Feb 25, 2025 | Your Health
Atrial fibrillation is an irregular and often fast heart beat that can cause poor blood flow. Usually known as AFib, it is becoming more common. In addition, this condition may affect people at younger ages.
In this Q&A, Georgios Syros, MD, a cardiologist and Director of Arrhythmia Services at Mount Sinai Queens and Mount Sinai Brooklyn, explains the symptoms of AFib, why it is important to see a doctor, and how something as simple as an Apple watch can help.
Georgios Syros, MD
Why are more people diagnosed with AFib?
More people are being diagnosed with AFib these days for a couple of reasons. First, the population is aging, and the older you are, the greater the chance you have of developing AFib. Second, we are seeing increasing rates of obesity and diabetes, and these conditions can also lead to an irregular heartbeat. Third, there is more public awareness of AFib. People know that when they feel symptoms, such as heart palpitations, they should seek medical help immediately.
And why more young people?
With young people, there is an additional reason for the increased rates of diagnosis: technology. More young people are wearing devices like the Apple watch, which help us diagnose AFib earlier, often before there are any symptoms. All of this is to the good. The earlier we diagnose AFib, the easier—and more effective—the treatment.
What are the most important symptoms I should look for?
There are a lot of symptoms of AFib. The most common is having a sense of a fast, fluttering heartbeat, which we call heart palpitations. You might also feel dizziness, fatigue, chest pain, shortness of breath, weakness, lightheadedness, or an inability to exercise. Some people who have AFib don’t notice any symptoms. In fact, if we tell them they have AFib, they respond, “But I feel fine.” That usually just means we are catching it earlier than if we waited until they felt symptoms or, unfortunately, a stroke.
Why is it important to see a doctor if you think you might have AFib?
The main issue with AFib is that it can cause a stroke. AFib is responsible for about one in four strokes among people over 80 years old. If AFib is untreated, it can also lead to other problems, including heart failure, blood clots, and even dementia. But if we diagnose and treat AFib early on, there is a greater chance we can get it under control.
What causes AFib?
There are a number of causes of AFib. They include:
- obesity
- genetics
- consuming too much alcohol
- increasing age
- high blood pressure and high blood sugar
- structural heart disease
- sleep apnea
How can I avoid developing AFib?
You can’t do anything about age or genetics, but there are some things you can do to avoid getting AFib. Obesity is a major cause of AFib, and it has been proven that weight loss and exercise can be a powerful combination to help people prevent the incidence of AFib. Another cause of AFib is sleep apnea. Treating sleep apnea, either with lifestyle changes such as weight loss, or with a continuous positive airway pressure machine, also called a CPAP, can help decrease the incidence of AFib. Another cause of AFib is excessive alcohol, so cutting down your drinking of alcohol can lower your chances of developing this condition as well. Stopping smoking can help. It is also a good idea to eat a heart-healthy diet. That means cutting down on salt, saturated fats, transfats, and cholesterol. You can also talk to your doctor about managing your high blood pressure.
How do you diagnose AFib?
We diagnose AFib with an electrocardiogram, known as an EKG or ECG. We may also do blood tests to see if there are any other issues that might be causing the arrhythmia. But the definitive test is the electrocardiogram. To do this test in our office, we put sticky patches or electrodes on your chest and sometimes arms and legs. The electrodes are connected to a computer, which shows us how your heart is beating. We can also use other types of electrocardiograms, including a wearable device called a Holter monitor, an at-home machine, or a smart watch.
How do you treat AFib?
One approach is with medications. We use several types of medications. Blood thinners prevent blood clots, which cause strokes. Calcium blockers and beta blockers slow the rate at which your heart pumps blood throughout the body. Other medications can restore a regular heartbeat. But all of these approaches come with side effects.
