DEAR MAYO CLINIC: My older sister was recently diagnosed with thickened heart muscle, and her doctor recommended a procedure called a "septal myectomy." I’ve never heard of it before. What does this surgery do, and how do doctors know when it's the right treatment? 

ANSWER: Hearing that someone you love may need heart surgery can be scary, especially when you're also trying to understand an unfamiliar heart condition. Treatment usually starts with medication. However, for some people, surgery becomes the best option when symptoms continue despite medical therapy.  

Your sister's condition is called hypertrophic cardiomyopathy, or HCM. It's a relatively common genetic condition that affects about 1 in 500 people. It causes the heart muscle to become abnormally thick, most often in the wall between the heart's two main pumping chambers. As a result, the normal pathway where blood leaves the heart can become blocked. 

HCM can affect the heart in two ways. The muscle may become obstructive from the thickening, or it may become stiff. Both forms can cause symptoms such as shortness of breath, chest pain, fatigue, low energy and reduced endurance. The obstructive form caused by the thickened heart muscle is the one that surgery can often correct. Most people with HCM have this type, which is why septal myectomy can be an effective treatment for appropriately selected patients. 

Doctors usually diagnose HCM with an echocardiogram, an ultrasound that lets them see the heart and measure the thickness of the heart muscle. Because HCM is a genetic disease, blood tests can identify some genetic mutations. However, not every mutation can be detected with a blood test, so imaging remains the primary way doctors diagnose the condition. 

Treatment

Treatment usually begins with medications such as beta blockers, calcium channel blockers and newer medicines called myosin inhibitors to help manage symptoms. Surgery is rarely the first treatment that is recommended. Instead, it is considered when symptoms continue despite medication or when patients are not able to tolerate their medical therapy. That's why deciding whether surgery is the right treatment depends not only on the diagnosis but also on how well symptoms respond to medication. A cardiologist experienced in treating HCM can help determine when it's time to consider surgery or another form of septal reduction therapy called alcohol septal ablation. During this procedure, a small amount of alcohol is delivered through a catheter to shrink a portion of the thickened heart muscle and improve blood flow. In general, this procedure is reserved for patients who cannot undergo surgery. 

A septal myectomy is an open-heart operation that removes the portion of thickened heart muscle blocking blood flow. During the procedure, echocardiographic imaging helps surgeons identify where the muscle is thickened. Afterward, imaging confirms that blood flow out of the heart and the function of the heart valves have returned to normal. 

Like any heart operation, septal myectomy has risks. When it's performed at a center with expertise in this procedure by an experienced surgeon, the risk of death or a major complication like stroke is less than 1%. Another possible complication is the need for a pacemaker because the area where the muscle is removed is close to the heart's electrical system; in specialized centers, this is usually less than 2%. 

After surgery, most patients stay in the hospital for about five days. Recovery takes about six to eight weeks. During that time, patients are encouraged to stay active by getting up, walking and moving around. The main restriction is avoiding heavy lifting until the breastbone heals. By two or three months, many people can return to activities such as exercising, running and weightlifting.  

One of the biggest benefits of the procedure is a significant improvement in quality of life. People who were limited by their symptoms before surgery often are able to return to the activities they enjoy afterward. Many patients need less medication after surgery, and others no longer require it. Growing evidence also suggests surgery may help people live longer than medication alone. 

Because HCM is a complex disease, experience matters. Patients considering septal myectomy should feel comfortable asking where the procedure will be performed and how much experience the multidisciplinary care team has treating HCM. Centers with expertise in HCM use a multidisciplinary approach, bringing together cardiologists, surgeons, imaging specialists, genetic experts and other specialists to determine the best overall treatment plan for each patient. 

Joseph Dearani, M.D., Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 

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Fainting became commonplace for Brenda in 2021. She and her husband, John, were so accustomed to what they called "blood pressure crashes" that they developed a routine.  

"I would feel dizzy, nauseated and sweaty, and (I would) alert my husband. He would run for a bucket and a cold compress. I would lie on the ground and get my feet up," Brenda shares.  

John would check her blood pressure. Once she stabilized, they would go about their day.  

Brenda, then 53, attributed the episodes to traveling too much for work or not drinking enough water, especially because many occurred on hot days in her home state of Arkansas.  

"I had an excuse every time," she says.  

But in 2023, as she headed out for a run with John — her favorite leisure activity — Brenda fainted and couldn't get back up. John called an ambulance.  

Watch: Dr. Guru Kowlgi explain cardioneural ablation

Journalists: Broadcast-quality sound bites are available in the downloads at the end of the post. Please courtesy: "Mayo Clinic News Network." Name super/CG: Guru Kowlgi, M.B.B.S./Cardiovascular Medicine/Mayo Clinic.

After extensive testing at the hospital and a review of Brenda's smartwatch health data, her physician found that the fainting episodes coincided with drops in her heart rate. Brenda received a pacemaker, a device implanted under the skin that sends small electrical impulses to the heart to keep it from beating too slowly or pausing too long.   

But the fainting episodes continued. Brenda also experienced fatigue, brain fog, hair loss and inflammation throughout her body.  

"I'd gone from a person with great energy and vitality to someone who struggled to walk. I was trying every remedy possible," Brenda says.  

She tried cold plunges, gluten-free and dairy-free diets, and intermittent fasting. She took 13 different medications and multiple vitamins, and she stopped air travel. Nothing worked. She lived in constant fear that something was seriously wrong with her heart.  

Brenda continued checkups with her local care team. Despite her symptoms, she kept receiving the same report: "Your heart is fine. Your pacemaker is working. You're good." 

