Cardiovascular Surgery

Our Team      Photogallery

A brief overview od the Cardiovascular Surgery Specialized Center

At the center of cardiovascular surgery, we provide comprehensive care across the whole range of our specializations: cardiac surgery and vascular surgery. We ensure 24-hour surgical service for all emergencies of the cardiovascular system, including traumas.

Yearly, we provide outpatient care to more than 4.000 patients and we carry out around 1.000 major surgeries. Half of these surgeries are cardiac procedures and half are vascular interventions. The number of such procedures increases each year.

We closely cooperate with the Specialized Center of Surgery, Anesthesiology, Radiology and ICM, as well as our Specialized Center of Rehabilitation and Sports Medicine, since recovery after surgery can be lengthy.

How will your detailed schedule look like? What kind of surgeries, procedures, methods or treatment can you observe? Check what can you see by shadowing every member of the mentoring team.

 

Is this specialty placement ideal for you?

  • As this surgical placement allows you to be in close contact with the patients, before, during and after their cardiac surgery, you need to be determined to pursue this specialty and ready to withstand all the demanding aspects of our work. You will stand side-by-side with our skilled cardiovascular surgery team members and observe every single detail they perform within their job - how our patients are prepared for surgeries, what kind of procedures and methods we use and what kind of post-operative care is required in particular cases. 
  • This placement suits perfectly to those of you, who desire to understand the comprehensiveness of cardiovascular surgery and for all students, who are still uncertain about their desired healthcare profession. Among our mentors are doctors, nurses, as well as, healthcare assistants. This way, you can get a complete picture of the work in our center with all its trimmings, where each member of the team is irreplaceable.

Let's take a closer look at the specialties…

Cardiosurgery is a specialty targeting a wide range of pathologies. As part of the treatments provided, we use various types of surgeries and approaches, according to the specific procedure. Vascular surgery is a branch of medicine focused on veins and arteries. The vascular issues we deal with include arterial occlusive disease, aneurysmal disease and blockages in the bloodstream.

We perform ischemic heart disease surgery (aortocoronary bypass), including complete arterial revascularization and operations without extracorporeal blood circulation, as well as the whole range of acquired defects of valves surgeries with emphasis on restorative operations (plastic surgery) of the mitral and aortal valves. We further focus on allotransplantation of human valves into the aortal position, especially in cases of infectious endocarditis (we performed the first operation of this kind in the Czech Republic in 1994). We provide surgical treatment in cases of heart failure, thoracic aorta diseases (including implantation of stent grafts), congenital heart defects in adult patients and atrial fibrillation (MAZE). We also offer the complete range of vascular surgeries, including treatment for aneurysms of the abdominal aorta, treatment for peripheral artery diseases and dialytic approaches.

Our team has performed a total of 40 extracorporeal membrane oxygenations (ECMO) on patients from our department, the 3rd Department of Surgery, the Specialized Center of Anaesthesiology, Resuscitation and ICM. Within the transplantation programs, 31 lung transplants have been performed via extracorporeal circulation. We have collaborated on four heart transplants in patients with congenital heart disease at the Children's Heart Center.

The department includes an Intensive Care Unit (ICU), Intermediate Care Unit and two standard units. We use two modern operating rooms in the central complex, and we share a septic operating room with the Specialized Center of Orthopedics and the Specialized Center of Surgery. Our patients can be hospitalized in the 12-bed ICU, as well as in the intermediate and standard units, which have a flexible number of beds.

In cooperation with our Specialized Center of Surgery we have performed an ex-vivo lung reconditioning using extracorporeal circulation. This new method will save more lives, as it keeps the out-of-body lungs usable.

Our center includes the following specialized outpatient facilities:

  • Cardiology
  • Cardiac surgery
  • Vascular diseases
  • Congenital heart defects in adults
  • Arrhythmology after surgical treatment for atrial fibrillation
  • Child vascular diseases
  • Treatment of ischaemic defects of the lower extremities
  • Clinic for patients after surgical treatment of infective endocarditis

Our cardiology and vascular diseases outpatient facilities are in daily operation with the constant presence of cardiologist and surgeon, not only for consultative purposes, but also for indications, preoperative preparation and postoperative patient checks.

Who do we take care of?

In our department, we examine patients suspected of having any heart problems. Our patients also come to us for post-surgical and other medical check-ups.

