MedStar Health DocTalk

The athlete's heart

January 05, 2024 Aubrey J. Grant, MD, FACCC Season 4 Episode 2
MedStar Health DocTalk
The athlete's heart
Show Notes Transcript

For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.

>> Speaker A:

Comprehensive, relevant, and insightful conversations about health and medicine happen here on Medstar health. Doc talk. Any form of intense exercise will increase our body's need for oxygen. With elite athletes, the heart responds to that need, too. It's the pump in the body's engine that supplies oxygenated blood to muscles. Over time, an athlete's heart can grow larger and stronger. In a sense, it remodels itself. Treating elite, high performance athletes requires a highly specialized cardiology program. Sports and performance cardiology at Medstar Health is the first program of its kind in the Baltimore, DC region and is one of only a few like it in the United States. Today, we welcome Dr. Aubrey Grant, a graduate of the only sports cardiology fellowship in the country who has a unique understanding of the athlete's heart. I'm your host, Debra Schindler. Welcome to Doc Talk. Thank you for being with us, Dr. Grant.

>> Speaker B:

Happy to be here. Thank you for having me.

>> Speaker A:

With only one program in the country and maybe two graduates a year.

>> Speaker B:

Yeah, just two. it actually depends on the year. Sometimes it's just one, sometimes it's two. My year over two.

>> Speaker A:

But I've heard it described, or graduates of that program described as a unicorn, because you're so unique.

>> Speaker B:

We are certainly a small collective of general cardiologists. the field of sports cardiology is sort of in its infancy, and it's a new and growing subspecialty within cardiology. I mean, in fact, it's probably less than 20 years old, but we are learning much, much more about what it takes to take care of high level athletes and just highly active individuals. And so it's a wonderful year to learn about all the things that are involved in taking care of these individuals.

>> Speaker A:

Why do you think it did form just 20 years ago?

>> Speaker B:

I think part of that is we are just starting to understand and learn and think about all the things that go into athletics. and we're just starting to be on the cusp of what an understanding of superphysiological training, what that can do to a heart, and the adaptations that can be seen because of the elite, athleticism and performance that these individuals are undergoing. And so in that time, there's been new studies. The thought process of how we manage and take care of individuals who have cardiovascular disease, who are athletes, has changed over time. and this science and this understanding has been sort of an artistic pathway in how we really creatively think about how to keep people active over the course of a lifetime and then manage people when they are highly active and elite athletes.

>> Speaker A:

It sounds a little bit complicated. Did you go into this, with an interest in cardiology or with an interest in sports medicine? Did you know that this program existed, that you wanted to check it out?

>> Speaker B:

Yeah. So I had no idea that the program existed. I think for me, I always was thinking general cardiology, more so on the preventative route. and I'm an active human myself, so I'm a former division one college soccer player, and sport has always been important to me. and even after I finished college athletics, I lived abroad teaching individuals on how we can use sport for sort of development. And I did some HIV AIDS work as well in the sports medicine type world. so sports has always been sort of central to my understanding of medicine, health, and sort of longevity in life. and then to be able to blend that with my understanding and love of cardiology, it felt like the perfect fit. fortunately, I did my cardiology training here at Medstar. and Medstar being one of the premier locations for sports cardiology, it afforded me the opportunity to be able to learn about this beautiful subspecialty during my training. And then I was again fortunate enough to receive the opportunity to move to Boston to complete that training. And now I'm back home, applying everything I've learned in that year.

>> Speaker A:

Excellent. We're glad that you are. how would you describe athletes heart?

>> Speaker B:

So, athletes heart, it is a catch all phrase essentially used to describe the adaptations that we can see when individuals engage in sort of long term sport or high level of activity. And it's really an interesting, nuanced, understanding of cardiology in the sense that what we have learned is that different activities can create different adaptations in the heart. for instance, a long distance runner's heart may look drastically different than an NFL lineman's heart or someone who does short, high intensity, starts, and stops in activity. and so understanding the activity that the elite athlete is engaging in certainly has a reflection on the adaptations that we see in the heart. and so that's a big part of what we do in the world of sports cardiology is really sort of understanding how the individual sport that the person is taking part of creates these adaptations that we then can see in the heart. additionally, we oftentimes have to understand that these adaptations can sometimes look like physiological and pathological heart disease. And so being able to differentiate between the two, is a really big part of my job as well.

>> Speaker A:

You said that the hearts look different depending on the athlete or the sport.

