Kenneth Civello MD, MPH

Atrial fibrillation: A fast, irregular heartbeat and the most common rhythm problem I see. Read the AFib risk guide
Atrial flutter: A fast but regular rhythm from the upper chambers. Ablation often cures it.
Pacemakers and ICDs: Implanted devices that keep the heart from going too slow or stop a dangerous rhythm.
Lead extraction: Safe removal of old or infected pacemaker and defibrillator wires.
Syncope: Fainting, and finding out if the heart rhythm is the cause. About heart monitors
POTS: A racing heart on standing. It improves with a steady daily plan. Read the POTS guide
Wearables and digital health: Using watches, rings, and connected home devices to track heart rate, rhythm, activity, and sleep. Read the watch alert guide
Nutrition: Food and lifestyle changes that protect the heart. Read the eating guide

How atrial fibrillation is treated

Most people start at the top of this list and move down only if they need to.

Lifestyle changes
Exercise, weight loss, and treating sleep apnea reduce how often episodes happen and how bad they are.
Medicines
Flecainide, propafenone, and amiodarone help hold a normal rhythm by slowing the electrical signals that cause the irregular beat.
Cardioversion
A brief electric shock or a medicine that resets the heart to a normal rhythm. It works quickly.
Ablation
A catheter treats the small areas of heart tissue that trigger the rhythm. Options include cryoablation, radiofrequency ablation, and pulsed field ablation.
Surgery
For atrial fibrillation that has not responded to other treatment. At Our Lady of the Lake we perform both the Convergent procedure and the Cox Maze procedure.

About Dr. Civello

I am board certified in cardiovascular disease and clinical cardiac electrophysiology. I trained at Vanderbilt and the Cleveland Clinic, where I served as chief electrophysiology fellow.

I also work on digital health. Wearables and cellular connected devices let me see how a patient is doing at home, and that data helps us make better decisions together.

1994Bachelor of ScienceLouisiana State University
1999Doctor of Medicine and Master of Public HealthLouisiana State University
2001Internal medicine residencyVanderbilt University
2003Cardiology and cardiac electrophysiology fellowshipsCleveland Clinic. Served as chief electrophysiology fellow.
2007Board certificationCardiovascular disease and clinical cardiac electrophysiology. American College of Cardiology Young Investigator of the Year finalist.
2007Heart Rhythm CenterJoined Louisiana Cardiology Associates and led the development of its Heart Rhythm Center.

Journal publications 12

Casey BE, Civello KC Jr, Martin LF, O’Leary JP. The medical malpractice risk associated with bariatric surgery. Obes Surg. 1999;9(5):420–425.
Dugaw JE Jr, Civello K, Chuinard C, Jones GN. Will patients use a computer to give a medical history? J Fam Pract. 2000;49(10):921–923.
Yamada H, Popović ZB, Martin DO, Civello KC, Wallick DW. The effects of altering time delays of coupled pacing during acute atrial fibrillation. Heart Rhythm. 2006;3(6):722–727.
Di Biase L, Fahmy TS, Patel D, Bai R, Civello K, et al. Remote magnetic navigation: human experience in pulmonary vein ablation. J Am Coll Cardiol. 2007;50(9):868–874.
Di Biase L, Auricchio A, Sorgente A, Civello K, et al. The magnitude of reverse remodeling irrespective of aetiology predicts outcome of heart failure patients treated with cardiac resynchronization therapy. Eur Heart J. 2008;29(20):2497–2505.
Iler MA, Hu T, Ayyagari S, Callahan TD 4th, Civello KC, et al. Prognostic value of electrocardiographic measurements before and after cardiac resynchronization device implantation in patients with heart failure due to ischemic or nonischemic cardiomyopathy. Am J Cardiol. 2008;101(3):359–363.
Riedlbauchová L, Brunken R, Jaber WA, Popová L, Patel D, Lánská V, Civello K, et al. The impact of myocardial viability on the clinical outcome of cardiac resynchronization therapy. J Cardiovasc Electrophysiol. 2009;20(1):50–57.
Civello KC, Smith CA, Boedefeld W. Combined endocardial and epicardial ablation for symptomatic atrial fibrillation: Single center experience in 100+ consecutive patients. J Innov Cardiac Rhythm Manage. 2013.
Anderson LH, Black EJ, Civello KC, Martinson MS, Kress DC. Cost-effectiveness of the convergent procedure and catheter ablation for non-paroxysmal atrial fibrillation. J Med Econ. 2014.
Wazni OM, Dandamudi G, Sood N, et al. STOP AF First Trial Investigators. Cryoballoon ablation as initial therapy for atrial fibrillation. N Engl J Med. 2021;384(4):316–324.
Tarakji KG, Mittal S, Kennergren C, et al. WRAP-IT Investigators. Antibacterial envelope to prevent cardiac implantable device infection. N Engl J Med. 2019;380(20):1895–1905.
Gill J, Crossen KJ, Blauth C, Kerendi F, Oza SR, Magnano AR, Mostovych MA, Halkos ME, Tschopp D, Osorio J, Tabereaux P, Boedefeld W, Civello K, et al. Atrial fibrillation symptom reduction and improved quality of life following the hybrid convergent procedure: a CONVERGE trial subanalysis.

Book chapter and thesis 2

Civello KC. Mitral Valve Disease. In: Manual of Cardiovascular Medicine. 2004.
Civello KC. Using Information Technology to Improve Public Health. Master of Public Health thesis. 1998.

Abstracts and presentations 10

Reverse Left Atrial Remodeling and Improved Systolic Function after Pulmonary Vein Antrum Isolation for Atrial Fibrillation. NASPE abstract, 2004.
Benefits of Cardiac Resynchronization Therapy Extend to Patients with Mechanical Dyssynchrony due to Right Ventricular Pacing. NASPE abstract, 2004.
Effect of High Voltage Stimulation on Left Ventricular Torsional Deformation in Patients with Dilated Cardiomyopathy. ACC abstract, 2004.
Effect of Cardiac Resynchronization Therapy on the Left Ventricular Torsional Deformation in Patients with Dilated Cardiomyopathy. ACC abstract, 2004.
Usefulness of Plasma BNP to Determine Responders and Non-Responders of Cardiac Resynchronization Therapy. NASPE presentation, 2005.
Evidence of Inflammatory and Hemodynamic Remodeling After Biventricular Device Implantation for Heart Failure. NASPE presentation, 2005.
Axillary Vein Puncture Access Causes a Unique Lead Failure Mechanism. NASPE poster, 2005.
Survival After Cardiac Resynchronization Therapy: Evidence for Inflammation as a Predictor of Mortality in Patients with Heart Failure After Bi-Ventricular Device Implantation. NASPE presentation, 2005.
Validation of an Institutionally Accepted Standardization of the Coronary Sinus Tributaries and Left Ventricular Myocardial Segments. HRS featured abstract, 2006.
Positron Emission Tomography Scan Abnormalities Do Not Predict Response to Cardiac Resynchronization Therapy. American Society of Nuclear Cardiology abstract, 2006.

Call the office to schedule a visit

225 767 3900

civellonurse@lca-br.com

Baton Rouge, Louisiana

This is not for emergencies. Call 911 for chest pain, trouble breathing, or fainting.

How do I schedule an appointment?

Call the office at 225 767 3900 or email civellonurse@lca-br.com.

What should I bring to my first visit?

Your medical records, a list of your current medicines, and your insurance information. Tennis shoes are a good idea too.

Do you offer telemedicine visits?

Yes, for certain types of appointments. Ask when you schedule.