We perform acute and elective cardiac operations across the spectrum of the specialty (except for heart transplantation) by using both on-pump and off-pump coronary artery bypass grafting. We also treat aortic aneurysms (thoracic and abdominal) and aneurysms of large vessels, including dissecting aneurysms of the ascending and descending aorta. With the exception of heart transplants, we provide a full range of treatments in the field of cardiovascular surgery.

Our methods and procedures

Our coordinated team performs these procedures within the department:

  • Video-assisted mini-invasive surgery of the mitral valve
  • Mini-invasive surgery of the aortic valve, using valve prosthesis without stitches
  • Video-assisted mini-invasive surgery of some congenital cardiac defects (e.g. defect of the atrial septum)
  • Comprehensive care for adult patients with congenital heart disease
  • Surgical treatment of infectious endocarditis, including the treatment of drug addicts in cooperation with the Department of Infectious Diseases of the MUH
  • Hybrid mini-invasive solution for polymorbid patients with ICHS (PCI – stent + MIDCAB – bypass via a minithoracotomy without extracorporeal circulation)
  • Mechanical cardiac and lung supports – EMCO
  • Reconstructive (sparing) surgeries of the aortic valve
  • Revascularization of the myocardium without using extracorporeal circulation

How does the usual schedule look like?

  • Work in our specialized center varies and it includes a lot of direct contact with the patients. If you are interested and confident, you can expand your schedule and stay for both the day and the night shift. We guarantee you will be in your placement at least 25 hours per week.

If you are not sure whether this choice is suitable for you, don’t hesitate to contact us. We will discuss your experience and motivation and come up with the best solution for you.

Our Team


Photo Jan Šibík

Bc. Susan Kely Corea Gamboa

ICU Nurse

Nurse


What I appreciate the most at our ICU is the variety of job tasks. You can witness the daily work of surgeons and anesthesiologists. You will see the operating room and the after-care and follow-up of the patients. Seeing the patient before, during, and after the surgery gives a complete idea that helps understand the treatment process. The care for our patients is demanding, and as a team, we can handle all from mechanical ventilation and dialysis to ECMO.

Why did I become a healthcare professional?

I am from Costa Rica. I have been a nurse in the intensive care unit of Cardiovascular Surgery here in the Czech Republic for almost two years (from 2019).

From a very young age, I always wanted to be a doctor, but due to life circumstances, this was not possible. My path, on the other hand, always led me to become a nurse. For several years I resisted this idea, until one day I said to myself: "And why not?" and it was the best decision I could have made. I got a scholarship to study in the Czech Republic. I took the risk and came to learn the language for almost one year and finished my degree. Afterward, I decided to stay and work at the University Hospital in Motol. I love taking care of my patients in all the spectra that nursing allows me and training myself to be a better professional.

I got a scholarship to study in the Czech Republic. I took the risk and came to learn the language for almost one year and finished my degree. Afterward, I decided to stay and work at the University Hospital in Motol. I love taking care of my patients in all the spectra that nursing allows me and training myself to be a better professional.

What do I love the most about my specialty?

The best thing about being a nurse is the wide variety of specialties and possibilities regarding what type of work to do. You can try different departments until you find your passion. When you find the ideal job, then you can specialize and learn everything about it. What I like the most about being a nurse in intensive care is the fact that I am close to the patient during all 12 hours of my shift. I can give him my support, help, and continue his treatment during each stage of his recovery. I see every little evolution, and I can recognize changes no matter how small they are. When things get complicated, the adrenaline, the speed of response, the incredible teamwork, the fact of saving a life in a matter of minutes is a feeling that cannot be compared to anything in the world.

What can you see by shadowing our team?

You can be part of immediate nursing care to patients after open-heart surgery, lung transplant, vascular surgeries, the task of restoration of vital functions and postoperative recovery, and the use of highly specialized equipment. Last but not least, you will observe holistic care in action, which integrates physical, spiritual, and psychological care. In the case of a patient who for some time loses his independence, it is our team that leads him to his recovery to be able to take care of himself and return to his everyday life.

It is a fantastic process and a huge opportunity to be part of it. You can see the interaction of a multidisciplinary team where nurses, anesthesiologists, surgeons, pharmacists, physical therapists, speech therapists, and many others work together to achieve complete and successful recovery of the patient.

