symptoms may come and go, they're delaying care because of a fear of going to the hospital because of COVID, but we don't want them doing that, right?
Dr. Louis Janeira: Yeah, fortunately COVID is getting a little bit to be in our backview mirror, which is so good, but yes, absolutely, even now, but certainly during the peaks that we had before, people were staying home because they were afraid of getting COVID or they were assuming their symptoms were related to COVID or that sort of business. But either way, if care is delayed, then there is a very high chance of getting into a lot of trouble. So absolutely, I would agree with what you just said.
Scott Webb: Yeah. So call 911, get to the hospital. It's the safest place. If you go to the grocery store, you can definitely go to the hospital and that's where the treatment is. And one of the things I want to talk to you as we get close to wrapping up here, doctor, is about sudden cardiac events and abnormal heart rhythms. And just this sort of idea that there are people walking around that are these sort of time bombs, if you will, these walking time bombs that they don't know that they have heart issues and they suffer an abnormal heart rhythm, and then that results in sudden cardiac deaths. So what do we do about that? What do we tell people?
Dr. Louis Janeira: It's one of these things that once that happens is a little bit too late and the chances of survival having a cardiac arrest at home are very low. So the best thing of course is again, as we discussed earlier for heart attacks, is know your risk, know what could happen and discuss with your doctor the best way to delay or prevent these awful things from happening.
But what we're talking about is the emergence of very dangerous, very rapid heartbeats that essentially cause the heart to stop functioning and the patient dies suddenly. A lot of this happens in the middle of the night while the patient's asleep. So unfortunately, we don't even know this is happening until the next morning when it's way too far, too late to do anything about it.
Fortunately, we do have a lot of things we can do to predict some of these things. Not always, of course, but in a lot of patients, we're able to predict these things. For patients that are at risk and we can't make that risk lowered with medications, for instance, we have these implantable defibrillators that are devices, like pacemakers that are implanted in the body. The devices monitor for these dangerous rhythms. And if they occur, the device would shock the heart from within and result in restoration of normal rhythm and the saving of the person's lives.
Scott Webb: Yeah. And that'd be outstanding if we could do that. And it just sounds to me in basically talking to you today that a lot of people have risk factors, but there is help available there's treatment available, there's technology, you know, that was unimaginable, let's say, when you became a doctor and you've been at this for decades. So as we wrap up here, what's the takeaway? What's the message you want everyone to know when it comes to heart conditions, caring for themselves, preventing heart attacks? What would you like everybody to know?
Dr. Louis Janeira: Of course, talking to their doctor about their risk of these things happening. But in general, you know, we want people to be physically active, to walk or run, to just move more. Obesity as a humongous problem in this country, certainly in our state. So working on the weight and, of course, it's hard to work on weight unless you exercise. So I think exercise is an amazing thing. And again, it could be as easy as walking for people that have a lot of hip problems or orthopedic problems. I tell my patients, you know, walk five minutes every hour while awake. At the end of the day, you'll get near a mile and near or even over an hour of exercise a day, which is not that bad. So even as little as five minutes of walking around the house could help for those with the really bad arthritis.
For those that are able to do more, of course more is best. I myself use my smartphone and I try to do 10,000 steps a day. I try to do a little bit of running with that, try to do some weights as well. But I'm pretty much always looking at my phone to make sure that I'm going to be able to do those 10,000 steps a day. Again, you don't go from zero to 10,000, but slowly little by a little, get up there. But I think physical activity is humongous. It very important in helping folks.
If you smoke, we talked about this already, but absolutely you have to quit. It's a must. And some people need help with that, some people can do it on their own, either way it's an important thing to do. Staying well-hydrated and making sure you get enough sleep. Making sure that you have a balanced nutrition is always a good idea to stay healthy overall and certainly heart-healthy as well.
Scott Webb: As you say, a little goes a long way. And when we talk about heart attacks and preventing them, we need to know our family history, know our risk factors, address those things, seek treatment when necessary. So doctor, thanks so much for your advice, your wisdom today and you stay well.
Dr. Louis Janeira: Thank you. You as well. It was a pleasure to do this.
Scott Webb: For more information, visit FranciscanHealth.org/heartcare. And we hope you found this podcast to be helpful and informative. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well and we'll talk again next time.