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A guide for my patients

Eating for your heart

What the newest cardiology research says about food, put into plain language you can use at the grocery store and at the table.

From Dr. Kenny Civello, cardiologist and electrophysiologist

Focus on whole foods, not single nutrients.

The healthiest way to eat for your heart is mostly plants, foods close to how they grow, and very little that comes out of a factory wrapper. How your food is made matters more than counting fat, carbs, or protein.

Food affects your blood pressure, cholesterol, blood sugar, weight, and kidneys. These all feed into heart disease together. Changing how you eat helps all of them at once, and it works alongside your medicines.

Why is this the advice?

The evidence

In 2026 the American College of Cardiology reviewed decades of research on food and heart health. Large studies following hundreds of thousands of people, plus clinical trials, point the same way. People who eat more vegetables, fruit, beans, nuts, whole grains, and plant oils, and less processed meat, sugary drinks, and refined starch, have fewer heart attacks and strokes and live longer.

The same report found that the type of fat, carb, or protein you eat matters more than the amount. A carb from oatmeal acts very differently in your body than a carb from soda.

What to eat

Use this as your shopping list. Fill most of your cart from the first column.

Eat more

Vegetables of every color
Fruit, whole not juiced
Beans, lentils, chickpeas
Oats, brown rice, barley, quinoa, whole wheat
Nuts and seeds
Olive, canola, or soybean oil
Fish, especially oily fish like salmon or sardines
Water, unsweetened tea, filtered coffee

Choose wisely

Chicken and turkey, not fried
Low fat or fat free dairy
Plain yogurt
Eggs in moderation
Whole grain bread and cereal (check the label for salt and sugar)
Diet drinks, only as a step away from soda

Limit

Soda, sweet tea, energy and sports drinks
Bacon, sausage, hot dogs, deli meats
Red meat
Butter, lard, coconut and palm oil
White bread, chips, crackers, pastries, candy
Fast food, frozen dinners, canned soup
Alcohol

Why plant protein over meat?

People who get more of their protein from beans, nuts, soy, and whole grains live longer than people who get it mostly from red and processed meat. Swapping some meat for plant protein lowers that risk.

Meat carries saturated fat that raises LDL ("bad") cholesterol. Processed meat adds a lot of salt and preservatives. Very hot cooking like grilling and frying creates compounds linked to inflammation and cancer. Baking, steaming, and stewing are better choices.

Why olive oil instead of butter?

Fats that are solid at room temperature (butter, lard, coconut oil) are high in saturated fat. Fats that are liquid (olive, canola, soybean oil) and the fats in nuts, seeds, and fish are unsaturated.

Swapping saturated fat for unsaturated fat lowers LDL cholesterol and lowers heart disease risk. Swapping butter for white bread or sugar does not help. The replacement matters.

What counts as "ultra processed"?

These are factory made foods built with ingredients you would never find in a home kitchen. They are designed to be cheap, shelf stable, and hard to stop eating. Think soda, packaged snacks, candy, hot dogs, instant noodles, and most ready meals.

The strongest harm is from sugary drinks and processed meats. In one study, people ate more calories and gained weight on an ultra processed diet even when the fat, sugar, and fiber were matched.

Not every packaged food is bad. Plain yogurt, whole grain bread, and simple whole grain cereal can be good choices. Read the label for salt and added sugar.

Daily targets

A few numbers worth knowing. You do not need to track everything. These are the ones that matter most.

<1,500 mgSodium per day is ideal. Stay under 2,300 mg at most. Most Americans eat over 3,400 mg.

30 g+Fiber per day. Most adults get about half that.

2 servingsFish per week, ideally oily fish like salmon, trout, or sardines.

2 to 5 cupsFiltered coffee or tea per day is fine for most people (up to 400 mg caffeine).

Where does all the salt come from?

Most salt does not come from the salt shaker. It comes from packaged and restaurant food. The top sources are pizza, bread, deli and processed meats, soup, burgers, tacos and burritos, and salty snacks.

Cutting salt can lower your top blood pressure number by about 6 to 8 points. That is about as much as some blood pressure pills.

How do I get 30 grams of fiber?

A cup of cooked beans or lentils has about 13 to 16 grams. A cup of oatmeal has about 4. A pear or an apple with the skin has 4 to 6. A handful of almonds has about 3. Build meals around beans, whole grains, fruit, and vegetables and you will get there.

Fiber lowers blood pressure, blood sugar, and cholesterol, and helps you feel full. Add it slowly and drink water to avoid bloating.

Can a fiber supplement help? (psyllium husk)

Yes. If food alone does not get you to 30 grams, psyllium husk is a good add on. It is the fiber in Metamucil and many store brands. It is a thick, gel forming fiber that lowers LDL cholesterol and helps blood sugar and regularity.

How to take it: Start with about 1 teaspoon (3 to 5 grams) once a day stirred into a full glass of water. Drink it right away. Over a few weeks you can work up to 1 to 2 doses a day. Pick an unflavored or sugar free version.

Be careful: Always take it with plenty of water. Take other medicines at least 2 hours before or after, since psyllium can slow how they are absorbed. Do not use it if you have trouble swallowing or a narrowing of the bowel. Ask us if you are unsure.

Psyllium adds to a good diet. It does not replace beans, whole grains, fruit, and vegetables.

Easy swaps

You do not have to change everything at once. Pick one swap this week.

Instead of	Try
Soda or sweet tea	Sparkling water, unsweetened tea, water with lemon
Bacon and sausage at breakfast	Oatmeal with berries and walnuts
Deli meat sandwich	Tuna, chicken, or hummus on whole grain bread
Butter for cooking	Olive or canola oil
White rice or white bread	Brown rice, quinoa, whole wheat
Chips or crackers	Unsalted nuts, fruit, carrots with hummus
Beef or pork most nights	Beans, lentils, fish, or chicken on most nights
Regular table salt	Herbs, lemon, pepper, or a potassium salt substitute (ask us first)
Canned soup	Homemade or "no salt added" soup

Salt substitutes: Potassium based salt substitutes lower blood pressure and lower the risk of stroke. They are not safe for everyone. Do not use them if you have kidney disease, or if you take spironolactone, eplerenone, triamterene, amiloride, or a potassium supplement, unless we have cleared it. Ask us first.

Drinks

Coffee and tea

Good news. Two to five cups a day of filtered coffee or tea is safe for most adults. Regular coffee drinkers have lower rates of diabetes, heart disease, stroke, heart failure, and atrial fibrillation (AFib).

In one trial of patients with AFib, people who drank at least one cup of coffee a day had fewer AFib returns than people told to avoid it. You do not need to give up coffee because of AFib unless it clearly triggers yours.

Use a paper filter when you can. French press, boiled, Turkish, and espresso coffee can raise LDL cholesterol.

Alcohol

Do not start drinking for your heart. The idea that a glass of wine protects your heart is not proven.

Alcohol raises blood pressure and can trigger AFib, even in small amounts. It also raises the risk of several cancers. If you drink, keep it light. If you have AFib, less is better.

Diet soda and sweeteners

Switching from regular soda to diet soda can help with weight and blood sugar. The long term effects of sweeteners are still unclear. Use diet drinks as a step toward water and unsweetened drinks, not as the goal.

Eating plans that work

These three have the best research behind them. They share the same core. Pick the one that fits your taste and culture.

Mediterranean

Best proven for heart attack and stroke

Lots of olive oil, vegetables, fruit, nuts, beans, and whole grains. Fish and chicken in moderation. Little red meat or sweets.

DASH

Best proven for blood pressure

Fruits, vegetables, whole grains, low fat dairy, fish, poultry, beans, and nuts. Low in salt, fatty meat, and sweets.