We do daily intubation, extubation, tracheostomy, thoracic drains, central venous catheter, arterial catheter, dialysis, ECMO, and assisted mechanical ventilation or Intraaortic balloon counterpulsation to give you more examples of methods and procedures.

Apart from being a healthcare professional...

I am a bit of a foodie. I love visiting new restaurants and trying new and exciting food. A good wine with good company is always welcome. I have a wonderful family. With my beloved husband and my little daughter, we love to watch movies and visit new places.

But even in my spare time, I try to study and learn more and more. It's never enough.

My motto…

If you don't have anything nice to say, don't say anything at all.

Photo Jan Šibík

MUDr. Radovan Fiala

Head of the Unit

Doctor


I started to study medicine with the clear goal to become a surgeon, specifically in cardiology. I like the challenge of being the one on whom the fate of an organ or a limb depends. During my university studies I was taking internships in hospital and assisting in minor surgeries. I was so proud and excited when I got into the Cardiovascular Surgery Specialized Center as during that time a specific program in vascular surgery started to evolve. Being a part of this process was particularly inspiring for my professional career.

Why did I become a healthcare professional?

As a child I dreamed about being a dustman, firefighter, or cosmonaut, but these ideas quickly evolved into more practical plans. In seventh grade, I decided that I definitely wanted to become a doctor. I wanted to be helpful and I loved the smell of hospitals. My mother was a nurse and the unknown scent from her clothes– the aroma of hospital disinfectant – welcomed me every time she got home. During my first year of lyceum, I was wandering about becoming an archeologist but finally I realized it is better to be a doctor with an interest in archeology than an archeologist with an interest in medicine. My last moment of hesitation occurred just before applying to medicine. I came up with the idea of fullfiling my childhood dream and applying to the military university to become a pilot. But for lack of interest, this subject wasn’t open that year. Maybe it was a sign of destiny to not give up on medicine and that is how I became a doctor.

You will try, you will see, you will know.

What do I love the most about my specialty?

For me the main benefit of this specialty are the immediate results and improvements for the patient after a surgery. Furthermore, current vascular surgery takes place not only in a typical operating room, but also in an angiographic one. I have the chance to provide various types of surgeries – from treatment for varicose veins, to minor and major reconstruction procedures, to organ transplants. This specialty combines modern techniques with surgical and endovascular interventions. Vascular surgery is for me a field that brings new challenges all the time.

What can you see by shadowing our team?

This placement gives you an excellent opportunity to see how the week really looks for a person in my position. Apart from an everyday routine in the patient’s wards and morning rounds, you will also participate in common x-ray indication seminars and see vascular surgeries. If you are interested, you may stay for the afternoon and night shift. On Mondays I work in the outpatient department where I meet patients that have come in for their first vascular exams (concerning venous or arterial system) or meet with patients for post-surgical and other medical check-ups. On Wednesdays, I participate in endovascular interventions together with my colleague – an interventional radiologist - in an angiographic operation room. In the afternoon I have outpatient work again, but this time for children that suffer from inborn or acquired diseases of the vascular system and children after reconstructive procedures. On Thursdays and Fridays I usually conduct surgeries, for example to correct lower limb disorders. Apart from seeing the work of a vascular surgeon you will have the opportunity to study the problems of vascular system diseases.

Apart from being a healthcare professional...

I like motorcycling, traveling, historical literature, movies, theater, scuba diving, taking photographs, and sports (squash and mountain biking)

My motto…

Never know, never try.

Photo Jan Šibík

MUDr. Daniel Hujo

Anesthesiologist

Doctor


I was passionate about first aid since elementary school. It is a set of several techniques and methods when you can save a life with minimal equipment and bare hands. As in a majority of cases, it is a question of life and death the worst you can do is to do nothing. And about that is as well my specialty. I am the kind of a person who needs to see the results of his work immediately or the soonest as possible. And that is what anesthesiology and intensive medicine offer to me. As somebody smarter already said: "Anesthesiology is from 99% boring and the 1% is pure adrenalin." And I can tell you it is absolutely worth it. 

Why did I become a healthcare professional?