>> Speaker B:

Very much so.

>> Speaker A:

How so? The shape of the heart is different, the size of the valves. What do you mean by that?

>> Speaker B:

For example, I took care of a weightlifter, highly trained weightlifter, who bench presses in the upwards of 300 pounds, lifting five to six days a week. As someone who's doing that level of static activity and engaging in high level, high intensity interval type activity, their heart can sometimes be a little bit thicker than someone who perhaps is a marathon runner who engages in endurance training. For that athlete, the right side of the heart may be a little bit larger, to really sort of adjust for the amount of work that is required to maintain that constant level of endurance that a marathon will require. Really, the adaptations that we see tend to be reflective of the demands of that sport and the, sort of central adaptations that are required in order to sort of meet the needs of that athlete.

>> Speaker A:

Do you think that you would be able to identify the athlete if you were only looking at the cardiac imaging, for example?

>> Speaker B:

Yeah, there are a lot of clues, that we could pick out, on someone's heart that's actually a really good game that we should probably think about as training our residents and fellows, being able to guess the sport based on the heart. Yeah. But a lot of the adaptations that we see certainly can be reflective in the changes that we see in the heart. In particular for athletes that have been doing it consistently for months or for years and that are highly trained.

>> Speaker A:

I remember doing a story once on a runner, marathon runner who had a, cardiac arrest. It turns out that his heart had rerouted itself many times, and that had sort of what was described as almost like a spaghetti effect around the heart because of its own bypassing around blockages. Is, that common for a runner?

>> Speaker B:

What we see in another big part of my job is helping people maintain activity for a long period of time. So masters athletes, people being able to run marathons well into their. Unfortunately, historically, what we have seen is these people tend to be quite healthy. and so oftentimes their previous doctors have allowed them to exist with cholesterol levels that are above normal, certain biomarkers that are abnormal, just because they're kind of a highly active, healthy individuals. But we're learning that, just because someone is highly active and someone is an elite, perhaps master's athlete, that doesn't mean that they don't require the same medical therapy and the same intensity for medical options that the general public requires. additionally, a part of that information is, understanding that intensity really matters when thinking about exercise. And risk of exercise. And there was a recent study, actually a few years ago at this point, looking at marathon runners, and oftentimes we see a lot of sudden cardiac arrest, while people are engaging, in this high level of activity. And so having an understanding of who is at risk for sudden cardiac arrest when they're doing marathon training, understanding how to counsel people on healthy practices when you're engaging in that level of activity, is really a big part of my job, too.

>> Speaker A:

Is athletic heart syndrome the same as athlete's heart?

>> Speaker B:

Kind of similar. Tomato, tomato type. I think athletic, heart, essentially is really just that understanding that the heart is like any other muscle that exists in the body. So if I train my bicep, and I do bicep curls with 45 pounds every day for the rest of the week, my bicep is going to reflect in hypertrophy in a way that allows me to do the work that I'm asking of my bicep. And the heart is no different, and it's a similar muscle. If you are asking your heart to do certain types of work, over time, we'll be able to see and image and reflect and see what type of adaptations that the heart can have based off of the requirements that we're asking of that. So, like I said, high intensity challenges tend to present differently than sort of long endurance, marathon type activity. NFL players'hearts look a lot different than NHL players'hearts. Baseball, players are kind of in the middle somewhere. but it's a really beautiful thing to really sort of understand how all of this activity in sport has reflections on what people's hearts look like over time.

>> Speaker A:

So if you were looking at some of the things that you would identify in a heart as a specific athletes, and you were looking at that in a non athlete image, would you treat it differently?

>> Speaker B:

I think we are learning a lot about athletes. in particular, one, of the things that I do a lot is learning about coronary, disease, in particular in master's athletes. And I think over time.

>> Speaker A:

Excuse me, what do you mean by master's athletes?

>> Speaker B:

Master's senior athletes?

>> Speaker A:

Yeah, senior level.

>> Speaker B:

Senior level athletes. Yeah. Older athletes. So I think there was a time, like I was mentioning, where these athletes might have had some level of maybe perhaps low level, high level blood pressures or high level cholesterols. And over time, people have been like, oh, you're kind of healthy. You don't really need to manage it, and it's okay. but what we are learning is that just because someone engages in high level athletics, that doesn't mean that they can't procure disease over time. and so I'm just as intense with my master's athletes as I would be with general population. I'm getting similar level of testing, genetic testing, all these things in my athletes as well, because we know that these persons can ultimately have just as much disease as the general population.