In April 2025, before Brenda left to visit her home country of Ireland, a nurse practitioner who had been part of her care team from the beginning expressed concern about Brenda's condition and advised her to seek care elsewhere. The nurse practitioner referred Brenda to Mayo Clinic, and soon afterward, Brenda and John made the 10-hour drive to Rochester, Minnesota. 

Finding the cause of years of fainting 

In September 2025, after months of extensive evaluations at Mayo Clinic, Brenda met Guru Kowlgi, M.B.B.S., a cardiologist and cardiac electrophysiologist. 

She walked into the appointment with little hope, expecting him to deliver the same message she had heard from other physicians: "You're fine. Keep doing what you're doing."  

Instead, Dr. Kowlgi said, "Brenda, we know exactly what the issue is, and we have a plan to solve it." 

"I couldn't believe it. John and I felt relieved to finally have answers," Brenda says.  

Brenda was diagnosed with vasovagal syncope, a common condition that causes fainting when the vagus nerve triggers a drop in heart rate and blood pressure.   

"A pacemaker is usually the last treatment option for patients like Brenda, but it does not solve all their issues," says Dr. Kowlgi.  

Pacemakers treat slow heart rates, which are the result of vasovagal syncope, but do not address the root cause. Thus, Dr. Kowlgi says patients may continue to have lightheadedness, and even faint, and the condition can significantly affect quality of life.  

For Brenda, Dr. Kowlgi recommended a specialized procedure called cardioneuroablation, also referred to as cardioneural ablation. The procedure uses a catheter to target and ablate, or destroy, areas around the nerve cells in the heart that contribute to the abnormal reflex.   

"It is like a recalibration," explains Dr. Kowlgi. "Since the vagus nerve activity is high, we are trying to blunt it and bring it closer to normal."   

Using cardioneuroablation to target the cause  

Dr. Kowlgi first performed cardioneuroablation at Mayo Clinic in 2022 and has helped advance its use for vasovagal syncope.   

Cardioneuroablation builds on techniques used in cardiac ablation procedures to treat heart rhythm disorders. Dr. Kowlgi is among the physicians using the approach to treat vasovagal syncope, including in patients with pacemakers, such as Brenda. 

In 2024, Dr. Kowlgi performed cardioneuroablation for the first time on a patient with an existing pacemaker. "We started building on that experience. I realized there was an opportunity to not only make patients' symptoms better but to remove pacemakers, which can cause a multitude of issues, especially when implanted in young patients who would otherwise live with them for life."  

Brenda underwent the procedure in October 2025. "When I came off the operating table, I could feel my energy coming back. I was out walking within a week," Brenda says.  

Within two months of the procedure, Brenda went from having her pacemaker provide pacing 40% of the time to no pacing, and her symptoms resolved.  

She spent Christmas in Rochester, skiing with her family for the first time in years. In February 2026, Brenda's pacemaker was removed.  

Returning to running, traveling and family life 

As Dr. Kowlgi continues clinical research on cardioneuroablation and its potential uses, Brenda and John are reclaiming their life together.  

"I thought I'd never be able to run another marathon or plan travel with John to see my mum in Ireland, our sons in New York and Kentucky, and visit the last state on our bucket list," Brenda says. "Now I run 3 to 4 miles a day and am about to go on a cruise to Alaska. It's not just me who got my life back, but my family did too." 

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ROCHESTER, Minn. — Mayo Clinic researchers tested an approach that uses artificial intelligence (AI) to help people without previous ultrasound experience capture heart images and identify patients who may have a common and serious heart valve condition. In a study published in JAMA Cardiology and presented at the 2026 ESC Congress, after four hours of training, novice users were able to collect focused heart ultrasound images while using  AI models to guide their image collection and help to analyze the images for signs of moderate or greater aortic stenosis.

Aortic stenosis happens when the heart's aortic valve narrows, making it harder for the heart to pump blood to the rest of the body. It affects approximately 7% of people age 75 and older and is the most common reason for heart valve intervention worldwide. People with aortic stenosis may not experience symptoms until the condition is more advanced. Finding the disease earlier can help ensure patients receive appropriate monitoring and care.

"A comprehensive echocardiogram is the standard diagnostic test for aortic stenosis. However, its use is resource-intensive, requiring specialized equipment as well as trained personnel with expertise in both image acquisition and interpretation. These requirements can limit access, particularly in resource-constrained settings, and make comprehensive echocardiography neither feasible nor cost-effective as a broad screening tool," says Gal Tsaban, M.D., Ph.D., a cardiologist at Mayo Clinic and senior author of the study.

"We wanted to see whether combining AI guidance with focused cardiac ultrasound could help people with no previous ultrasound experience capture usable heart images and identify patients who may need further evaluation," adds Jared Bird, M.D., a Mayo Clinic cardiologist who co-led the study.

First, the researchers developed and validated the deep learning algorithm using echocardiograms from patients at Mayo Clinic sites in Arizona, Florida, the Mayo Clinic Health System and Rochester. They evaluated the model's performance on hand-held ultrasound images collected by experienced sonographers.

In the prospective study, nine research staff members with no previous clinical or ultrasound experience used AI guidance to perform focused heart ultrasounds after four hours of training. The staff members were able to use the AI model to analyze nearly 97% of the exams. It helped the researchers correctly identify 93% of patients with moderate or more severe aortic stenosis and correctly rule out 96% of patients who did not have the condition.

About 10% of exams were flagged for review by a heart imaging specialist. The combined approach of AI plus human review reduced false-positive results, but it also meant that some patients with aortic stenosis were not identified.   