Vegetarian or plant forward

Lower heart disease risk

Mostly or all plants. Plant forward means small amounts of meat, fish, or dairy are fine.

How strong is the proof for the Mediterranean diet?

Two large clinical trials tested it directly. PREDIMED followed about 7,400 people at high risk who had not had a heart event. CORDIOPREV followed about 1,000 people who already had heart disease. In both, a Mediterranean diet with extra virgin olive oil or nuts led to fewer heart attacks, strokes, and heart deaths than a low fat diet. It also lowered the chance of getting type 2 diabetes.

Your situation

I have diabetes or prediabetes

Eating fewer carbs can help control blood sugar and may help with weight loss. Choose slow carbs like beans, oats, and whole grains over white bread, rice, and sweets.

If you cut carbs, replace them with plant protein and healthy fats like nuts, olive oil, avocado, and fish. Low carb diets built on bacon, butter, and red meat raise LDL cholesterol and are linked to more heart disease. Plant based low carb eating is linked to less.

I want to lose weight

The eating plans above help with weight because whole foods and fiber keep you full. Cutting sugary drinks is one of the biggest single changes you can make.

Intermittent fasting (eating within a set window each day) helps some people lose weight in the short term. We do not yet know if it helps long term. Very low carb or keto diets cause fast early weight loss, but after a year or two they do about the same as other diets.

I take Ozempic, Wegovy, Mounjaro, or Zepbound

These medicines help with weight and lower heart risk. Because you eat less on them, each bite counts more. Make sure you get enough protein (beans, fish, chicken, yogurt, eggs), fiber, and fruit and vegetables. This helps protect your muscle and keeps you from running low on vitamins and minerals.

I have kidney disease

A plant based diet that is moderate in protein can help slow kidney disease. But some high potassium foods and salt substitutes can be risky. Talk with us or a kidney dietitian before making big changes.

Should I take fish oil?

For most people, no. Eat fish instead. Fish oil pills have not been shown to prevent heart disease in healthy adults. Some studies found that omega 3 supplements raise the risk of AFib. A prescription form is used for some patients with high triglycerides. We will tell you if that applies to you.

Healthy food is hard to afford or find near me

You are not alone, and it matters for your health. Some of the best foods are also the cheapest: dried or canned beans (rinse them to remove salt), oats, brown rice, frozen vegetables, frozen fish, peanut butter, bananas, and cabbage.

Let us know at your visit. We can connect you with a dietitian, food assistance programs, or local "Food Is Medicine" resources.

This week

Check off what you did. Your progress saves on this device.

0 of 8

Went a full day with no soda, sweet tea, or juice Ate beans, lentils, or chickpeas at least 3 times Ate fish at least twice Had vegetables at lunch and dinner most days Cooked with olive or canola oil instead of butter Skipped bacon, sausage, hot dogs, and deli meat Swapped white bread or rice for a whole grain Snacked on nuts or fruit instead of chips

Other guides

Lowering your AFib risk Lowering your blood pressure Sleeping well Living with POTS My watch says I have AFib

This page is general education for my patients. It does not replace advice from your own doctor or dietitian. If you have kidney disease, diabetes, or take blood thinners or diuretics, talk with us before making big changes.

Based on: Hu FB, Beleslin B, Blaha MJ, Kris-Etherton PM, Seligman HK, Williams KA Sr. Food and Health: Nutrition for Prevention and Management of Cardiovascular Disease. 2026 ACC Scientific Statement. JACC. 2026. Read the full statement.

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A 12 week plan for my patients

Sleeping well

Better sleep comes mostly from what you do during the day and in the hour before bed. This plan builds one habit each week.

From Dr. Kenny Civello, cardiologist and electrophysiologist

Habits beat pills.

The most effective treatment for poor sleep is changing behavior. Sleep specialists use a program called CBT for insomnia (CBT‑I) before any sleeping pill, because it works as well and the results last after you stop. Teas and supplements can help you relax, but they work best on top of good habits.

Sleep is part of heart health. Short or broken sleep raises blood pressure, blood sugar, weight, and the risk of atrial fibrillation (AFib), heart attack, and stroke. Most adults need 7 to 9 hours a night.

The core habits

If you only remember one part of this page, make it this list.

Wake up at the same time every day

Weekends too. A steady wake time sets your body clock more than anything else.

Use your bed only for sleep

No TV, phone, work, or worrying in bed. Your brain should link bed with sleep.

If you can't sleep, get up

After about 20 minutes awake, go to another room and do something quiet in dim light. Return when sleepy.

Go to bed when sleepy, not just tired

Lying in bed wide awake teaches your brain that bed is for being awake.

Get morning light

Go outside for 10 to 30 minutes soon after waking. Dim the lights in the evening.

Wind down for an hour

Screens off, lights low. Read, stretch, take a warm shower, or sip a caffeine free tea.

Stop caffeine by early afternoon

Caffeine stays in your body for hours. Have your last cup at least 6 to 8 hours before bed.

Skip the nightcap

Alcohol helps you fall asleep but breaks up sleep later in the night and can trigger AFib.

The 12 week plan

Add one new habit each week and keep the ones before it. Keep a simple sleep diary the whole time: bedtime, wake time, how long it took to fall asleep, times you woke up, and how rested you felt (1 to 5). Bring it to your visits.

0 of 12 weeks

Weeks 1 to 4: Set the foundation

1Start your diary and set a schedule

Start of the week

Write down how you sleep now and what bothers you most.
Set a goal of 7 to 9 hours.
Pick one bedtime and one wake time and keep them every day.

Rest of the week

Fill in your sleep diary each morning.
No caffeine or heavy meals in the 4 to 6 hours before bed.
Build a calm pre‑sleep routine: reading, meditation, gentle stretches.

2Fix your bedroom

Make the room dark, quiet, and cool (about 65 to 68°F).
Check that your mattress and pillow are comfortable.
Move phones, tablets, and the TV out of the bedroom. Use a regular alarm clock.
Try white noise or calm music if your room is noisy.
Start slow deep breathing or progressive muscle relaxation at bedtime.

3Adjust what you eat and drink

Look for things that hurt your sleep: caffeine, sugar, big late meals, alcohol.
Finish dinner 2 to 3 hours before bed.
Try foods linked to better sleep: kiwi, tart cherries, almonds, walnuts.
Start a caffeine free bedtime tea (see the tea guide below).

4Move every day

Note how active you are now.
Aim for a 30 minute walk, bike ride, or yoga session most days.
Morning or afternoon exercise outdoors gives you light and activity together.
Avoid hard workouts in the 2 to 3 hours before bed.

Weeks 5 to 8: Train your mind and body clock

5Manage stress

Write down what stresses you and keeps your mind busy at night.
Set a "worry time" early in the evening. Write worries and a next step on paper, then close the notebook.
Practice 10 minutes of mindfulness or meditation daily.

6Change your thoughts about sleep (CBT‑I)

Notice thoughts like "If I don't sleep 8 hours, tomorrow is ruined." Replace them with "I have handled short nights before."
Stop watching the clock at night. Turn it to face the wall.
Follow the "get up after 20 minutes" rule strictly.
If you are still struggling, ask us about a CBT‑I therapist or a CBT‑I app.

7Cut evening screen time

All screens off at least 1 hour before bed.
Replace them with a paper book, music, a podcast with the screen off, or a conversation.
Charge your phone outside the bedroom.

8Manage light

Get outdoor light within an hour of waking, even on cloudy days.
Spend time near windows or outside in the early afternoon.
Dim lights and use warm bulbs after sunset.

