Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Jeremy Swartzberg

Jeremy Swartzberg, MD

Hospital Medicine

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1190

See all office information »

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Atrial fibrillation is an abnormal heart rhythm in the upper chambers (atria) of the heart. It can feel like your heart is racing, beating irregularly, fluttering, or pounding. 

Fortunately, atrial fibrillation can be treated. Treatment also helps reduce your risks of stroke and heart failure.

The heart has 4 chambers:

  • 2 upper chambers, called atria
  • 2 lower chambers, called ventricles 

To keep the heartbeat steady, all 4 chambers must contract in a regular order and rhythm. The heart’s electrical system sends tiny signals to maintain a normal heartbeat.

When abnormal electrical signals occur, usually in the left atrium, the upper chambers beat very fast and irregularly. The heart literally quivers (fibrillates).

If atrial fibrillation goes on for weeks or months, it can:

  • Damage the heart muscle.
  • Lead to complications, such as heart failure.

During fibrillation, the atria can’t pump blood normally. Blood clots can form in an atrium. If a clot breaks loose and circulates into the brain, a stroke can occur.


Atrial fibrillation can happen at any age, but is more likely in older people. Symptoms can include:

  • Rapid heartbeat with an irregular rhythm
  • Flopping, fluttering, or pounding feeling in your chest (heart palpitations)
  • Extreme sweating
  • Chest pain or pressure (angina)
  • Difficulty catching your breath
  • Feeling very weak and tired
  • Feeling faint, dizzy, or lightheaded

Some people with atrial fibrillation have no symptoms.


People may not know they have atrial fibrillation because they have no symptoms. Often, we diagnose it after hearing an irregular heartbeat with a stethoscope during a checkup.

If we think you may have atrial fibrillation, we’ll ask you to have an electrocardiogram (EKG/ECG). This test checks your heart's electrical activity. The results can confirm the diagnosis.

We may use other tests to find the cause and guide treatment planning. These may include:

  • Lab tests to check your blood levels of thyroid hormones and certain electrolytes (minerals).
  • Chest X-ray.
  • Echocardiogram, an ultrasound picture of the heart. It checks the heart chambers’ size and function and valve function.


Atrial fibrillation can develop if you have another medical problem, such as one (or more) of these conditions:

  • High blood pressure (hypertension)
  • Coronary artery disease (CAD)
  • Heart valve disorders
  • Obstructive sleep apnea
  • Obesity 
  • Overuse of alcohol, stimulants, or caffeine
  • Lung disease, pneumonia, or hyperthyroidism

Sometimes we find atrial fibrillation in people who have no related medical condition.


By getting treatment for atrial fibrillation, you also reduce your risks for heart failure or stroke.

We’ll talk with you about treatment options, based on the cause, your symptoms, and your stroke risk.

Studies show that people can have fewer atrial fibrillation episodes by:

  • Losing weight and improving their fitness level through walking. 
  • Stopping any use of alcohol and decongestants, and stopping overuse of coffee, tea, and other caffeine sources.

Our usual treatment goals are to:

  • Control your heart rate.
  • Try to restore a normal rhythm.
  • Prevent blood clots from forming in the heart.

We may recommend these types of cardioversion to help your heartbeat return to a normal rhythm. 

Chemical cardioversion. You take medication to restore your heart to its normal rhythm.

Electrical cardioversion. You receive low-voltage electrical shock through paddles or patches on your chest. The shock converts your irregular heart rhythm back to normal. If chemical cardioversion doesn’t work well for you, we may recommend this procedure.


If atrial fibrillation continues with serious chest pain and difficulty breathing, and it can’t be controlled with oral medications, you may need to receive care in the hospital. Intravenous (IV) medications and careful monitoring can be provided there.

Additional References:


We prescribe medications to either slow your heart rate or return it to a normal rhythm. This is usually the first method we use for atrial fibrillation.

Atrial fibrillation sometimes comes back after cardioversion treatment. We would then prescribe antiarrhythmic medications.

These are the medications we use most often.

Rate-control medications. These help keep the heart from beating too fast during atrial fibrillation.

These medications include:

  • Metoprolol (Lopressor), atenolol (Tenormin)
  • Verapamil (Calan, Isoptin)
  • Diltiazem (Cardizem, Tiazac)
  • Digitalis (Digoxin, Lanoxin, Digitoxin)

Rhythm-control medicines (antiarrhythmics). These help return the heart to its normal rhythm and keep it there.

These medications include:

  • Amiodarone (Cordarone, Pacerone)
  • Flecainide (Tambecor) 
  • Propafenone (Rythmol)
  • Sotalol (Betapace)
  • Dofetilide (Tikosyn)

Side effects of antiarrhythmics can include:

  • Nausea
  • Dizziness
  • Fatigue
  • Headache
  • Congestive heart failure 
  • Slow or abnormal heartbeat

We usually also recommend taking a blood-thinning medicine to help prevent strokes, such as the anticoagulant warfarin (Coumadin). 