>> Speaker A:

One thing that I kept reading about while researching this was a thickening of the ventricle wall. Is that a common factor involved with athletes heart?

>> Speaker B:

Yeah, we see a lot of that.

>> Speaker A:

what's the consequence of that?

>> Speaker B:

So, to take a step back, sometimes the heart muscle can thicken, and sometimes it can thicken pathologically because there's some sort of disease that's at play, or it can thicken because of athletic activity, and certain types of movements can promote that level of athletic change in the heart. And, so a big part of my job is being able to differentiate. Is this normal remodeling because of the sport that, the activity that this person is doing, or is this actually some pathological disease that we need to manage? fortunately, at Medsar, we have a swath of diagnostic modalities that help us differentiate between the two. Cardiac MRI, echocardiogram, EKG, cardiac CT, all of the imaging, modalities we have available. and I'm able to use even a cardiopulmonary exercise testing in order to help gather information, to really sort of paint a broad picture about, is this pathological, or is this sort of just the normal changes that we expect to see from athletics?

>> Speaker A:

Who are your typical patients that you see?

>> Speaker B:

So I see elite level athletes all the way down from your elite level pelotoner. and so people who are highly active and encouraged, to maintain, activity over a lifetime. I see, a broad range of, quote unquote athletes. I think that term athlete. Sometimes people just think it's, oh, he just does. Professional persons. But I work a lot of the sort of local marathoners, local five k's, ten k's. I see people who are just interested in, endurance training and activity and all those sorts of things.

>> Speaker A:

And are they coming to you because they've had a cardiac event or cardiac issues, or are they just preventive, just coming to you because they want to make sure they don't have one?

>> Speaker B:

So I think that's the beautiful part of my job, too, is I oftentimes see people, who have had a family history of heart disease, and they're highly active, and they want sort of an understanding of where they are in their baseline health. I see people who are planning for a big event, a big race, and they want to make sure that they do it in a safe way. I oftentimes do see people, after they've had some sort of cardiovascular event, heart attack, stroke, cardiac arrest, et cetera, and help them understand how to get back to training. My goal with my practice is to keep people as active for as long as possible. I, think what I have learned and understood in my training is that exercise really is medicine. and the fitter you are, the longer you tend to live in all aspects of even cardiovascular disease. When we think about oncology, I mean, just all the things, the fitter that a person is, they tend to do better in life. And so I encouraging of all of my patients to engage in some sort of activity. I mean, the American Heart association recommends at least 150 minutes of activity per week. And so that is sort of the baseline recommendation I tend to give to people. But as active as people can be, I tend to encourage that.

>> Speaker A:

So you see a lot of athletes, and maybe they come to you with some symptoms. Are you specifically looking for athletes heart?

>> Speaker B:

Yeah. Oh, certainly. It's always in the back of my mind. anytime I read a study, and then being a sports cardiologist is really important because it's giving me that sort of clinical eye to suspect, a lot of these adaptations that athletes tend to have. Sometimes athletes can get labeled as having cardiovascular disease, but it's really just the athletic adaptation that's causing that abnormality in the diagnostic test.

>> Speaker A:

that means they don't have any cardiac.

>> Speaker B:

Yes, right. They do not have cardiac disease. However, they might appear as though they have cardiovascular disease to the non way on imaging, on imaging or symptoms, et cetera. A lot of times, for example, athletes, tend to have really funny looking ekgs. EKG is the, way we pick up people's electrical signature. Your heart runs on electricity. And so we use the EKG to try to determine what that actual signature is. but in athletes, EKG tends to look wildly different than the persons in the general population. In fact, we have different guidelines for people who are highly active and elite level athletes for how we look at their ekgs. and for someone who's not trained in that, you might not keep that in the top of mind, but for me, that's kind of always what I'm thinking about.

>> Speaker A:

So an athlete's heart as someone who is diagnosed with an athlete's heart doesn't necessarily have an unhealthy heart, am I right?

>> Speaker B:

Correct, yeah, correct.

>> Speaker A:

It just means that it's been remodeled because of their athleticism.

>> Speaker B:

Correct? Yeah. There are certain adaptations that can happen over time, with high, high level of training activity, et cetera. And one thing in particular, endurance runners, long distance endurance runners, they tend to get atrial fibrillation, at a little bit of a higher rate than others. Atrial fibrillation is an arrhythmia of the top chamber of the heart. Right. And so, understanding that that tends to happen in a little bit more frequent. For marathon runners and highly active people, I keep that in the back of my mind, and so I'm oftentimes counseling.