Weeks 9 to 12: Fine tune and keep it going

9Review and adjust

Look back over 8 weeks of your diary. What helped most? What still gets in the way?
Adjust your schedule and routine based on what you see.
Keep the habits that are working.

10Consider teas and supplements

If sleep is still not where you want it, review the tea guide and melatonin section below.
Talk with us before starting any supplement, especially if you take a blood thinner or heart rhythm medicine.
Try one thing at a time for 2 to 4 weeks so you know what works.

11Look at work and social life

Note how shift work, late events, travel, or family duties affect your sleep.
Protect your wake time even after a late night. Take a short nap (20 minutes, before 3 pm) instead of sleeping in.
Talk with family about quiet hours if needed.

12Make a long term plan

Compare your diary from week 1 and week 12.
Choose the 3 habits that matter most for you and commit to them.
Plan what you will do after a rough week: go back to the diary and the core habits.
Bring your diary to your next visit with us.

After week 12

Keep your wake time steady, keep practicing your wind down and stress routines, and check your habits whenever sleep slips. If problems last more than a few weeks, let us know.

Bedtime teas

A warm, caffeine free tea is a good signal to your body that the day is ending. Some herbs also have a mild calming effect. The research is modest, so think of tea as a helper for good habits, not a replacement for them.

How to use bedtime tea

Drink it 60 to 90 minutes before bed, so you are not up at night to use the bathroom.
Steep covered for 5 to 10 minutes to keep the plant oils in the cup.
Check the label: it should say caffeine free. Some "relax" blends contain green or black tea.
Skip the honey and sugar, or keep it to a small amount.
Give it 2 to 4 weeks. Herbal effects build over time.

Chamomile

Best place to start

The classic bedtime tea. Gentle, calming, and safe for most people. Small studies show modest improvement in sleep quality, especially in older adults.

Brew: 1 to 2 tea bags or 1 tablespoon dried flowers
Taste: Mild, apple like

Avoid if you are allergic to ragweed, daisies, or marigolds. It may increase the effect of warfarin. Tell us if you take a blood thinner.

Valerian root

Strongest herb

The most studied herbal sleep aid. It may help you fall asleep faster and sleep more deeply. It usually takes 2 to 4 weeks of nightly use to notice a difference.

Brew: 1 teaspoon dried root, steep 10 minutes
Taste: Earthy and strong. Many people blend it with chamomile or mint.

Do not combine with alcohol, sleeping pills, or anxiety medicines. Avoid in pregnancy and liver disease. Some people feel groggy the next morning. Stop 2 weeks before surgery.

Passionflower

Good for a racing mind

Used for anxiety and restlessness. A small study found better sleep quality after a week of nightly passionflower tea.

Brew: 1 teaspoon dried herb, steep 10 minutes
Taste: Mild, grassy

Can add to the effect of sedatives. Avoid in pregnancy.

Lemon balm

Pairs well

A member of the mint family that eases stress. Often blended with valerian, and the pair has shown better results than either alone.

Brew: 1 to 2 teaspoons dried leaves
Taste: Lemony, fresh

May affect thyroid medicine. Ask us if you take levothyroxine or have thyroid disease.

Lavender

Calming scent

Relaxing as a tea or as a scent in the bedroom. Studies of lavender aroma show small gains in sleep quality.

Brew: 1 teaspoon dried buds, or blend with chamomile
Taste: Floral; a little goes a long way

Generally safe. Do not swallow lavender essential oil.

Rooibos and tart cherry

Easy swaps

Rooibos is a naturally caffeine free red tea. It is a good evening swap if you miss black tea. Tart cherry juice contains natural melatonin, and small studies show it can help sleep.

Amount: Rooibos: 1 cup. Tart cherry: 8 oz unsweetened, once or twice a day

Tart cherry juice has natural sugar. If you have diabetes, count it in your carbs.

Herbs are real medicine

"Natural" does not mean free of side effects or interactions. Tell us about any tea or supplement you use, especially if you take:

A blood thinner (warfarin, Eliquis, Xarelto) or an antiplatelet drug
Heart rhythm medicines
Sleeping pills, anxiety medicine, or opioid pain medicine

Avoid kava. It has been linked to serious liver injury.

Melatonin and sleeping pills

Is melatonin a good idea?

Melatonin helps most with timing problems such as jet lag, shift work, or a body clock that runs late. It is less helpful for general insomnia.

Less is more. Start with 0.5 to 1 mg, taken 1 to 2 hours before bed. Higher doses often cause grogginess without better sleep.
Supplement doses vary widely from the label. Look for a "USP Verified" seal.
Use it for a few weeks at a time, not as a nightly habit for years, unless we have discussed it.

What about over the counter sleep aids?

Products like Benadryl, ZzzQuil, Tylenol PM, and Unisom contain antihistamines. They can cause next day grogginess, confusion, falls, constipation, and trouble urinating, especially after age 65. Long term use has been linked to memory problems. We do not recommend them for regular use.

What about prescription sleeping pills?

Prescription sleep medicines can help in the short term, but they carry risks of dependence, falls, and next day impairment. CBT‑I works as well and the benefit lasts. If you think you need a sleep medicine, let's talk about it together.

When to call us

These can be signs of sleep apnea or another sleep disorder

Loud snoring, gasping, or pauses in breathing that someone else notices
Waking up with a headache or a very dry mouth
Feeling sleepy during the day even after a full night in bed
Nodding off while driving
Restless, crawling feelings in your legs at night
Trouble sleeping most nights for more than 3 months

Sleep apnea is common in people with high blood pressure, AFib, and heart failure. Treating it can improve blood pressure and make AFib easier to control. A home sleep test is simple. Ask us.

Other guides

Lowering your AFib risk Eating for your heart Lowering your blood pressure Living with POTS My watch says I have AFib

This page is general education for my patients. It does not replace advice from your own doctor. Talk with us before starting any supplement or herbal product, or if your sleep problems continue.

Back to all patient guides

A guide for my patients

Living with POTS

POTS makes your heart race when you stand up. It is real, it is common, and it gets better with a steady daily plan.

From Dr. Kenny Civello, cardiologist and electrophysiologist

Your heart is responding to a blood flow problem.

POTS stands for postural orthostatic tachycardia syndrome. When you stand, gravity pulls blood toward your legs and belly. Normally your blood vessels tighten to push it back up. In POTS that response is weak, so your heart speeds up to keep blood moving to your brain.

How we diagnose it

Heart rate rises 30 beats per minute or more within 10 minutes of standing. For ages 12 to 19 the number is 40. Blood pressure does not drop much. Symptoms have lasted 3 months or longer.

What it feels like

Racing heart, lightheadedness, fatigue, brain fog, shakiness, and trouble exercising. Symptoms are worse upright and better lying down.

What to expect

POTS is not life threatening. It can still limit daily life. Most people improve a lot with the plan on this page. It takes weeks to months, so stay with it.

Why did this start?

POTS often begins after a stress on the body. Common triggers:

A viral illness such as mono, the flu, or COVID
Surgery, injury, or a long stretch of bed rest
Pregnancy
Autoimmune conditions such as lupus or Sjögren's syndrome

It is more common in women ages 15 to 50. It is also more common in people with very flexible joints (hypermobility or Ehlers Danlos syndrome) and in people with mast cell problems. Often there is more than one cause.

Are there different types?

Doctors describe a few patterns. Many people have a mix.

Neuropathic. Small nerves that tighten the blood vessels in the legs do not work well, so blood pools.
Hyperadrenergic. The body releases too much adrenaline on standing. Shakiness and a pounding heart are common.
Low blood volume. There is less blood in the system to begin with.