Dr. Tsaban and Dr. Bird note that the approach is intended to help people screen for aortic stenosis and determine who may benefit from additional testing. It is not intended to replace a comprehensive echocardiogram or a physician's evaluation. Patients identified as potentially having moderate or more severe aortic stenosis still need comprehensive echocardiography to confirm the diagnosis and determine the severity of the condition.

The findings suggest that putting AI tools in the hands of people with limited ultrasound experience could help more patients access screening for aortic stenosis, particularly in communities where comprehensive echocardiography and trained imaging professionals are less readily available.

A full list of authors, appropriate disclosures and funding sources for this research can be found within the paper: "Artificial Intelligence-Enabled Acquisition and Interpretation for Screening Aortic Stenosis." Mayo Clinic has a financial interest in the technology referenced in this news release and will use any revenue it receives to support its nonprofit mission in patient care, education and research.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Terri Malloy, Mayo Clinic Communications, newsbureau@mayo.edu

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On June 17, 2026, Kayla Gengler walked through the doors of Mayo Clinic in Rochester, Minnesota, with her husband, AJ, and their youngest daughter, Ida. 

The date carried more than one meaning. It was Ida's first birthday. It was Kayla and AJ's ninth wedding anniversary. And it marked one year since a rare and life-changing obstetric emergency required multiple Mayo Clinic care teams to respond within minutes. 

Watch: Suspected amniotic fluid embolism leads to maternal cardiac arrest and rapid ECMO response at Mayo Clinic

Journalists: Broadcast-quality video (2:28) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

What happened when Kayla suddenly collapsed at 39 weeks pregnant? 

A year earlier, Kayla, then 33, was 39 weeks pregnant with the couple’s third child. She was at Mayo Clinic receiving care late in her pregnancy when her condition suddenly changed. While being monitored, Kayla reported severe nausea and heart palpitations before losing consciousness.  

Kayla’s care team, including obstetrician Vanessa Torbenson, M.D., immediately called for an emergency cesarean delivery.  

"Moving rapidly was essential. If too much time passed, blood flow to the uterus could have been reduced, putting both mother and baby in danger," says Dr. Torbenson.  

In situations this complex and fast-moving, having obstetrics, anesthesia, and critical care available within minutes can make a crucial difference. Those teams began mobilizing simultaneously as Kayla's condition deteriorated. 

Four minutes later, Ida was born safely as another team continued working to stabilize Kayla.  

Then, Kayla's heart stopped. 

How did Mayo Clinic respond when Kayla went into cardiac arrest? 

When Kayla went into cardiac arrest, Mayo Clinic’s ECMO team was activated immediately.  

Extracorporeal membrane oxygenation, or ECMO, is a form of temporary life support that can assist heart and lung function during critical illness. It requires specialized equipment and a team certified to manage patients whose condition can change rapidly. 

At Mayo Clinic, maternal cardiac arrest triggers immediate consultation with the ECMO team, allowing specialists to assess the need for advanced life support while resuscitation continues. In Kayla's case, ECMO preparation began as other teams worked to restore and stabilize her circulation. 

Troy Seelhammer, M.D., an anesthesiologist, critical care physician and medical director of Mayo Clinic's ECMO Program, was on call that morning. 

"We had a very short window to try to save Kayla’s life," Dr. Seelhammer says.  

 Within minutes, specialists, ECMO equipment and transportation resources were mobilized across Mayo Clinic campuses.  

"Cases like this are incredibly rare," Dr. Seelhammer says. "Survival depends on having experienced, multidisciplinary teams that can quickly come together while remaining coordinated throughout the patient's journey." 

Why did Kayla's emergency require so many specialized teams? 

For Kayla, several urgent needs were developing at once.  

The obstetric team needed to deliver Ida while continuing efforts to stabilize Kayla. While in cardiac arrest, critical care and ECMO specialists were needed to provide advanced life support. Nurses, transport teams and other specialists helped coordinate care, equipment and movement across Mayo Clinic as her condition changed. 

Mayo Clinic's team-based model brought together specialists from across disciplines who routinely work side by side, allowing Kayla's care plan to evolve rapidly as new challenges emerged.

Later, when imaging revealed that Kayla had experienced multiple strokes, neurologic care became part of her treatment.  

What is an amniotic fluid embolism? 

As Kayla stabilized and began recovering in the intensive care unit, specialists from several disciplines worked to understand what had caused her sudden collapse. 

The exact sequence of events remains uncertain. Kayla's care team determined that an amniotic fluid embolism, or AFE, was the most likely explanation. 

AFE is an exceptionally rare obstetric emergency that can occur when amniotic fluid or fetal material enters the mother's bloodstream and triggers a sudden, severe reaction. It can develop during pregnancy, labor or delivery and may rapidly lead to breathing and circulatory failure, abnormal blood clotting and cardiac arrest. 

"There is no single test that can confirm AFE, and it can happen without warning or an obvious cause," Dr. Torbenson says. 

AFE is estimated to occur in about 6 of every 100,000 pregnancies in the U.S. 

Why was Kayla's case so medically complex? 

Surviving the initial cardiac arrest was only the beginning of Kayla's medical course. 

Further imaging revealed that Kayla had experienced multiple strokes. During the evaluation, her care team also discovered a previously undiagnosed opening in her heart, called a patent foramen ovale, or PFO. 

Kayla’s physicians say this opening may have provided a pathway for amniotic fluid in her bloodstream to pass through the heart and reach the brain, potentially contributing to her strokes. 