Another method, if it is appropriate for you, is an electrophysiology procedure called an ablation, a procedure in which small, malfunctioning spots in the heart are targeted and eliminated, and this can improve symptoms. The latest form of this procedure is pulsed field ablation, or PFA. This approach was approved by the U.S. Food and Drug Administration in January 2024. It uses short bursts of high energy (rather than heat or cold, which are the older approaches). The bursts of energy let us precisely target the cells that are causing AFib and render them inactive. This approach is faster than the others, which means you are under anesthesia for less time. It is also safer. Depending on the situation, we may even likely be able to do the PFA as an outpatient procedure, meaning you can go home after the operation rather than spend the night in the hospital. The fact that the approach is faster also means we can treat older patients than we used to be able to. If you develop AFib these days, we’re much better position to help you now than we were 20 years ago.
Updated on Feb 24, 2025 | COVID-19 Reflections, Featured, Your Health
The year 2025 marks five years since the COVID-19 pandemic went global. Among the many who contracted COVID-19 and recovered from the acute infection, some feel as though the disease has changed their day-to-day health for the worse. Many report a “brain fog” in which it has become harder for them to focus or think clearly, while others have various symptoms, including fatigue, pain, or even digestion issues.
This collection of symptoms has many names, but it became most commonly known as “long COVID.” When it was first observed a few years ago, physicians and researchers were divided on how to define, diagnose, or even treat it. Even less was known about why long COVID occurs and who is at risk of developing it.
Today, the medical and research communities have come a long way in understanding and tackling long COVID, says David Putrino, PhD, Director of Rehabilitation Innovation at the Mount Sinai Health System. There are, unfortunately, still misconceptions about long COVID among patients and even some health providers, and dispelling such myths is key to proper treatment, he adds.
In this Q&A, Dr. Putrino discusses to say what is known about long COVID today.
Is there a clear definition for long COVID today?
Physicians now have clear clinical guidelines and criteria for diagnosing long COVID. According to the National Academies of Science, Engineering, and Medicine, long COVID is an infection-associated chronic condition whereby somebody who has survived an acute infection with SARS-CoV-2—the virus that causes COVID-19—fails to return to their pre-infection health status within a period of three months.
Long COVID symptoms can present in different ways:
- Continuous, where symptoms remain constant and do not go away
- Progressive, where symptoms worsen over time
- Relapsing and remitting, where a patient can feel good for a while, and then have a period of feeling very poorly, and back and forth
“We need to start thinking about long COVID in the same way that cancer researchers have been thinking about cancer for the past three or four decades.” —David Putrino, PhD, Director of Rehabilitation Innovation at the Mount Sinai Health System
What different kinds of long COVID symptoms can patients have?
Long COVID has been described as a highly diverse disease state, with studies collectively noting more than 200 symptoms.
The most commonly reported symptom, which affects more than 90 percent of patients, tends to be fatigue and a phenomenon known as post-exertional malaise. The latter is a distinct kind of energy limiting illness where if you ask someone to perform an action—such as walking on a treadmill or riding a bike—they are able to do so. But after they exert themselves, they experience a significant worsening of symptoms or a cluster of new symptoms that persist weeks to months afterwards.
Cognitive symptoms are also common, such as a worsened ability to make decisions, plan things in advance, or even regulate emotions. People speak of “brain fog,” which includes changes in attention and in short- and long-term memory, and it is evident that SARS-CoV-2 infection can significantly affect cognition. In fact, a study published in The New England Journal of Medicine in 2024 showed that any person who survives a COVID-19 infection experiences, on average, a loss of six IQ points. This is a sobering fact that makes a strong case for all healthy individuals to avoid SARS-CoV-2 infections by taking the appropriate precautions.
Some people also report gastrointestinal disturbances. These can be wide-ranging, including having diarrhea, having to go to the bathroom more than usual, increased difficulty in food moving through the body, and/or extreme constipation. In addition, some might gain new intolerances to certain kinds of food, have difficulty finishing a meal, or reduced appetite.
Recently, researchers are discovering that around 50 percent of long COVID patients might have new-onset pain. This is a disease state that really affects every organ system.