I remember the moment when I decided to become a doctor quite well. I was nine years old, at the third grade of elementary school and I registered for the First Aid training. I was so fascinated by the fact that I can save a life by a few simple procedures and bare hands that medicine has become my love ever since. Then all that it took was to follow my goal; I was an active member of the Red Cross and also became a lecturer of first aid techniques. At first, I was considering the surgical specialties, but then my passion for urgent and acute medicine prevailed. Anesthesiology and Intensive Medicine were number one choice for me.

Come and see and try for yourself what is the reality of our job. It is a life experience no one can ever take from you. You will meet lots of new people; you will see a top-notch facility with a world-class level of care and all that in a beautiful city of Prague.

What do I love the most about my specialty?

My profession makes me not only to re-think my approach but also to improve it every day. I am a competitive type, and I do not like to lose wink Every patient is unique, and their cases are specific, you cannot do your job as a robot. People require individual approach, and you need to be ready for every unexpected eventuality or complication and what is the most important. You must be able to respond immediately in an adequate manner. What I like about cardiac anesthesia is the continuity of the care. I take care of the patient at the OR, and I see him at the ICU, too. As a cardiac anesthesiologist, I influence the result of the provided care immensely. If the patient's situation is life-threatening, it is real adrenaline. And if all works well, the feeling of inner satisfaction is indescribable. And what is more than when a patient smiles back at you when you help him or her to relieve the pain, that is everything.

What can you see by shadowing our team?

You can see the complete range of care in cardiovascular medicine with me. I work at the ORs and also at the cardiovascular ICU. Thus you have the chance to witness the surgeries as well as the specific care we provide in the Intensive Care Unit. At the OR we perform the whole spectrum of anesthesia for invasive surgery from the use of intravenous cannulas to double lumen cannulas for extracorporeal circuits using Doppler ultrasound check. You can observe different methods including total anesthesia, central or peripheral blockades as well as combined ones. You will see the biluminal cannula insertion once there is a need for selective ventilation of right and left lung. And the whole process of my cooperation with a patient before, during and after the intervention.

At our IC Unit, you will be able to observe our team during the intensive care for patients after the cardiovascular surgeries, daily ward rounds, invasive interventions such as tracheal punctures or pericardial punctures and so on. 

Apart from being a healthcare professional...

I like to spend my free time actively. I love to visit new places like castles and nature as there is nothing better than the to be in the forest after a fresh spring rain. During the week I work out, and if I feel I have a lack of energy, I take a sauna or go to see a good movie. Apart from that, I enjoy papercraft as a way how to train my skills.

My motto…

Good news, bad news... Who can say?

Photo Jan Šibík

Libor Javorka, DiS.

Head of a Shift for Nurses and Healthcare Assistants

ICU Nurse


I have been working in healthcare for ten years. I followed my path from being a paramedic and healthcare assistant in the UK to be the head of the shift at my intensive care unit. Since many patients are in very difficult life situations and their families are worried about their lives, the work can sometimes be very tiring. But I am still very satisfied when I can see them making progress, and I leave the hospital with the feeling that my work has a purpose.

Why did I become a healthcare professional?

My decision was actually a matter of circumstance. After studying electronics in high school, I was supposed to fulfill a one-year military service requirement if I did not continue with my studies. As I did not plan on a career in the army, I was looking for a discipline in which I could gain valuable knowledge and use it later. That turned out to be healthcare. I chose the higher school of nursing, specifically as a qualified paramedic. After finishing my studies, I became qualified as a general nurse and became registered. During my work, I passed the aptitude test and kept practicing, and a year later I passed the graduation exam in the field of general nursing.

I can guarantee that whatever will be happening, you will be there with me to see it!

What do I love the most about my specialty?

In addition to the satisfaction from patients´ recovery, I appreciate very much that I have a certain amount of independence. I can modify the parameters of the ventilators, the dosage of drugs, and react to condition changes of my patients. I like this responsibility, as I can use my experience without being dependent only on the decisions of my other colleagues or doctors.

What can you see by shadowing our team?