The combination of suspected AFE, cardiac arrest, ECMO support and multiple strokes made Kayla's case unusually complex. It also meant her care did not end when the immediate emergency passed. 

Recovery would require time, specialized care and continued support. 

What does recovery look like after an obstetric emergency? 

After 31 days in the hospital, including nearly two weeks of inpatient rehabilitation, Kayla was able to return home. 

Recovery was not simple. The strokes left Kayla with lasting effects on her vision, cognition, balance and movement. Vision loss in both eyes meant losing her ability to drive, while weakness and nerve pain in her legs made everyday activities more difficult.  

The emotional recovery has been just as real. 

"At first, I was just so happy to be home with my kids," Kayla says. "Now, I’m learning more about what happened, and there is a bigger emotional piece. I’ve come down from that initial high and am learning to live with a disability." 

As she navigated the physical and emotional challenges of recovery, Kayla leaned on the support of those around her. 

While many memories from the weeks after Ida's birth remain unclear or missing for Kayla, both Kayla and AJ vividly recall the love that surrounded their family from those who stepped in to provide help and encouragement. 

"What I will always remember is the positivity of all the people who sent food and lent a helping hand. There's just so much kindness in the world," says Kayla.

One year later, a return to Mayo Clinic 

One year after the emergency, Kayla, AJ and Ida chose to mark the anniversary by walking through the doors of Mayo Clinic again.  

They came to reunite with some of the physicians and nurses who had cared for them, including Dr. Torbenson and Dr. Seelhammer. 

For Kayla and AJ, the reunion offered a way to reclaim a difficult anniversary. 

"It's so special to be here," Kayla says. "We get to celebrate Ida's first birthday and we get to celebrate all of life's amazing moments." 

For the physicians and nurses, seeing the family together again was a reminder of what coordinated care had made possible. 

"This is what really keeps us going," Dr. Seelhammer says — seeing patients return to their families and their lives after illness. 

Kayla’s recovery continues, and she is still adapting to physical challenges that have changed parts of daily life. But she holds close the ordinary moments with AJ and their children — walks, bedtime routines and watching them grow. 

Those moments are possible because, when a rare obstetric emergency unfolded without warning, specialists from across Mayo Clinic came together within minutes to deliver highly coordinated care. As Kayla's needs evolved from emergency delivery to cardiac resuscitation, ECMO support, neurologic care and rehabilitation, teams across disciplines remained connected at every stage. 

The expertise required to manage each complication was different, but the goal was shared: helping Kayla return to her family. 

No single specialty carried her through the experience. Her care moved seamlessly from one team to the next, with specialists working together to meet each new challenge as it emerged. 

“We drew on years of planning, experience and team training to bring the right resources rapidly to Kayla’s bedside,” says Troy Seelhammer, M.D.. “That preparation allowed teams across Mayo Clinic to respond together when she needed them most."

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PHOENIX — Mayo Clinic researchers have developed and externally validated an artificial intelligence (AI) model that can identify a potentially significant heart obstruction from routine ultrasound videos without relying on specialized Doppler imaging. The technology could help clinicians flag patients with hypertrophic cardiomyopathy (HCM) who may need additional testing, particularly in settings where specialized echocardiography expertise is limited. Study findings are published in Circulation: Cardiovascular Imaging.  

HCM is a genetic condition that causes the heart muscle to become abnormally thick. About two-thirds of these patients develop left ventricular outflow tract (LVOT) obstruction, which restricts blood leaving the heart, causing symptoms such as chest pain and shortness of breath with exertion or when lying flat. Knowing which patients develop LVOT obstruction is important because it influences treatment decisions and long-term management for patients with HCM. 

"Measuring LVOT obstruction typically requires Doppler echocardiography, which depends on precise ultrasound-beam alignment and operator expertise," says Imon Banerjee, Ph.D., an AI researcher at Mayo Clinic in Phoenix and senior author of the study. "We wanted to determine whether AI could recognize subtle patterns that are imperceptible to the human eye in routinely acquired B-mode ultrasound videos and identify patients with LVOT obstruction earlier, enabling timely confirmatory Doppler evaluation and referral when appropriate." 

The study included 1,833 patients in the Mayo Clinic cohort. The model was tested in 275 patients and externally validated in 46 patients from a hospital in South Korea. The AI model used only resting, non-Doppler ultrasound videos to predict whether a patient had a potentially significant obstruction to blood leaving the heart. Researchers found that combining information from three standard ultrasound views improved the model's ability to distinguish patients with elevated LVOT gradients. The model also helped identify obstruction that may only appear when the heart is under stress. 

The model maintained strong performance in the South Korean group despite substantial differences between that population and the patients used to develop the model, supporting further study of the technology across different patient populations and clinical settings.  

In a subset of cases, the AI model identified obstruction more accurately than two expert echocardiographers who reviewed the same non-Doppler images. The findings highlight how difficult it can be to recognize LVOT obstruction from routine two-dimensional images without Doppler measurements. 

"This technology is intended to complement, not replace, Doppler echocardiography," Dr. Banerjee says. "By enabling earlier identification of patients with potential LVOT obstruction, it could escalate timely detection and prompt confirmatory Doppler measurements, stress testing, or referral to an HCM specialty center. It also could support evaluation using portable ultrasound or in settings where comprehensive Doppler assessment may not be readily available, helping expand access to earlier screening and risk assessment." 

Dr. Banerjee notes that the next steps include additional prospective validation across broader clinical settings, ultrasound platforms and patient populations. 

The list of authors and disclosures may be found in the article, Beyond Doppler: Scalable AI Detection of LVOT Obstruction in HCM. This study received no external funding. 

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About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.  