In 2024, about 17 million adults report having long COVID
For adults with long COVID, 79% say long COVID has limited their activities
Of those who said long COVID limited their activities, 25% say it has done so by a lot
The group most likely to experience long COVID is adults ages 35-49
Women are more likely to experience long COVID than men, with 8.5% of women reporting past long COVID, compared to 5.2% for men
Do we know why long COVID happens?
We are starting to understand that in some cases, it could be just one path causing the symptom. In other cases, it could be a combination of pathologies. Here’s what we have found so far:
- Viral persistence: Different studies have identified the presence of SARS-CoV-2 remaining in the bodies of patients with long COVID, even after the acute COVID-19 phase. There is evidence of circulating viral antigens, spike proteins in plasma, viral fragments in the gut, and so forth. We are seeing that the persistence is not latent and it’s not harmless for people with long COVID—it’s causing problems.
- Latent pathogen reactivation: For some people, even if persistent SARS-CoV-2 does not cause any damage to organs, it could have caused immune dysregulation, leading to reactivation of other latent viruses. There are studies that have shown herpes virus reactivations, such as Epstein-Barr virus, in patients with long COVID, and others showing reactivation of Bartonella infection as well. It may be that the SARS-CoV-2 viral infection kicks up other pathogens that were smoldering below the surface, causing inflammation and other problems.
- Autonomic nervous system dysfunction: This is the part of your nervous system that controls blood pressure, digestion, sweating, and temperature control. And we’re seeing that the virus can knock this system out of balance. When it is disrupted, people can experience something called postural orthostatic tachycardia syndrome: when they go from lying down flat to standing, they experience unpredictable blood pressure and heart rate changes that can lead them to feel as though they’re about to pass out. This is frequently misdiagnosed as anxiety or panic attacks.
- Autoimmunity: Relating to immune dysregulation, we are starting to see evidence that for a subset of people with long COVID, they have functional autoantibodies circulating in their body that are designed to attack and cause damage to the body’s own tissues. We have animal studies where mice that were injected with IgG antibodies from patients with long COVID started to develop symptoms similar to that of the patient, especially in new-onset pain, whereas that phenomenon was not seen in mice receiving IgG from healthy controls.
- Hormonal dysregulation: There are multiple papers on long COVID impacts on hormones like cortisol, which affect wakefulness and inflammation, as well as androgenic hormones, such as testosterone and estradiol. So women with long COVID are much more likely to have extremely low levels of testosterone, and men with long COVID might have low levels of estradiol. This may also explain why long COVID is more frequently diagnosed in women compared with men.
Are there any misconceptions about long COVID?
For the clinical community, we’ve been focusing on getting out a main message, which is that long COVID requires a precision response. If a physician is asking, “Is there a cure—singular—for long COVID,” that is the wrong question. The correct question should be, “What are the tests and techniques I should be using to identify the symptoms of the patient with long COVID in front of me, and how do I proceed from there?”
We need to start thinking about long COVID in the same way that cancer researchers have been thinking about cancer for the past three or four decades. We have seen attitudes about cancer change, starting in the ‘80s when patients were told they got cancer because they had a “Type A” personality, to one today where a patient gets individualized treatment based on age, sex, gene profile, and so much more.
That’s the sort of precision we need in long COVID. What is your medical history? Your immune history? Any genetic expression that might predispose you to chronic illnesses?
Long COVID is classified as an infection-associated chronic condition, which includes chronic Lyme disease and myalgic encephalomyelitis/chronic fatigue syndrome. Historically, these chronic conditions have been viewed as largely psychogenic, and people have been told they can be cured with cognitive behavioral therapy and exercise.
I cannot stress how damaging this is to patients, and perhaps in 30 years, we will be looking back at our approaches and be ashamed of how we were framing long COVID for patients.
Long COVID affects many people, and it disproportionately affects young people too. These are people who are in their active, prime years and we need to help them lead their best lives.