The daily basics below help all three.

Is my heart damaged?

No. In POTS the heart muscle and its electrical system are normal. The fast rate is a reaction to blood pooling below the heart. We check an ECG and sometimes an ultrasound or a monitor to make sure nothing else is going on.

The four daily basics

These do more than any pill. If you only do one part of this page, do this part every day.

Fluid

2 to 3 liters a day

Drink 16 ounces of water before you get out of bed.
Carry a bottle and sip all day.
Drink extra in the heat and before exercise.

Why

More fluid means more blood volume. More blood volume means less pooling and a slower heart rate on standing. A large glass of water can raise standing blood pressure within minutes.

Salt

Up to 10 grams of salt a day

That is about 4,000 mg of sodium. We will set your personal goal.
Salt your food freely. Choose salty snacks such as broth, pickles, olives, and salted nuts.
Spread it through the day with fluid.

Why

Salt holds water in your bloodstream. Without it, the extra water you drink leaves through your kidneys. Salt and fluid work as a pair.

Compression

Waist high, 20 to 30 mmHg

Waist high stockings or compression leggings work best.
An abdominal binder helps a lot and is easier to put on.
Put them on before you get out of bed. Take them off to sleep.

Why

Most blood pools in the belly and thighs, not the calves. Knee high socks alone do little. Squeezing the belly and legs pushes blood back toward the heart.

Exercise

Start lying down or seated

Rowing, recumbent bike, or swimming to begin.
Build up slowly over 3 months.
See the full plan below.

Why

Training increases blood volume and makes the heart pump more with each beat. In studies, a 3 month program improved symptoms in most patients who finished it.

Check with us before adding salt

A high salt diet is wrong for people with high blood pressure, heart failure, or kidney disease. Do not raise your salt unless we have told you it is right for you.

Ways to get your sodium

Electrolyte mixes are a convenient way to take salt and fluid together. Pick a low sugar version. Amounts are approximate, so check the label.

Source	Serving	Sodium
Table salt	1/4 teaspoon	about 575 mg
Broth or bouillon	1 cup	about 800 mg
Dill pickle	1 large	about 800 mg
LMNT	1 packet	1,000 mg
Liquid I.V.	1 packet	about 500 mg
Nuun Sport	1 tablet	about 300 mg
Salt tablet	1 gram tablet	about 390 mg

What about vitamins and supplements?

No supplement has strong evidence as a POTS treatment. The ones worth checking are those where a true deficiency can cause symptoms.

Ask us to test your ferritin (iron stores), vitamin B12, and vitamin D. Replace them only if you are low.
Magnesium, CoQ10, vitamin C, and NAD infusions have no POTS data behind them. Save your money.

Habits that help

Stand up in stages

Sit on the edge of the bed for a minute before you stand. Pause again before you walk.

Squeeze when you feel symptoms

Cross your legs and tense your thighs and buttocks. Clench your fists. Do calf raises. Sit or lie down if it does not pass.

Don't stand still

Shift your weight and move your legs in lines. Use a stool in the kitchen and a chair in the shower.

Eat small meals

Four to six small meals instead of three large ones. Large or sugary meals pull blood to the gut and worsen symptoms.

Stay cool

Heat opens blood vessels. Take lukewarm showers. Skip hot tubs and saunas. Plan outdoor time for cooler hours.

Limit alcohol

Alcohol opens blood vessels and dries you out. Most people with POTS feel worse after drinking.

Test your caffeine

A small amount helps some people and makes others jittery. See what it does to you. Avoid energy drinks.

Raise the head of your bed

Put 4 to 6 inch blocks under the head of the bed frame. This helps your body hold on to fluid overnight.

The 10 minute stand test

This is a simple way to see how your heart rate responds to standing. Use a watch, a pulse oximeter, or count your pulse. It is not a diagnosis. Write the numbers down and bring them to your visit.

How to do it

Have someone with you. Stand next to a bed or a wall.
Lie flat and rest quietly for 5 to 10 minutes. Record your heart rate.
Stand up and stay still. Do not talk, shift, or lean on anything.
Record your heart rate at 2, 5, and 10 minutes.
Stop and lie down right away if you feel like you may faint.

Lying down Standing 2 min Standing 5 min Standing 10 min

I am 12 to 19 years old

Enter your lying down heart rate and at least one standing heart rate.

If you have a blood pressure cuff, record your blood pressure lying down and at each standing time too. Morning tests show the biggest change.

The exercise plan

Exercise is the most effective long term treatment for POTS. It is also the hardest, because upright exercise brings on symptoms. The fix is to start where gravity is not working against you and move upright slowly.

Month 1Lying down or seated cardio

Rowing machine, recumbent bike, or swimming.
Start with 5 to 10 minutes, 3 days a week. Shorter is fine if that is what you can do.
Add a few minutes each week.
Pace: you can talk but not sing.
Add leg and core strength work on the floor 2 days a week: bridges, leg lifts, side planks.

Month 2Build time and effort

Work up to 30 minutes per session, 4 days a week.
Stay with seated or lying down machines.
Keep strength training twice a week. Seated weight machines are a good choice.
Keep a log of minutes, heart rate, and how you felt.

Month 3Move upright

Add an upright bike first. Then walking on a treadmill or outside.
Swap one seated session a week for an upright one. Add more as you tolerate it.
Goal: 30 to 45 minutes, 4 to 5 days a week, plus strength work twice a week.
Jog only if walking feels easy.

What to expect

You may feel worse for the first 2 to 3 weeks. That is common and it passes.
Drink 16 ounces of fluid with salt before each session.
Cool down slowly. Do not stop and stand still.
If you miss a week, drop back a step and rebuild. The gains fade if you stop, so plan to keep going after month 3.

Medicines

Medicines are added on top of the daily basics, not in place of them. No drug is FDA approved for POTS. We use medicines that are approved for other conditions and have been studied in POTS. The choice depends on your pattern of symptoms.

Medicines that slow the heart rate

Low dose beta blocker such as propranolol. Small doses work better than large ones in POTS. Can cause fatigue.
Ivabradine. Slows the heart without lowering blood pressure. Can cause brief bright spots in vision. Not for use in pregnancy.

Medicines that tighten blood vessels

Midodrine. Taken during the day while you are upright. Do not take it within 4 hours of lying down. Can cause tingling of the scalp and goosebumps.
Pyridostigmine. Boosts the nerve signal to the blood vessels. Can cause stomach cramps or loose stools.

Medicines that raise blood volume

Fludrocortisone. Helps your kidneys hold on to salt and water. We check your potassium while you take it.
Desmopressin. Lowers urine output. Used only now and then because it can lower blood sodium.

Medicines that can make POTS worse

Bring a list of everything you take, including supplements. Some medicines raise heart rate or lower blood volume. Examples include water pills, some antidepressants and ADHD medicines, decongestants, and some blood pressure drugs. Do not stop any medicine on your own. We will review the list together.

Tracking at home

Numbers help us see what is working. You do not need to watch them all day.

Watch or fitness band

Apple Watch, Garmin, Fitbit, and similar devices track heart rate all day. Look at trends across weeks, not single spikes.

Blood pressure cuff

Use an upper arm cuff. Check lying down and after 3 minutes of standing, once or twice a week or when we change a medicine.

Pulse oximeter

A cheap way to spot check heart rate. Oxygen levels are normal in POTS.

Symptom log

Note your fluid, salt, exercise, and how you felt each day. Patterns show up quickly.

What about the Lumia ear device?