Media contact: 

• Terri Malloy, Mayo Clinic Communications, newsbureau@mayo.edu 

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Dr. Frye’s pioneering work transformed cardiac catheterization from an experimental procedure into a cornerstone of routine cardiovascular care. 

Robert L. Frye, M.D., professor emeritus of Cardiovascular Medicine, passed away on Aug. 4 at age 94. Dr. Frye helped shape cardiovascular medicine at Mayo Clinic and beyond through his pioneering work in coronary angiography, an X-ray procedure using contrast dye to show blood flow through the heart's blood vessels, as well as his visionary leadership and mentorship of generations of cardiologists.  

After earning his medical degree from Vanderbilt University School of Medicine in Nashville, Tennessee, and completing training at the National Heart Institute and Johns Hopkins University in Baltimore, Dr. Frye joined Mayo Clinic in 1961 as a special appointee in Cardiology — a position meant to last just one year. Instead, it marked the beginning of an extraordinary career and enduring commitment to Mayo Clinic. 

Dr. Frye went on to become one of Mayo Clinic's longest-serving staff members, retiring in 2025 after more than 60 years of service. 

"Through decades of leadership, innovation, and commitment to our patients, Dr. Frye strengthened Mayo Clinic and advanced the practice of cardiovascular medicine for all of healthcare," says Gianrico Farrugia, M.D., president and CEO of Mayo Clinic. “His legacy will endure through the patients he served, the colleagues he inspired, including myself, and the generations of physicians who will continue his work." 

Shaping the future of cardiovascular medicine 

Dr. Frye was a key figure in building Mayo Clinic's modern cardiovascular program, integrating clinical care, research and education. During his tenure as co-director of the Cardiac Catheterization Laboratory (1965–1974), he helped transform the laboratory into one of the country's premier centers for invasive cardiovascular diagnosis and moved cardiac catheterization from the experimental arena to routine use in the hospital. He was co-editor of "The Mayo Clinic Cardiac Catheterization Laboratory: History, Research, and Innovations," published in 2021, which chronicles the development of one of the world's premier catheterization programs. 

Dr. Frye held numerous leadership positions throughout his time at Mayo Clinic, having served as chair of what was then the Division of Cardiovascular Diseases (later to become the Department of Cardiovascular Medicine) from 1974 to 1984 and chair of the Department of Internal Medicine from 1987 to 1999. He also served as president of the staff of Mayo Clinic in 1983, a one-year elected position. He continued to shape the field of cardiovascular research and clinical care throughout that time, serving as a principal investigator of the NIH-sponsored Bypass Angioplasty Revascularization Investigation (BARI) in the 1990s and exploring the use of coronary angiography — at the time, a diagnostic procedure — as a cornerstone of evidence-based coronary artery disease management, particularly among patients with diabetes. 

Dr. Frye received numerous honors throughout his distinguished career; among them, he was named the Rose M. and Morris Eisenberg Professor (1986-2006) and received the Distinguished Clinician Award (1995) at Mayo Clinic, as well as the American College of Cardiology Distinguished Fellowship Award (1995) and the American Heart Association Distinguished Achievement Award (2007). 

His impact at Mayo Clinic is recognized by multiple named positions, including the Norman Blane and Billie Jean Harty Chair, Department of Cardiovascular Medicine, Honoring Robert L. Frye, M.D.; the William S. and Ann Atherton Professor of Cardiology Honoring Robert L. Frye, M.D.; the Thomas J. Watson Professor in Honor of Dr. Robert L. Frye; and the Department of Cardiovascular Medicine's Robert L. Frye, M.D., Visiting Lecturer. In addition, seven named scholarships and research funds were created in his honor. 

A heart for service 

Dr. Frye and his late wife of 70 years, Margaret Ellen, were loyal benefactors whose support helped advance Mayo Clinic’s mission for many decades. Most recently, the Frye family provided generous support to create the Robert L. & Margaret Ellen Frye Rose Garden at Mayo Clinic in Rochester. The garden will leave a lasting legacy of hope and healing as part of Mayo Clinic’s Bold. Forward. Unbound. reimaging of how healthcare building should be built to better support better healthcare outcomes. 
 
In his leadership roles at Mayo Clinic as well as the American Heart Association, the American College of Cardiology and the Heart Rhythm Society, Dr. Frye mentored generations of cardiologists who continue to advance the field today. He also left a mark on countless patients. One patient shared this message with him in 2025: "I have been sick since I (was) 13. I am now 19, and it is thanks to your efforts, compassion and care that I received a diagnosis as well as solutions to my health issue. ... It means the world to me, truly. You have changed my life, and I am grateful for everything you've done." 

"For so many at Mayo Clinic, Dr. Frye represented the very best of who we strive to be," says Paul Friedman, M.D., the Norman Blane and Billie Jean Harty Chair, Mayo Clinic Department of Cardiovascular Medicine Honoring Robert L. Frye, M.D. "He led with humility, kindness, purpose and an unwavering focus on the needs of patients. Those who worked with him will remember not only his brilliance and accomplishments but also the warmth, compassion and quiet steadiness he brought to every interaction. He inspired by example that reminded us that meaningful work is made even more powerful when it is carried out with humanity, generosity and a deep commitment to others."  

In addition to his passion for roses and spending time with his large extended family, Dr. Frye enjoyed opera, skiing and supporting local football and swim teams. He also was a huge proponent of local farmers’ markets.  