Updated on Feb 21, 2025 | Cardiology, Your Health
Mary Ann McLaughlin, MD
Your heart rate is the number of times your heart beats per minute. You may pay little to no attention to your heart rate, but it can give you vital insight into your health—and may even save your life.
In this Q&A, Mary Ann McLaughlin, MD, MPH, FACC, Medical Director of Cardiovascular Health and Wellness, Mount Sinai Fuster Heart Hospital, and Associate Professor of Medicine, Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, discusses the importance of heart rate, as well as how to monitor it.
What is a normal heart rate range?
The normal heart rate for an adult is between 60 and 100 beats per minute. The average is 72 beats per minute.
How can I measure my heart rate?
The easiest way to detect your heart rate (without a device) is to feel your pulse in your wrist or neck for 60 seconds. For a more accurate heart rate, you can purchase a device, such as a wearable fitness tracker (e.g., smart watch), which can monitor your heart rate during sleep (resting heart rate) and exercise.
What affects my heart rate?
Heart rate increases to deliver more oxygen to your muscles. With any physical activity, your heart rate will go up. In addition, anxiety or emotional stress can cause an increase in adrenaline leading to high heart rates, often called the “fight or flight” response.
Can I improve my heart rate, and how?
You can improve your resting heart rate with regular exercise, adequate sleep, a healthy diet, and avoiding too much caffeine.
When is it time to see a doctor?
If you notice a very strong thumping sensation in your chest, feel dizzy or light-headed or faint, you need to talk to a doctor. If you are sitting or relaxing, and your heart rate is more than 100 beats per minute, you should talk to your doctor. If you have a family member who is diagnosed with an arrhythmia or irregular heart rate, you should notify your doctor. One particular arrhythmia, which can run in families, is called atrial fibrillation, and it can lead to stroke.
What is atrial fibrillation, and how is it related to heart rate?
Atrial fibrillation is an irregular heart rhythm. Symptoms are palpitations or thumping in the chest. If a family member has a history of atrial fibrillation, your risk for it is higher, which is why you should speak to a doctor.
My heart rate is below 60 beats per minute. Is that bad?
Having a low heart rate is generally a good thing, and is common among athletes. In most cases, it means the heart and cardiovascular system are working efficiently. However, in rare cases, a low resting heart rate can be a sign that something is wrong, especially if it is unusual for you. If you feel dizzy, fatigued, out of breath, or feel pain in your chest, you should see a doctor.
Updated on Feb 28, 2025 | Adolescent Health, Heart Health, Your Health
Decades of advances in pediatric cardiology has allowed for children with congenital heart conditions to thrive, growing into adolescents and then adults capable of starting families of their own. Adult congenital heart disease patients should seek specialized care throughout their lifetime.
In this Q&A, Kali Hopkins, MD, Director for the Adult Congenital Heart Disease Transition Program at Mount Sinai Fuster Heart Hospital and Assistant Professor of Medicine and Pediatrics at the Icahn School of Medicine at Mount Sinai, discusses the importance of transitioning to an adult congenital cardiologist and continuing care to ensure that patients can lead long, healthy lives.
Kali Hopkins, MD
What are the different types of congenital heart disease?
Congenital heart disease is a condition that children are born with and can range from the very simple to very complex. Sometimes children need interventions or operations shortly after birth, and for others, we may simply monitor their condition.
On the simple side, there are atrial or ventricular septal defects, often termed “a hole in the heart,” which is a defect in the wall between the right and left chambers of the heart. These are very common defects and may or may not warrant treatment. More complex congenital heart conditions, include diagnoses like tetralogy of Fallot or transposition of the great arteries, which usually do require that the infant or child undergo surgery. Other more complex conditions include single ventricle heart disease, a condition that requires a series of operations to reroute the child’s bloodflow.
What treatments are available?
Sometimes infants or children born with congenital heart disease need interventions that are minimally invasive. An example would be a catheterization in which a tube is guided into the heart through the blood vessels for diagnosis or treatment. If there is a major problem, a child may need open-heart surgery.