Lumia is a small sensor worn in the ear that estimates blood flow to the head. Early research suggests its readings track with symptoms in some patients, even when heart rate looks normal. It is new and it is not needed to diagnose or treat POTS. Ask us if you are curious about it.

A caution on tracking

If checking your numbers makes you more anxious, check less. A weekly look is enough for most people.

When to call us

Call the office for any of these

Fainting, especially with an injury
Fainting or near fainting during exercise
A racing heart that starts while you are resting or lying down, or that starts and stops suddenly
Symptoms that keep getting worse despite the daily basics
Side effects from a medicine

Call 911 for chest pain, trouble breathing, or fainting without waking up quickly.

Other guides

Lowering your AFib risk Eating for your heart Sleeping well Lowering your blood pressure My watch says I have AFib

This page is general education for my patients. It does not replace advice from your own doctor. Talk with us before you change your salt intake, start a supplement, or start an exercise program.

Back to all patient guides

A guide for my patients

Lowering your blood pressure

What you eat, how you move, and how you measure can lower your blood pressure as much as a pill. Here is the plan, step by step.

From Dr. Kenny Civello, cardiologist and electrophysiologist

Daily habits are real blood pressure treatment.

Cutting salt alone can lower your top number by 6 to 8 points. That is about what one blood pressure pill does. Stack a few habits together and the effect grows. These changes work alongside your medicines, not instead of them.

Know your numbers

Blood pressure has two numbers. The top number (systolic) is the pressure when your heart beats. The bottom number (diastolic) is the pressure between beats.

Category	Top number		Bottom number
Normal	under 120	and	under 80
Elevated	120 to 129	and	under 80
Stage 1 high blood pressure	130 to 139	or	80 to 89
Stage 2 high blood pressure	140 or higher	or	90 or higher

Your goal

Under 130 on top and under 80 on the bottom. For many people, a top number under 120 is even better. We will set your goal together.

Why it matters

High blood pressure strains your heart, brain, kidneys, and blood vessels. Lowering it cuts your risk of stroke, heart attack, heart failure, kidney disease, and AFib.

Home beats the office

Readings at home, over several days, tell us more than one reading in the clinic. They are what we use to adjust your plan.

Measure it the right way at home

A wrong cuff size or bad position can throw a reading off by 10 points or more. These steps keep your numbers honest.

Use a good cuff

Pick an upper arm cuff that has been tested for accuracy. You can check your model at validatebp.org. Make sure the cuff fits your arm size.

Get ready

For 30 minutes before, skip caffeine, exercise, and smoking. Empty your bladder. Then sit quietly for 5 minutes.

Sit right

Back supported. Feet flat on the floor, legs not crossed. Arm resting on a table at heart level. Cuff on bare skin.

Stay still and quiet

Do not talk or look at your phone during the reading. Take a second reading 1 minute later.

The schedule before a visit

Take 2 readings, 1 minute apart, in the morning before your medicines.
Take 2 more readings in the evening.
Do this for 7 days before your visit. If you cannot, do at least 3 days.
That gives us at least 12 readings. Write them all down or use the log below.

Why so many readings?

Blood pressure changes all day. One high reading can come from stress, a full bladder, or a cup of coffee. The average of many readings shows your true blood pressure. Doctors call this home blood pressure monitoring, and the latest guidelines strongly recommend it.

Some people run high only in the office. Others run normal in the office but high at home. Home readings catch both.

Should I bring my cuff to my visit?

Yes, at least once a year. We will check it against our office readings. Up to 1 in 5 home cuffs read more than 10 points off for reasons that are hard to predict.

What about my smartwatch or ring?

Do not use a watch, ring, or phone app to manage your blood pressure yet. Devices without a cuff have not been proven accurate, and some read poorly at night or on darker skin. FDA clearance is not the same as proof of accuracy. Use a validated arm cuff for the numbers you send us.

What works, and how much

Each bar shows how many points the top number usually drops with that one change. Tap a row to mark the ones you will try.

Can I just add these up?

Not exactly. These numbers are averages from studies of people with high blood pressure. Your result may be bigger or smaller. Changes often work better together than alone. Cutting salt while eating the DASH way works better than either one by itself.

Salt down, potassium up

Sodium

Under 1,500 mg a day

That is the ideal. Stay under 2,300 mg at most. Most of the salt you eat is already in the food before it reaches your table.

Where the salt hides

Bread and rolls
Pizza
Deli meat, bacon, sausage, ham
Canned soup
Restaurant and fast food
Chips, crackers, pretzels
Sauces, dressings, seasoning packets

Potassium

3,500 to 5,000 mg a day

Potassium helps your body flush out sodium. Get it from food first: beans, potatoes, sweet potatoes, spinach, bananas, oranges, tomatoes, yogurt, and avocado.

Who should be careful

If you have kidney disease, or take spironolactone, eplerenone, amiloride, triamterene, or a potassium pill, ask us before you add potassium. Some blood pressure medicines (lisinopril, losartan, and others like them) also raise potassium.

Salt substitutes:

Potassium salt substitutes (like NoSalt or Nu-Salt, or blends that replace part of the salt) lower blood pressure and lower the risk of stroke. They are not safe for everyone. Check with us first if you have kidney disease or take any of the medicines listed above.

Reading a food label for salt

Look at the sodium line. 140 mg or less per serving is low. 600 mg or more in one item is a lot. Check the serving size. A can of soup often holds two servings, so double the number.

Rinse canned beans and vegetables. That washes away a good share of the salt. Choose "no salt added" when you can.

For a full eating plan built around DASH and Mediterranean eating, see Eating for your heart.

Move most days

All three kinds of exercise lower blood pressure. Pick what you will actually do.

Aerobic

90 to 150 minutes a week. Brisk walking, cycling, swimming. You should breathe harder but still talk. That is 30 minutes, 3 to 5 days a week.

Strength

2 to 3 days a week. Six exercises, 3 sets of 10. Use weights, bands, or your body weight. Pick a load you can lift 10 times with good form.

Handgrip

3 days a week, about 12 minutes. Squeeze a handgrip at a light to medium effort for 2 minutes. Rest 1 minute. Repeat 4 times.

Why does a handgrip lower blood pressure?

Holding a steady squeeze is called isometric exercise. Over weeks, it helps your blood vessels relax. In studies it lowered the top number by 5 to 10 points. It is cheap, quick, and you can do it sitting down. Use about a third of your hardest squeeze. Do not hold your breath.

Is exercise safe for me?

For most people, yes. Start slow and build up over a few weeks. If your blood pressure is 180 or higher on top, or you get chest pain, unusual shortness of breath, or dizziness with exercise, stop and call us before you continue.

Weight and alcohol

Weight

Lose 5% of your weight

If you carry extra weight, losing even a little helps. Expect about 1 point lower on top for every 2 pounds you lose. For someone who weighs 200 pounds, 5% is 10 pounds.

What about weight loss shots?

Medicines like Wegovy and Zepbound help with weight and also lower blood pressure. They are not first choice blood pressure medicines. Ask us if one might fit your plan.

Alcohol

Less is better. None is best.

Alcohol raises blood pressure. If you drink, cut back by more than half. Stay at 2 drinks a day or fewer for men, 1 or fewer for women.

What counts as one drink?

12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor. Many bar pours and craft beers are bigger than one drink.

Stress and sleep

Slow your breathing

Breathe slowly, fewer than 10 breaths a minute, for 15 minutes a day. Try in for 4 counts, out for 6. A breathing app or guide helps.

Meditate

Two 20 minute sessions a day, seated with eyes closed. Learn from a teacher or a good app.