The post Mayo Clinic remembers visionary cardiologist Dr. Robert L. Frye  appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My neighbor spends a lot of time outdoors gardening and doing yard work, especially during the summer. Recently, after working outside on a hot day, she became lightheaded and noticed her heart racing. She suspected dehydration was to blame, but it made me wonder: Can dehydration affect your heart? When should symptoms like this be taken seriously? 

ANSWER: Dehydration can affect much more than your thirst. It also can place extra stress on your heart and cardiovascular system. 

Think of the heart as a pump. For it to work properly, enough blood needs to return to it with every heartbeat. When you become dehydrated, the amount of fluid circulating in your bloodstream decreases. That means less blood returns to the heart, so it has to work harder to keep blood moving throughout your body. 

Your body has several built-in ways to respond to dehydration. Blood vessels narrow to help maintain blood pressure, and your heart beats faster to keep blood moving. If dehydration becomes more severe, those usual responses can begin to fail. As a result, organs such as the brain, kidneys, liver and digestive system may not receive enough blood to function properly. 

Recognizing dehydration and knowing your risks

As dehydration worsens, symptoms can include: 

• Racing heartbeat or palpitations 

• Fatigue 

• Lightheadedness 

• Dizziness 

• Vision changes 

• Shortness of breath 

• Chest discomfort 

If dehydration becomes severe, it can lead to heatstroke or fainting. These are medical emergencies and should be evaluated by a healthcare professional immediately. 

Anyone can become dehydrated, but some people are at greater risk, including: 

• Older adults 

• Children 

• Athletes 

• Outdoor workers 

• People with heart disease 

• People taking certain medications, such as diuretics or GLP-1 receptor agonists 

People with heart failure or other forms of heart disease should be especially careful. Their hearts may have less reserve to respond to the added stress of dehydration. Many also take medications that remove fluid from the body, lower blood pressure or slow the heart rate, which can limit the body's usual ability to compensate.  

Staying hydrated and preventing compliations

There isn't a one-size-fits-all recommendation for how much water you need. For most healthy people, thirst is a reliable guide. If you feel thirsty, drink something. If you know you'll be spending time outdoors in the heat or exercising for an extended period, increase your fluid intake beforehand. 

Dehydration isn't always easy to recognize, so it helps to look for other signs. Dry mouth, dry skin, dark urine, foamy urine or a burning sensation when you urinate may all indicate you need more fluids. One of the simplest ways to monitor your hydration is to pay attention to the color of your urine. Pale or clear urine generally suggests you're well hydrated, while darker urine may be a sign that you need more fluids. 

Water is an excellent first choice for staying hydrated, but if you're truly dehydrated, water alone may not always be enough. Your blood contains electrolytes such as sodium, potassium and magnesium. Drinking water along with consuming something salty may help replace both fluids and electrolytes. People participating in prolonged exercise or endurance activities also may benefit from electrolyte-containing sports drinks. 

Alcohol is a large contributor to dehydration because it changes how the brain and kidneys regulate fluids and can increase fluid loss. Highly caffeinated drinks also can contribute to dehydration. If you're trying to rehydrate, choose water or electrolyte-containing drinks instead of sugary drinks or soda. 

The best way to prevent dehydration is to stay ahead of it. Make drinking fluids a regular part of your day. Drinking smaller amounts throughout the day is often more effective than consuming a large amount all at once. If you'll be gardening, exercising or working outdoors in hot, humid weather, plan ahead, stay aware of how you're feeling and adjust your activities if needed. 

Most importantly, know your personal risk. If you're older, have heart disease or take medications that affect your body's fluid balance, you may need to pay especially close attention to staying hydrated. Planning ahead, listening to your body and recognizing the signs of dehydration can help protect your heart and your overall health. 

Brodie R. Marthaler, M.D., Cardiology, Mayo Clinic Health System, Eau Claire, Wisconsin  

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DEAR MAYO CLINIC: My father frequently experiences heartburn, but sometimes I worry that what feels like heartburn to him could be a heart attack. How can you tell the difference, and when should someone seek emergency care? 

ANSWER: Many people worry that heartburn-like symptoms could be a heart attack — and that concern is understandable. Heartburn and chest discomfort caused by a heart problem can sometimes feel remarkably similar. Although there are important differences between the two, the symptoms can overlap enough that it isn't always possible to tell the difference without a medical evaluation. 

One reason the distinction is difficult is that internal organs don't signal pain the same way muscles, bones and joints do. If you stub your toe, your brain quickly recognizes where the pain is coming from. But the heart, esophagus, lungs, and even the muscles and joints of the chest can all cause discomfort in a similar area. Because those sensations overlap, it can be hard to know where the pain is coming from. Even healthcare professionals often need to get additional information from a good physical examination, an electrocardiogram (ECG or EKG), blood work and other testing to determine the source of the symptoms. 

Heartburn is most commonly caused by acid reflux, which occurs when stomach acid flows back into the esophagus. It typically causes a burning sensation behind the breastbone and may leave a sour or acidic taste in the mouth. Symptoms often develop after eating and may become worse when lying down or bending over. Certain foods and beverages, large meals, excess weight, tobacco use, and lying down soon after eating all can increase the likelihood of heartburn. 

Heart-related chest discomfort has some characteristic features, although symptoms can vary from person to person. Many people describe pressure, heaviness, squeezing or tightness in the center of the chest rather than a burning sensation. A common misconception is that every heart attack causes sudden, severe chest pain. While some people experience symptoms that way, others notice milder pressure or fullness instead. The discomfort also may spread to the shoulders, one or both arms, neck, jaw, back, or upper abdomen. And it may occur with shortness of breath, nausea, lightheadedness or dizziness. 