Most patients with congenital heart disease will need to receive lifelong evaluation and treatment. More than 90 percent of children who are born with congenital heart disease survive into adulthood. It’s very important to understand that the treatments we now have are tremendously successful—and these children can grow up and lead typical adult lives. It is estimated that there are more adults with congenital heart disease than children living with the condition in the United States.
When should an adolescent with a congenital heart condition transition from their pediatric cardiologist to an adult congenital cardiologist?
It is very important that children and adolescents who are born with congenital heart disease continue to seek appropriate specialized care. Transition of care is an educational process which often should begin in the teenage years with the goal of the patient gradually taking over the responsibility of their care rather with the support of their caregiver. Sometimes, it takes multiple visits to have an adolescent patient appropriately prepared to transition to adult-based health care. Transfer of care, however, is the event of changing providers from a patient’s pediatric cardiologist to an adult congenital heart specialist. This should happen when they are older. There is no hard and fast rule, but by the time a patient is about 21 years old, they should be receiving care from an adult congenital cardiologist.
What kind of care should an adult congenital heart patient expect?
Often, patients go for many years without the need for any intervention. But adult congenital heart disease patients often require interdisciplinary care. There may be kidney, liver, or lung issues that come up as a result of the patient’s underlying condition or as they get older, patients tend to acquire adult-based health conditions like high blood pressure, diabetes, or coronary artery disease. It is also possible that there may never be a problem, but it is best to follow patients with congenital heart disease on a regular basis so that issues can be identified early.
We also have to think about the social fabric of their lives. Patients grow up and get jobs. They often move to another city or country; they get married and often want to have kids of their own. In doing so, they may pass the condition down to their own children. Young women with congenital heart disease may need to consult with a maternal fetal medicine specialist since some of these patients are considered higher-risk pregnancies. At the Mount Sinai Adult Congenital Heart Disease Center, we bring in a multi-disciplinary approach to meet the ongoing needs of patients as their lives change, including women with congenital heart disease who are pregnant or are considering pregnancy.
Are there lifestyle considerations that these patients should be aware of?
We always encourage our patients with congenital heart disease to try to have as normal a life as they can. When I see patients who are in their 20s and 30s, and they are doing well, I encourage them to enjoy life and have fun—within measure and with regular follow-ups. Exercise is an essential part of a healthy lifestyle, and we review any precautions that these patients should take. We want these young patients to go out there and live full lives, have careers and, when desired, their own families. We will be there throughout their journey.
What services does Mount Sinai provide for adult congenital heart patients?
Our adult congenital heart disease program at Mount Sinai is one of the few programs in New York that has been accredited through the Adult Congenital Heart Association. This accreditation confirms that we are providing comprehensive, multidisciplinary care to adolescent and adult patients with all forms of the condition.
What does accreditation mean?
It means that we offer all facets of care when it comes to adult congenital heart disease. At Mount Sinai Heart, we provide state-of-the-art care for all forms of congenial heart disease from adolescents to older adults. We can enlist the Mount Sinai Health System’s world-class physicians to provide multi-disciplinary care be it for pregnant women with the condition, evaluations for transplantation, or cardiac interventions in the catheterization lab or operating room. We also provide pulmonary hypertension evaluation and treatment, which is an important part of adult congenital heart disease care. We have a specialized cardiac imaging team here at Mount Sinai exclusively for congenital heart disease providing exceptional multi-modality imaging for our patients. We provide 360-degree care—complete and comprehensive with excellent outcomes.
Is there anything else that patients should know?
I urge adult congenital heart patients to find the right provider and stay in care—that is very important. We see many patients in their 20s and 30s and often they feel fine. At that stage, it is easy to fall out of care and not seek appropriate long-term care with an adult congenital cardiologist. But congenital heart disease is a condition that needs to be followed throughout their life. Find the right adult congenital heart disease program and make sure to follow your physician’s instructions. You’ve got a full life ahead of you and our job is to take you all the way.