>> Speaker A:

but that is a condition that is concerning.

>> Speaker B:

It is a condition, absolutely. And even in the management strategy, we tend to have different management strategies for people who are highly active than the general population. Sometimes people who are highly active, the management, they don't tend to tolerate it as well, as the general public. So there are other medications that we. There are other medications and or procedures that we can offer, in order to, number one, help them tolerate, and then, number two, get them back active and achieving and completing all the things that they want to complete with their athleticism.

>> Speaker A:

There really are a lot of differences between an athlete's heart and a normal heart.

>> Speaker B:

Very much so.

>> Speaker A:

What are some of the symptoms, then? for athletes? Heart.

>> Speaker B:

So, in particular, all the major cardiovascular symptoms, chest pain, shortness of breath, lightheadedness, dizziness, passing out, those are things we kind of look for. One sort of unique symptom that I look for in athletes, that sometimes can go undetected in the people who are not trained in sports. Cardiology in particular is oftentimes we see athletes that aren't able to achieve. For example, so, if I have an endurance runner and they're saying, oh, my times are just a little bit slower than they were a year ago, or I'm not able to achieve the speeds that I previously were able to achieve, previously. Sometimes that can be a signal and a sign that there's something brewing and there's something at bay, and perhaps we need to do some diagnostic testing to try to figure that out. I found that sometimes that main symptom, that sort of exercise decrement, can go sort of unnoticed, in a lot of our high level athlete populations.

>> Speaker A:

Suggesting what? That there's blockage or cholesterol?

>> Speaker B:

Yeah, absolutely. I mean, there's a lot of things that could be the cause of that. poor, arrhythmias, blockages, decreased heart function. All of these things can support that diagnosis, but that's a symptom that oftentimes gets missed.

>> Speaker A:

Interesting. So, an athlete comes to you, what's the first appointment look like? What does their first walk through? Are there screenings and diagnostics? What might you do?

>> Speaker B:

So, usually on all of our first visits, everyone's coming in and getting an EKG and then having a clinical visit with me. where we meet, we talk. I try to understand your fitness goals, sort of where you've been with fitness, where athleticism and sport has taken you in your lifetime, and what are your future goals. I think a lot of understanding, of sports cardiologists and understanding of what are people's goals, for the activity that they're doing. And oftentimes, we will have different management strategies based on people's goals. If you tell me you want to compete in the Olympics, I might be more intensive about a medical strategy that I would create for you, as opposed to you're saying, hey, I just want to do exercise for longevity. and that sort of really frames how I think about the patient. Beyond that, we often do testing such as echocardiogram, cardiac MRI, cardiac cT. One of the unique testing tests that we do for sports cardiology is we offer cardiopulmonary exercise testing, and that is a wonderful test where patients can exercise while they're wearing a mask. and we're able to determine their, vo two. and their villain.

>> Speaker A:

What's vo two?

>> Speaker B:

Yeah. and basically, that is a measurement of a person's fitness, and so how fit a person is, we can determine additionally from that, we can determine what a person's anaerobic threshold is to help guide how they can improve their fitness, how they can improve their training, and how can they become an even better athlete, with the testing that we're able to provide.

>> Speaker A:

And that testing happens on a CPET machine, which is a rather unique piece of equipment.

>> Speaker B:

Very much so, yeah. So we have a unique protocol specifically designed in our exercise physiology lab for athletes, using our woodway treadmill. we also have, an agrometry machine, and then we have a bicycle as well, if, the person sporting is bicycling. but essentially, our unique protocol allows us to, adapt for highly active people that are coming for our treadmill testing, that on a normal, protocol, they would blow that out of the water because they're so fit. But with our protocol, that we have, we're able to really sort of hone in on highly active persons fitness, levels.

>> Speaker A:

And is there a follow up?

>> Speaker B:

Yeah, absolutely. I like to think of myself, I'm not intuitively and by nature a data oriented person. I'm really sort of like, I see things, as high level and so oftentimes I'm meeting people and we're going through the details, we're doing the sort of initial testing, but I think of them over the course of their lifetime. How can I be best helpful to this person, achieve their goals, live as long as possible, and offer the sort of the most longevity to them. so certainly, treating any sort of acute issues in the first couple of visits, but also coming up with a plan for how can I give this person the things, the strategies, the techniques, perhaps medication, perhaps procedures so that they can be as active as possible for as long as possible throughout their lifetime. I know prevention is a big strategy that I incorporate and then a fitness, I, think, like I said before, people that have higher levels of fitness, people that have higher vo two s, tend to live a lot longer, and that's a much better medication, in my opinion, than traditional pharmacological medications.