Some symptoms make a heart problem less likely. Chest pain that's very sharp, lasts only a few seconds, changes when you take a deep breath or moves from one location to another is generally less suggestive of a heart problem. However, that doesn't necessarily mean it's harmless. Conditions affecting the lungs, major blood vessels or digestive system also can cause chest pain and may require prompt medical evaluation.  

If your chest discomfort is new, different from your usual symptoms or occurs with shortness of breath, nausea, dizziness or pain that spreads to the arm, jaw, neck or back, call 911 or seek emergency medical care right away. Don't wait to see whether an antacid relieves the symptoms or assume they will simply pass. 

It's also important to remember that heartburn and heart disease aren't mutually exclusive — many people have both. Having a history of heartburn or acid reflux doesn't rule out the possibility that new chest discomfort could be related to your heart. Likewise, frequent heartburn shouldn't be ignored simply because it isn't an emergency. Persistent reflux symptoms can signal an underlying digestive condition that may require evaluation and treatment. 

If you're unsure whether you're experiencing heartburn or a heart problem, don't try to diagnose yourself. It's far better to be evaluated and learn your symptoms weren't caused by your heart than to delay treatment for a condition that could be life-threatening. 

Andrew Calvin, M.D., Cardiology, Mayo Clinic Health System, Eau Claire and Bloomer, Wisconsin 

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DEAR MAYO CLINIC: I've seen emergency defibrillators in public places, but I've also heard that some people need to wear them or have them implanted for heart rhythm problems. Can you explain the differences? 

ANSWER: Pacemakers and defibrillators are devices that help manage heart rhythm problems, but they work differently. 

A pacemaker helps the heart when the rhythm is too slow or irregular. A defibrillator is a specialized pacemaker designed to treat life-threatening heart rhythms that are dangerously fast or chaotic. It acts by shocking the heart out of a dangerous rhythm. 

Sometimes people unexpectedly have an irregular heartbeat that can cause sudden cardiac death or unconsciousness. During this emergency situation, the heart stops or quivers uselessly and is unable to pump in a coordinated way.   

That's when an automated external defibrillator (AED) can be lifesaving. These are the portable devices you see in airports, schools, gyms and other public places. An AED analyzes a person's heart rhythm during sudden cardiac arrest. If it detects a dangerous rhythm, it delivers an electrical shock to help the heart return to a normal rhythm.  

While people who take CPR courses learn how to use an AED, the devices also provide simple step-by-step instructions, including written, picture and voice prompts, so that a bystander can use one in an emergency.  

Defibrillators also can be worn or implanted. In general, they are used for people who are at higher risk of dangerous heart rhythms, including: 

• Those with heart conditions, such as a weakened heart muscle (also called cardiomyopathy), low pumping function or a history of heart attack. 
• Those born with electrical abnormalities of the heart, called channelopathies, or other inherited heart conditions. These can sometimes affect younger people, including athletes, and may cause fainting, sudden cardiac arrest or sudden cardiac death.  

A wearable defibrillator looks like a vest and is worn under clothing. It continuously monitors the heart rhythm and can deliver a shock if it detects a life-threatening rhythm. It's usually worn temporarily, often while a care team is deciding whether a person needs a permanent, implanted device or while the heart is recovering.  

An implantable cardioverter-defibrillator (ICD) is a permanent device placed inside the body. It monitors the heart rhythm and can deliver treatment if a dangerous rhythm occurs. Some ICDs are placed under the skin in the chest, with one or more wires, called leads, connected to the heart.  

Recovery after ICD placement usually takes about four to six weeks. During that time, patients may need to limit certain arm movements, especially on the side where the device was placed, and watch for signs of infection or increasing pain around the incision.  

After recovery, most people return to their usual daily activities. However, they should avoid strong magnetic fields and certain activities, such as arc welding, unless their care team says it's safe. 

Most patients aren't aware of their defibrillator unless it delivers treatment. If a person is unconscious when a shock occurs, they usually don't feel it. If they're awake, the shock may feel like a sudden jolt or kick in the chest. It can be startling, but it's meant to save a life. In some cases, people may not feel the shock at all, and the event is only found later during a device check. 

Anyone who feels a shock from their defibrillator, or is notified by their healthcare team that a shock occurred, should contact their care team for further evaluation. The device may need to be checked, and medications or other parts of the treatment plan may need to be adjusted. 

There's another type of device therapy called cardiac resynchronization therapy (CRT), which may include features of a pacemaker or defibrillator. It's used for some people with moderate to severe heart failure whose lower heart chambers don’t beat in a coordinated way. 

When the heart’s pumping chambers are out of sync, the heart may not pump blood as efficiently. CRT helps coordinate the timing of the heartbeat. 

As with implanted pacemakers or defibrillators, CRT implantation requires a minor surgical procedure to place a device in the chest, and the recovery and post-procedure care are similar. There are two main types: 

• Cardiac resynchronization therapy with a pacemaker (CRT-P). This device sends electrical signals to help the lower chambers of the heart beat together. 
• Cardiac resynchronization therapy with a defibrillator (CRT-D). This device combines resynchronization pacing with defibrillator protection. It may be recommended for people with heart failure who also are at risk for sudden cardiac death. 

Defibrillators, whether they're used in public places, worn temporarily or implanted permanently, are designed to protect people from dangerous heart rhythms. They can be lifesaving, helping people live more safely and confidently. 

Divya Korpu, M.B.B.S., Cardiology, Mayo Clinic Health System, Eau Claire, Wisconsin 

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After years of testing performed at multiple hospitals that could not explain his intense, and sometimes painful, symptoms, long-distance runner Mike Singh found answers through an athlete-specific approach at Mayo Clinic, helping him adapt his routine and continue running. 