I work as the head of the shift so I determine who will take care of which patient. Therefore, I have an overview of all the patients in the Intensive Care of the Cardiovascular Surgery. There is a lot to see but just to have an idea, you may see a non-invasive ventilation that is provided by a full-face mask or a helmet. And if we have a patient on heart support, I will explain to you counterpulsation, which is an inserted catheter through the left ventricle to the aorta with a balloon that helps the heart with stretching. Here are few more procedures to mention: the changing of bandages on surgical wounds, invasive inputs, heart electrodes, and marrows, including their removal; ECMO device; dilution and administration of drugs through a vein catheter by a dosimeter and a pump to a gastric probe.
We will also be looking after patients who are going in for surgery differ from patients with complications in an acute phase. Procedures will vary in patients with chronic diseases who are hospitalized in our department for several weeks. But the care of patients is not my only task. As a head nurse, I need to organize the work of other nurses, as well as medicine and sterilized tools.

Apart from being a healthcare professional...

My wife and I used to spend our free days hiking in Czech Republic or Austria. We went biking, kayaking, and snowboarding in the winter. When our son was born a year ago, it was necessary for us to set our hobbies aside and give our free time to him. We go for shorter trips which our dog enjoys. Italian cuisine, museums, and fine wine are also things that I appreciate.

My motto…

Just do not be afraid. When it is not about life, it is about nothing.

Photo Jan Šibík

Jakub Lorenc

ICU Health Assistant

Health Assistant


I have always wanted to work in a department where one needs to decide very quickly and without mistakes in difficult and crucial situations, where life is hanging in the balance. I wanted to have a chance to talk to patients about their feelings and witness their progress. These criteria were essential for me when choosing my specialty. The Intensive Care Unit of the Cardiovascular Surgery Department matches them all.

Why did I become a healthcare professional?

Since I was a child I have had a positive attitude towards people. I enjoyed helping them, especially older people, so my choice to become a healthcare professional was easy to make. I wanted to find out how the human body works, how it can be cured, what is essential for basic vital functions, and how various actions within the body occur. Mainly, I wanted to be able to help an injured person when the situation occurs, to closely cooperate with doctors, and to watch how the disease or injury evolves during treatment.

Our department is one of the most interesting and most specialized ones in the Czech Republic. It will be exciting for students who like active jobs and want to learn something new. You will be able to watch medical procedures and see acute conditions that occur very often in our department, due to its nature.

What do I love the most about my specialty?

Choosing the perfect department to work at took some time for me. Finally, I decided to work in the Intensive Care Unit, and I bealieve it was the perfect choice. I like acute procedures such as intubation, artery cannula, or thorax punctures. And I thoroughly enjoy when we take care of someone for a couple of months and finally he or she goes back home. The attitude of my colleagues is amazing.

What can you see by shadowing our team?

At our department you will see acute conditions that actually occur very often here. I will show you ventilated and even spontaneously breathing patients or special devices such as intra-aortic balloon counterpulsation, ECMO, and others. In the meantime, you will have an opportunity to ask about anything that interests you. In some cases, you will also see the acute revision of the thorax directly in the department, as transport to an operating room could endanger the life of the patient. Furthermore, you may witness an open thorax due to massive bleeding during surgery or caused by poor healing and secondary infection. The professionals must work as a team.

Apart from being a healthcare professional...

I play bass guitar, read scientific literature, play video games, go for trips, and travel abroad. I enjoy taking part in contests with a paramedic theme.

My motto…

What is meant to happen will happen.

Photo Jan Šibík

Bc. Anna Palánová

ICU Nurse

Nurse and Paramedic


Thanks to my profession I know very well how precious our health is. Many people do not realize this and take it for granted until they get sick and often there's no way back. This is the reason why I enjoy every day a bit more than if I would work in a different field. As in that case I wouldn’t know that everything can dramatically change within seconds. 

Why did I become a healthcare professional?

I have become a healthcare professional by chance! After finishing high school, I was not accepted to my dream faculty of journalism. That was why I started to attend paramedical college. At the beginning, I thought that I would just spend there a year and then try to pass the journalism faculty exams. But then I fell madly in love with healthcare! During my studies, I gained hands on experience in many specialty departments and also in paramedicine. Something I enjoyed more, something less, but I have known ever since that I want to work in healthcare for the rest of my life. I have been working as a professional for two years now and I enjoy my job with every moment more and more. I have no doubts about my choice.

I always do my best to allow my patient to be as independent on the devices and medicaments as possible. My goal is to make the patients to be self-sufficient – that is what they physically and psychically need.

What do I love the most about my specialty?