>> Speaker A:

So when should an athlete come to see you? before they start training, maybe they're not really that elite yet, or, who's to say who's an elite athlete?

>> Speaker B:

Right.

>> Speaker A:

What's the right level?

>> Speaker B:

I think at any point is a wonderful opportunity and the goals can change as the relationship goes on. I think oftentimes I see a lot of persons prior to a marathon, or prior to any sort of events or any sort of competition, that they're trying to engage in. Number one, just to make sure that they're doing it in a safe way. Oftentimes we're able to discuss persons that perhaps might have had a family history of heart disease. And so getting a baseline sense of where they are in relation to the sport that they do, can be helpful in helping them understand how can I compete safely throughout my lifetime. Additionally, a good time is once someone actually has had a cardiovascular event and they would like to get back to sport. That's a great time, to really come up with an idiosyncratic plan for that person to really help them recover and then improve their fitness safely. and then certainly we see a lot of individuals who are engaging on sport at a yearly basis, just as do the sort of yearly check in prior to any sort of competition that you're trying to do.

>> Speaker A:

You mentioned earlier, sudden cardiac death, and that's a rare event, but when it happens, it often makes the news because it is so shocking and unexpected. And athletes wind up dying because they didn't know of maybe an underlying cardiac issue. Is athletes heart something that would lead up to something like that?

>> Speaker B:

sudden cardiac arrest and sudden cardiac death, is terrifying and it is absolutely scary. I mean, the thought of, these young tend to be young, healthy athletes dying, as they're competing and doing the things that they love. It shakes communities to their core, and sort of our fundamental understanding of health tends to get shaken as well. And that's why it's such a big event, and I mean, there have been countless instances, even over the last couple of years, where this has occurred and it's made national news, and it's really sort of highlighted the job and the role that I have, in the sports community of getting a baseline understanding of who is particularly at risk, and what type of person should have a plan about how they're going to be able to compete safely. To be clear, I think sometimes it gets misconstrued that as sports cardiologists, we want to pull people out of sport, and we're really restrictive about how we take care of people, but I think really we want people to be able to compete in a safe way, and so we have strategies that we utilize in order to help us restratify persons, that perhaps might have some level of heart disease. We have guidelines that help us understand who, is able to compete safely with cardiovascular disease, and then we have certain protocols that we implore to help understand who is really at risk, for these sudden cardiac events. Additionally, beyond that, what is really clear, sudden cardiac arrest does happen. our screenings do help, however, when it does happen, people need to be educated, number one on really what high quality CPR looks like and what a concerted resuscitation effort should look like. when Demar Hamlin unfortunately had his son in cardiac arrest on tv, unfortunately, it was a terrible event that most of us witnessed. What happened afterwards was beautiful. that concerted effort by the physical therapist, by the medical staff in order to resuscitate, that man and bring him back to life so quickly, was wonderful. And that should be the standard for, obviously, professional organizations, but obviously, colleges, high schools, et cetera. Everyone needs to have a broad understanding of what an emergency action plan can look like, and then dedicated CPR. Everyone should really sort of understand how to do that properly.

>> Speaker A:

And I should add that in my studies or in my research for this podcast, I did read that sudden cardiac death in sports has gone down. There's been a notable decline in that. Maybe because defibrillators are on location more often now.

>> Speaker B:

Absolutely, yeah. Making defibrillators available. Access to defibrillators was a big issue. There was a Prague price barrier to having them available at high school levels, lower levels, having an understanding of cardiopulmonary resuscitation. What does good CPR look like? having everyone in the community feel comfortable doing CPR, making sure that they're athletic trainers at all these events. It's not required that every school has an athletic trainer at their sporting events. That's certainly an area for disparity and certainly things that we should consider, having communities. one thing that I want to highlight and be very clear about is there is a big disparity between when persons do have cardiac arrest outside the hospital, that resuscitation event, oftentimes in communities of color, is not as robust in majority populations. And so why is that? I think certainly there are some issues related to structural racism and some social determinants of health, but also educating communities of color and empowering them to engage in CPR, having these afibrillators available could certainly work to reduce some of those disparities that we see.