A marathon moment that raised questions 

In November 2018, long-distance runner Mike Singh was competing in a marathon when he suddenly felt that something was not quite right. 

"I was on mile 22 or 23,” Mike remembers. "All of a sudden, I felt sort of out of breath, lightheaded. I thought I was having a heart attack." 

However, as a confident athlete who had completed many races, Mike kept going and finished the race without further incident. 

It would not be a one-time experience, though. The symptoms would often return during Mike's runs, usually when he pushed himself at longer distances. 

More than just exercise 

Running is, and has long been, a central part of Mike's routine. 

"It's not just exercise for me," he says. "Running is a huge part of my life and identity. The thought of losing that was a lot to process." 

Mike runs daily and trains for races throughout the year. So when something did not feel right during that 2018 marathon, it stood out significantly to him. 

Years of tests, no answers 

Early on, Mike sought care at multiple hospitals and medical centers, undergoing extensive testing. 

Despite numerous evaluations, the results always came back the same — no explanations, no real answers. Still, the symptoms continued during Mike's long runs, and so did the uncertainty. 

"I passed all those clinical tests with flying colors," Mike says. "But all that did was leave me with questions, unanswered questions." 

Up to that point (nearly four years into Mike's medical odyssey), no one had been able to re‑create the symptoms he experienced while running. 

Mike decided to visit the Mayo Clinic Sports Cardiology Clinic in Rochester, Minnesota, hoping a different approach could finally explain what others could not. 

Re-creating the run 

At Mayo Clinic, the Sports Cardiology team met Mike and focused on understanding when and how his symptoms occurred. As Mike described the clinical signs, the team immediately identified one key detail: Mike's symptoms typically began several miles into his long-distance runs. 

Instead of relying on standard tests, the team focused on re-creating the exact conditions that triggered his specific symptoms. 

"If symptoms are not reproduced on a stress test, you can't definitively say the test is negative," explains Nadia Elfessi, a physician assistant on Mike's care team in Sports Cardiology. 

"My care team said, 'Let's just do whatever is necessary to re-create those symptoms,'" Mike says. 

 To do that, Mike ran long enough to trigger the exact symptoms he experienced during long-distance races. Then, while those symptoms were still occurring, the Mayo Clinic team moved immediately into testing. 

Because Mike's symptoms had eluded diagnosis for years, the team also developed a customized testing protocol to evaluate whether abnormal vagus nerve activity was contributing to the problem. Drawing on Mayo Clinic's expertise in cardioneural ablation, specialists temporarily blocked vagal activity with medication and had Mike exercise again under carefully monitored conditions. 

For the first time, the team was able to observe changes in Mike's heart rhythm as they happened. While the testing ruled out vagus nerve overactivity as the cause of Mike's symptoms, it revealed an underlying problem with his heart's electrical conduction system, helping the team arrive at a diagnosis and management plan tailored specifically to him. 

Finding the cause 

Now, Mike had an answer.  

"They adapted the protocols to fit my situation," Mike says. 

Dr. Guru Kowlgi, a cardiac electrophysiologist at Mayo Clinic, says the team's approach focused on recreating the exact conditions that triggered Mike's symptoms — something that had not happened during years of previous testing. 

Once the symptoms were reproduced, the team identified a disruption in the electrical communication between the heart's upper and lower chambers that occurred only during intense exertion. The findings led to a diagnosis of exercise-induced chronotropic incompetence, a rare condition in which the heart cannot appropriately increase its rate during physical activity. 

"It took a level of creativity and time that went beyond a standard evaluation," Dr. Kowlgi says. 

Why it was difficult to detect 

Exertion made the difference. 

"High-level athletes, like Mike, may only experience symptoms when they're pushing themselves at nine-tenths or even ten-tenths of maximal performance," says Dr. Darrell Newman, a cardiologist and director of Mayo's Sports Cardiology Clinic. 

Choosing a path forward 

With a diagnosis in hand, Mike's medical odyssey was over. He now had options. He now had hope that he could possibly pursue his love of running throughout the rest of his life. 

One option was a pacemaker to help regulate Mike's heart rhythm, but it was unclear whether it would improve his symptoms enough to return him to his desired level of performance. Rather than pursue a pacemaker, Mike chose a personalized management plan focused on adjusting his training and monitoring his symptoms during exercise. As part of that approach, he uses wearable technology to track his heart rhythm and capture electrocardiogram (ECG or EKG) recordings that he can share with his Mayo Clinic care team. 

Still running — with a different approach 

Today, Mike still runs regularly, but his approach has changed. 

"It's a little bit of an inversion," he says. "Instead of my heart adjusting to my level of effort, I have to do the opposite and adjust my level of effort to my heart rate." 

"I can take that ECG, send it to the Mayo team and get pretty quick feedback," he says. 

Today, Mike continues to run (and compete), adjusting his effort but not giving up. 

"I'm still able to do it," Mike says. "Working with the experts at Mayo Clinic, I am able to continue living my lifestyle. I just enjoy running so much. It is a huge part of my life, and the Mayo care team was able to give that back to me."  

A new understanding 

For Mike, having answers made the difference. 

"It wasn't a simple answer, and not having any answers after so many years of searching can be defeating and also disheartening," Mike says. "But having this team of experts at Mayo just take time with me, work with me and find the information changed everything. In a manner of speaking, they saved my life, and they've allowed me to continue living that life." 

Today, Mike continues to run (a lot), adjusting his effort but not giving up the part of his life that matters so much to him. 

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