Sleep 7 to 9 hours

Short or poor sleep raises blood pressure. See Sleeping well for a 12 week plan.

Snoring? Tell us.

Loud snoring, gasping at night, or daytime sleepiness can mean sleep apnea. Treating it can help bring blood pressure down.

How strong is the evidence?

Breathing and meditation lowered the top number by about 5 to 7 points in studies. Those studies were smaller and shorter than the ones on salt, diet, and exercise. They are worth doing, but do them alongside the bigger changes, not instead of them.

Hidden blood pressure raisers

Some medicines and supplements push blood pressure up. Tell us about everything you take, including things you buy without a prescription.

Watch out for	Examples
Pain relievers (NSAIDs)	Ibuprofen (Advil, Motrin), naproxen (Aleve). Acetaminophen (Tylenol) is usually a better choice.
Decongestants	Pseudoephedrine (Sudafed), phenylephrine. Look for "D" on cold and allergy medicines.
Stimulants	Energy drinks, high caffeine pre workout powders, some diet pills, ADHD medicines
Herbal products	Real black licorice, ephedra, yohimbe, bitter orange
Other prescriptions	Steroids like prednisone, some birth control pills, some antidepressants. Do not stop these on your own. Ask us.

I take my pills, but sometimes I miss them

You are not alone. More than 1 in 3 people with hard to control blood pressure do not take every dose. Tell us. We can often switch you to one combined pill taken once a day, which is easier to remember. Use a pill box, a phone alarm, or tie your pills to a daily habit like brushing your teeth.

Your home reading log

Type each reading as top/bottom, like 132/84. Your readings stay on this device. Once you have 12, you will see your average.

Reading Time

This week

Pick a few. Check off what you did. Your progress saves on this device.

0 of 8

Took home readings morning and evening for 3 days or more Read the sodium line on 5 foods before buying them Cooked at home at least 4 nights Ate a potassium rich food every day Walked or exercised 30 minutes on 3 days or more Did handgrip or strength exercise twice Had no more than 1 alcoholic drink on any day Did 15 minutes of slow breathing on 3 days or more

When to call us

Call 911 if your blood pressure is 180 or higher on top, or 120 or higher on the bottom, and you have chest pain, shortness of breath, weakness or numbness, trouble speaking, vision changes, confusion, or a severe headache.

Call our office the same day if:

You read 180 or higher on top (or 120 or higher on the bottom) without symptoms. Rest 5 minutes and recheck first.
Your top number is under 90, or you feel dizzy or faint when you stand.
Your home average stays above your goal for 2 weeks.
You have side effects from a medicine.

Other guides

Lowering your AFib risk Eating for your heart Sleeping well Living with POTS My watch says I have AFib

This page is general education for my patients. It does not replace advice from your own doctor. Do not stop or change a medicine without talking with us. Ask us before using a salt substitute or potassium supplement.

Based on: Jones DW, et al. 2025 AHA/ACC/Multisociety Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. And: Davis LL, Yang E, et al. Optimizing Blood Pressure Care in Patients With Resistant Hypertension: 2026 ACC Expert Consensus Decision Pathway. JACC. 2026. Read the pathway.

Back to all patient guides

A guide for my patients

Lowering your AFib risk

Atrial fibrillation is not just bad luck. Most of what drives it is in your daily life, and changing those things can prevent it or make it go away.

From Dr. Kenny Civello, cardiologist and electrophysiologist

Treat the causes, not just the rhythm.

Medicines and ablation treat the rhythm. They do not fix what caused it. Extra weight, alcohol, high blood pressure, poor sleep, and too little exercise slowly change the upper chambers of the heart. Treating those causes makes every other AFib treatment work better and last longer.

It is common

Between 1 in 3 and 1 in 5 adults will get AFib at some point in their life.

It raises stroke risk

AFib makes a stroke about five times more likely. Your stroke risk is checked separately and may call for a blood thinner.

It can reverse

In people who lose weight and treat their risk factors, AFib often becomes less frequent. Some stop having it.

Quick check

Check each one that applies to you. Nothing you enter leaves this device.

My BMI is 27 or higher, or my waist has grown I drink alcohol most days of the week My blood pressure is often 130/80 or higher I snore loudly or someone has seen me stop breathing in my sleep I get less than 150 minutes of exercise a week I have diabetes or prediabetes I smoke or vape

What you can change

These have the strongest evidence. The 2023 national AFib guideline recommends all of them.

Weight

Lose 10% of your body weight

For a 220 pound person, that is 22 pounds.
Keep it off. Weight that swings up and down helps less.
Medicines like Wegovy or Zepbound can help. Ask us.

Why

Extra fat around the heart stretches and inflames the upper chambers. In studies, people who lost 10% or more of their weight were far more likely to be free of AFib years later than people who lost little or none.

Alcohol

Cut back or stop

Even one drink a day raises AFib risk.
Binge drinking is a common trigger for an episode.
Stopping completely works best if you already have AFib.

Why

In a trial of regular drinkers with AFib, the people who stopped drinking had fewer AFib episodes and went longer before AFib came back than the people who kept drinking.

Exercise

About 210 minutes a week

That is 30 minutes a day of brisk walking, cycling, or swimming.
Start where you are and build up over a few months.
Fitness itself protects you. Every step up in fitness lowers risk.

Why

Fit people have less AFib, and people with AFib who improve their fitness have fewer episodes. The goal of about 210 minutes a week of moderate to vigorous exercise comes straight from the guideline.

Blood pressure

Below 130/80

Check it at home with an upper arm cuff.
Less salt, more exercise, and weight loss all lower it.
Take blood pressure medicine every day if it is prescribed.

Why

High blood pressure is the most common treatable cause of AFib. Years of high pressure stiffen the heart and enlarge the upper chambers.

Sleep apnea

Get tested and treated

Loud snoring, gasping, and daytime sleepiness are warning signs.
A home sleep test is simple.
Use CPAP or another treatment every night if you need it.

Why

Each pause in breathing drops oxygen and spikes blood pressure. Sleep apnea is very common in people with AFib. Treating it helps your heart and makes AFib easier to control. See the sleep guide.

Smoking

Quit completely

This includes vaping and chewing tobacco.
Nicotine patches, gum, and prescription medicines double your chance of quitting.
Free help: call 1 800 QUIT NOW.

Why

Smoking damages blood vessels and heart tissue and raises the risk of AFib and stroke. Quitting lowers both.

Blood sugar

Diabetes raises AFib risk. Keeping your A1c in range helps. Some newer diabetes medicines also protect the heart. Ask us if one is right for you.

Thyroid

An overactive thyroid can trigger AFib. A simple blood test checks it. Treating it often stops the AFib.

What you cannot change

These raise your risk too. They are a reason to work harder on the list above, not a reason to give up.

Age

The biggest single risk factor. AFib becomes much more common after 65.

Family history

AFib in a parent or sibling raises your risk, especially if they got it young.

Sex and height

Men get AFib at younger ages. Taller people also have a higher risk.

Heart conditions

Heart failure, valve disease, coronary disease, and past heart surgery all raise risk.

Common questions

Does coffee cause AFib?

No. Regular coffee drinkers have the same or lower rates of AFib. In a recent trial of people with AFib, those who kept drinking coffee had less AFib come back than those who quit. Energy drinks are different. Avoid them.

I exercise a lot. Can that cause AFib?

Years of very high volume endurance training, like marathons or long distance cycling, can raise AFib risk, mostly in men. This is far less common than AFib from too little exercise. If you are an endurance athlete with palpitations, talk with us. Do not stop exercising on your own.

My watch says I might have AFib. What now?