>> Speaker A:

Important points. Thank you. Can and should athletes heart be prevented? Should it be?

>> Speaker B:

Well, I think, athletes heart in itself is just an understanding of the adaptations that can happen when the athlete engages in high level sport. And that's, As someone who is highly active and a sports person myself, I would never tell people to not be athletic or engage in sport. and it is a wonderful thing to see people be able to do sport for long periods of time. And so I think that's a good thing. And the adaptations that are, quote unquote athletes heart are really just a reflection of highly active persons. And so I think that's great. What we do need to understand is there's oftentimes this gray area between what is athletes heart and what is actually pathological cardiovascular disease. And being able to differentiate between the two is where I come in as a sports cardiologist, what would be next.

>> Speaker A:

For our patients you were examining or you put through on the CPET machine, and you did all these diagnostics, and you found something. What might you find wrong?

>> Speaker B:

So, one of the big things that we manage as sports cardiologists. As I was mentioning, we discussed, sometimes the heart can thicken, and it can thicken because of sport and activity, or it, can thicken because of what we call cardiomyopathy or cardiovascular disease. And so sometimes we do pick up cardiovascular disease in our athletes, and then what is next is oftentimes a shared decision making conversation where we bring all the stakeholders to the table, the athlete, perhaps athlete's family. If a school is involved, we bring the school involved. If it's a professional level athlete, we bring the team in, and we really sort of have, a unified conversation about what is the risk, allowing people to make their own decisions about how they want to move forward, understanding how important sport is in their life, and then coming to a unified decision with all the stakeholders involved about how we're going to proceed going forward. My role in that conversation is to provide the information to allow people to make sort of informed decisions with their lives.

>> Speaker A:

What do you hope people listening today to this podcast will take away from this?

>> Speaker B:

Yeah, I mean, I think for me, part of the biggest message that I try to preach is that activity, endurance sport, it really saves lives and it changes lives. I mean, we know about the psychological role that sport has in increasing confidence, and changing your mood, et cetera. But overall, people who are active for longer, they live longer, people who have higher level of fitness, they live longer, and they're able to stave off a lot of these cardiovascular disease. I think what I learned in my training, is that we know a lot about sick hearts. We know how to manage sick hearts really, really well. And we do an excellent job here. I mean, the cardiology team here is beyond amazing at how they take care of people acutely and people who are ill, and that what has been pressed upon me is I don't want that. I don't want heart disease, and I don't want that for my patients. And so we try to prevent that, as best as possible. And I truly believe that an answer prevention really goes a long way. And so encouraging people to be active and healthy throughout their lifetime really is the goal. Supporting people through endurance training, supporting people as they do sport, into their want to keep people as active as possible for as long as possible, because I really believe in sport as medicine and exercise as medicine. and so my main goal for this is really sort of a paradigm shift in how I think about medicine. Focusing on exercise and endurance training is really sort of, the bedrock of that and encouraging our society to try to be as active as possible. It's at least 150 minutes a week, we know, improves mortality. and so if we could do that as a community, I think we would really sort of move the needle because we know cardiovascular disease is one of the top killers in this country, and working towards that, I think, can be really beneficial.

>> Speaker A:

150 minutes a week sounds like so.

>> Speaker B:

Much, and that's per week. But it doesn't have to be. I mean, you could do 30 minutes for five days. If you're kind of a weekend warrior, you can just do 150 minutes in the morning when you wake up on Saturday.

>> Speaker A:

Far more doable when you see 30 minutes a day.

>> Speaker B:

Yeah, it could be broken up for m however you want to get the work done. As long as it gets done.

>> Speaker A:

That sounds much more feasible for me. Thank you for putting it in perspective.

>> Speaker B:

30 minutes a day would do a lot for you.

>> Speaker A:

Thank you.

>> Speaker B:

Dr. Grant.

>> Speaker A:

We've been talking with sports and performance cardiologist Dr. Aubrey Grant at Medstar Union Memorial Hospital. Dr. Grant, thank you for sharing your expertise with us here on medstarhealth. Doc, talk.

>> Speaker B:

Thank you so much.

>> Speaker A:

For more information or to schedule an appointment with Dr. Grant in Baltimore, call 410-3665 600. Or to see him at Medstar Health at Lafayette center in DC, call 202416 2000 and press option one.

>> Speaker B:

Close.