First and foremost, I work with amazing people and this means everything to me. I can always ask them for help or advice and without such cooperation, I would have never become a good nurse. My colleagues have become a part of my family. What I really love is the work with people. If you do this kind of job you really get to know your patients as I take care of one patients for two or three shifts in a row. My patients are usually older and they share with me their stories and life experiences. To me it is a wonderful profession.

What can you see by shadowing our team?

I will show you comprehensive care we take of our patients. Apart from my daily tasks you’ll shadow I will explain to you how to communicate with your patient and how to behave in certain situations professionally. A person, who must stay all day long in one room, who can socialize with a very limited number of people, who is stressed and worried about his or her health condition and who is not able to take care of himself or herself requires a completely different approach than others. I will help you to understand by concrete examples what is typical for patients after heart surgery and whenever there will occur something unusual, we will talk about it in details. You can take for granted that I will try to leave an extra time to explain you how the ICU works and what is its role within the Cardiovascular Surgery Specialized Center. All that in prestigious department in the largest hospital in central Europe.

Apart from being a healthcare professional...

I love stories in all forms. My passion is literature, especially fantasy, sometimes I also write when I am not fighting my addiction to TV series smile My other joy is travelling, my favorite place is definitely London. Sometimes I like to relax while swimming or riding a longboard.

My motto…

We are all stories in the end. Just make it a good one.

Photo Jan Šibík

Lucie Vavřínová, DiS.

ICU Nurse

Nurse


When I was deciding what specialization to choose, I knew it has to be something where I won't get bored by its stereotype. The Intensive Care Unit is definitely not a stereotypical workplace, because every day here is different. Very often you have to make quick decisions as the conditions of your patient can go wrong immediately, so you mostly remain on yourself, your knowledge and doing your best to save a life. Also, I am there just for my patient, and I make sure he gets my full attention, which is impossible at the standard department sometimes. That's what I was looking for and want to improve at my job every day.

Why did I become a healthcare professional?

Already at the elementary school, I was fascinated by the possibility of working in the hospital, especially as a nurse. So my decision about what to study next was made very early. Any other option than becoming a nurse did not even cross my mind. Nevertheless, I get a little distracted when I started part-time as a bartender when I was in my first year at university. Unfortunately, I quit and had a gap year break while working in the bar. However, I realized later on whom I want to be, so I went back to university and finally finished my studies. Nowadays, when I look back, I'm sure I made the best decision. Helping and taking care of people makes me happy, so as learning new things and technologies and getting new experiences which I'm going to use in the future.

It will be an excellent opportunity for you to see the real work in our hospital. We let you get involved in the procedures as much as possible. The moments you will experience here will be an exceptional benefit for your future. I can guarantee you won't be disappointed!

What do I love the most about my specialty?

What I like about my job the most is that I see something new every day. Every patient is different, so is taking care of them. Another part of it I like is independence. I follow the notes and prescriptions made by the doctor, but in certain situations, I am the first one who deals with the problems. By checking the symptoms, I can decide about the drug dosage the patient gets. This way I learned how to deal with unexpected situations and stay calm. The other reason why I like my job is the team of colleagues I cooperate with. They are amazing, and always there when I need help or advice. Although we share the same kind of humor when it gets serious, we stick up together and do our best to save patients lives.

What can you see by shadowing our team?

I will introduce you to my daily routine, which starts in the morning when I get my patient. I show you how to communicate with the patients because it is not always as easy, especially at the ICU. They are usually stressed and impatient, and we are there to calm them down and support them. You will witness how to provide complete care for our patients. It starts with the morning hygiene, taking care of the surgical wounds and invasion inputs, checking the patient's vital signs, administering and dosing the medication, and accompanying the patients to various examinations, for example to the Computer Tomography. We have a team of physical therapists, who provide pulmonary rehabilitation and take care of the patient's physical condition. Furthermore, you will see the work with technical equipment including life support devices such as the ventilation machine, intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO) and hemodialysis which is used quite often at our unit.

Apart from being a healthcare professional...

My biggest hobby is music. I love to sing and play the piano. And of course, I love good food and sleeping. wink Apart from that, I like to go out with my friends or to go for a walk or a run.

My motto…

Everything happens for a reason. Don't regret anything and learn from your mistakes. What is meant to happen will happen.

Photogallery

LOVE WHAT YOU DO WITH EVERY HEARTBEAT