Do not ignore it, and do not panic. Save the ECG recording if your watch makes one and bring it to your visit. Watch alerts are good at catching AFib but are not a diagnosis. We confirm it with a medical ECG or a monitor. See the watch alert guide.

If I fix my risk factors, can I stop my blood thinner?

Not on your own. Your need for a blood thinner depends on your stroke risk score, not on how often you feel AFib. Never stop a blood thinner without talking with us.

Will an ablation fix the problem so I do not need to change anything?

Ablation works better and lasts longer in people who also treat their risk factors. Weight, alcohol, blood pressure, and sleep apnea keep acting on the heart after an ablation.

Where to start

Do not try to change everything this week. Pick one.

If you drink most days

Start with alcohol. It is the fastest change to make and you will see results within weeks.

If you snore

Ask us for a sleep test. It takes one night at home.

If you carry extra weight

Set a goal of 10%. The eating guide shows what to change first.

If none of these apply

Buy a home blood pressure cuff and start walking 30 minutes a day.

When to call us

Call the office for any of these

A racing or irregular heartbeat that is new or happening more often
Your watch or monitor shows AFib you did not know about
Shortness of breath or swelling in your legs
Bleeding while on a blood thinner

Call 911 for chest pain, fainting, or signs of stroke: face drooping, arm weakness, or trouble speaking.

Other guides

Lowering your blood pressure Eating for your heart Sleeping well Living with POTS My watch says I have AFib

This page is general education for my patients. It does not replace advice from your own doctor. Talk with us before starting a new medicine or exercise program.

Based on: Joglar JA, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. Circulation. 2024.

Back to all patient guides

A guide for my patients

My watch says I have AFib

An AFib alert is worth checking. Here is what the alert means, how to record a useful ECG, and what happens at your visit.

From Dr. Kenny Civello, cardiologist and electrophysiologist

An alert means check, not panic.

Your watch is good at noticing an irregular pulse. It cannot tell you for sure that you have AFib, and it cannot tell you what to do about it. A doctor reads the tracing, confirms the rhythm, and checks your stroke risk.

How it notices

A light sensor on the back of the watch checks your pulse now and then. If the rhythm looks irregular several times in a row, you get an alert.

It can be wrong

Extra beats, movement, and a loose band can all set off an alert. A doctor has to look at a tracing to be sure.

Why it matters

AFib makes a stroke about five times more likely. Finding it early lets us lower that risk.

Why the alert and the ECG are different

The alert comes from your pulse, measured with light. It only sees the timing of each beat. The ECG app records the electrical signal of your heart for 30 seconds. That shows the actual rhythm, and it is what a doctor can read. An alert tells you to look. An ECG lets us see.

Record a useful ECG

If your watch can record an ECG, do it when you get an alert and any time you feel your heart racing or skipping.

Sit down
Rest your arms on a table or your lap. Stay still and do not talk.
Snug the band
The watch should sit firmly on the wrist you chose in its settings.
Touch the sensor
Hold a fingertip from your other hand on the crown or button your watch tells you to touch. Do not press down.
Hold for 30 seconds
Keep still until it finishes. If the result is unclear, wait a minute and record again.
Write it down
Note the time and what you felt, if anything. Then save or share the recording.

How to share a recording

Most heart apps let you save an ECG as a PDF. On an iPhone, open the Health app, tap Browse, then Heart, then Electrocardiograms, and choose the option to export a PDF. Other brands have a share or export button in their heart app. Bring the PDFs to your visit or have them ready on your phone.

What your ECG result means

Watch apps use a few standard labels. Here is what each one means for you.

Atrial fibrillation

The app saw a pattern that looks like AFib. Save it and call us to set up a visit. If the tracing is clear, a doctor can often confirm AFib from it.

Sinus rhythm

Your rhythm was normal during those 30 seconds. AFib can come and go, so if alerts keep coming, still tell us.

Inconclusive

Extra beats, a very fast or slow heart rate, or a pacemaker can confuse the app. Record again later. Save it either way.

Poor recording

Usually movement or a loose band. Rest your arms, snug the band, and try again.

What happens at your visit

The goal is to confirm the rhythm, find the cause, and protect you from stroke.

We read your recordings
We look at the tracings themselves, not just the label the app gave them.
An ECG in the office
A standard 12 lead ECG takes a few minutes and shows your rhythm in more detail.
A heart monitor, if needed
If AFib comes and goes, a small patch worn for days to weeks can catch it. About heart monitors
Tests for causes
Blood tests, including thyroid, and often an ultrasound of the heart called an echocardiogram.
Your stroke risk
A score based on your age, sex, blood pressure, diabetes, heart failure, blood vessel disease, and any past stroke. It tells us whether you need a blood thinner.
A plan
Treatment for the rhythm if you need it, and work on the habits that drive AFib. See the AFib risk guide.

Common questions

Can my watch miss AFib?

Yes. The background checks run only now and then, mostly when you are still. No alert does not mean no AFib. If you feel a racing or irregular heartbeat, record an ECG right then.

I got an alert, but my ECG says normal rhythm. Now what?

AFib can stop on its own within minutes or hours. Save both and tell us. Record another ECG the next time you get an alert or feel something.

Should I start taking aspirin?

No. Aspirin does not prevent AFib strokes well, and it raises bleeding risk. If you need a blood thinner, we will choose one with you.

The alerts make me anxious. Can I turn them off?

That feeling is common. Talk with us before you turn them off. Once we know your rhythm, we can decide together which alerts are worth keeping.

I already have AFib. Is the watch still useful?

Yes. Recordings help us see whether treatment is working. Some watches have a separate setting for people already diagnosed that shows how much time you spend in AFib each week. Ask us whether to turn it on.

Which watch should I buy?

Choose one with an FDA cleared ECG feature. The brand matters less than wearing it snug and recording when you have symptoms.

Other guides

Lowering your AFib risk Lowering your blood pressure Eating for your heart Sleeping well Living with POTS

This page is general education for my patients. It does not replace advice from your own doctor. Watch alerts and ECG apps are not a diagnosis.

Based on: Joglar JA, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. Circulation. 2024.

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Eating for your heart

Sleeping well

Living with POTS

Lowering your blood pressure

Lowering your AFib risk

My watch says I have AFib

Wearable Health AI

Heart rhythm care

How atrial fibrillation is treated

Lifestyle changes

Medicines

Cardioversion

Ablation

Surgery

About Dr. Civello

Call the office to schedule a visit

How do I schedule an appointment?

What should I bring to my first visit?

Do you offer telemedicine visits?

What to eat

Eat more

Choose wisely

Limit

Daily targets

Easy swaps

Drinks

Eating plans that work

Mediterranean

DASH

Vegetarian or plant forward

Your situation

This week

Other guides

The core habits

Wake up at the same time every day

Use your bed only for sleep

If you can't sleep, get up

Go to bed when sleepy, not just tired

Get morning light

Wind down for an hour

Stop caffeine by early afternoon

Skip the nightcap

The 12 week plan

Bedtime teas

How to use bedtime tea

Chamomile

Valerian root

Passionflower

Lemon balm

Lavender

Rooibos and tart cherry

Melatonin and sleeping pills

When to call us

Other guides

How we diagnose it

What it feels like

What to expect

The four daily basics

Fluid

Salt

Compression

Exercise

Ways to get your sodium

Habits that help

Stand up in stages

Squeeze when you feel symptoms

Don't stand still

Eat small meals

Stay cool

Limit alcohol

Test your caffeine

Raise the head of your bed

The 10 minute stand test

How to do it

The exercise plan

Medicines

Tracking at home

Watch or fitness band