For those who can’t tolerate warfarin, alternatives include:

  • Dabigatran (Pradaxa)
  • Aspirin
  • Clopidogrel (Plavix)


Sometimes atrial fibrillation doesn’t get better with cardioversion and medications. We may recommend one of these procedures for you.

Ablation. A small area of the heart’s electrical system is turned off. We will:

  • Thread tiny wires into a vein that leads to the heart. 
  • Use an X-ray to track the wires into the proper position.
  • Heat the wire’s end to turn off or disable (ablate) the tissue or node sending the irregular signal.

Patients are often awake during the ablation procedure. We numb the area where the wire enters the body. Ablation usually takes 2 to 4 hours. Afterward, we carefully monitor you as you recover. 

Heart surgery. An open-heart surgery called the maze procedure is often used. The surgeon creates scar tissue, which blocks the abnormal electrical signals causing atrial fibrillation. 

Surgery is used only when all other options haven’t worked. It would be done at the same time as another heart intervention, such as valve replacement or bypass surgery. 

After open-heart surgery, you would stay in the hospital for several days to recover.

Additional References:

Lifestyle Recommendations

Because atrial fibrillation often results from heart disease, making heart-healthy choices can improve your symptoms. You’ll also lower your risks for heart attack and stroke. We can help you find resources and support. 

Start by making one of these changes that means the most to you. As you succeed, you can gradually make other changes.

  • Quit smoking or don’t start. Quitting tobacco can quickly reduce your risk of stroke and heart attack. Don’t smoke marijuana. Recent research shows that it raises risks for some heart conditions. Ask your doctor about resources to help you quit.
  • Eat a heart-healthy diet, including plenty of fish, fruits, vegetables, beans, high-fiber whole grains, and “good” fats, such as olive oil. Avoid saturated and trans fats (in fast foods and many snack foods).
  • Exercise on most days.
  • Control your cholesterol and blood pressure levels. If you have diabetes, keep your blood sugar in your target range.
  • Learn to manage stress. Stress can put extra demands on your heart.
  • Limit your use of caffeine, alcohol, and other stimulants.
  • Lose weight (if needed).
  • Avoid the flu. Get a flu vaccination each year.

Your Care with Me

As your hospital medicine physician, my first contact with you will be either in the Emergency Department or in your hospital room.  Together we will go over your medical history and medications you are currently taking, perform a physical examination, and come up with a treatment plan.

While you are in the hospital

I will work closely with your bedside nurse and patient care coordinator each day of your stay to improve your health and to plan for a safe return home. We will also inform your family members of your care plan. If you are having symptoms that concern you when you are in the hospital, please inform me or one of the hospital staff immediately.

If specialty care is needed during your hospital stay, I may contact one of my specialty colleagues and discuss your care with them.

If I prescribe medications

During your hospital stay, we will work together to monitor and assess how your medications are working and make adjustments over time. Before you leave, we will go over each new medication, how to take it, and when/if to stop the medication. At the time of discharge, all medications can be picked up at the discharge pharmacy. 

After you are discharged from the hospital, you will have a follow up visit with your primary care clinician. You may also receive a follow up phone call from one of the hospital staff to see how you are doing once you are at home.

If you are having symptoms that concern you and you are not currently in the hospital:

  • You may contact your personal physician, who will evaluate your health and symptoms.
  • If you have urgent concerns or issues or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice and make an appointment with your doctor if needed.  
  • If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages to your primary care physician and specialist.
  • Manage your prescriptions.
  • View your past visits and test results. View your preventive services to see whether you are due for a routine screening or updated immunization.
  • Manage your family’s health by setting up access to act on their behalf. Learn how to coordinate care for the ones you love.
Learn more about your condition
  • Read about causes, symptoms, treatments, and procedures of common conditions we take care of in the hospital.
  • Find interactive health tools, videos, and podcasts to help you manage your condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate Health Education classes and support groups offered at every medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system that allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate. When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

This applies especially to your primary care physician, who will be notified electronically when you are hospitalized, and may review the care you are receiving while in the hospital. Upon discharge, your doctor will receive a summary of your care in the hospital, including some tests or imaging results that may still be pending.

Care After Hospital Discharge

If you require further testing and medications, or are having symptoms after leaving the hospital, we recommend that you contact your primary care physician.
You can also call the Appointment and Advice line. Our call centers are open every day of the year around the clock. If you need advice, we will transfer you to one of our skilled advice nurses (RNs). They can help you determine when you need to be seen and in what location. The advice nurse can often start your treatment by telephone depending on the situation and has access to your electronic medical record.

If refills are needed in the future after you leave the hospital, you can:

  • Contact your primary care physician.
  • Order them online or by phone.
  • Order future refills from my home page or your primary care physician’s home page.
  • Order by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost.
  • Or pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact your primary care physician regarding your prescription.
If further lab testing or imaging is needed 

For lab tests that are needed after discharge, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the radiology department. Your primary care physician will follow up on these results unless your condition needs immediate attention. In addition, you can view most of your laboratory results online, along with any comments that your primary care physician may have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, I will make an electronic referral to the appropriate department and they will contact you for an appointment.

If Surgery or a Procedure is a Treatment Option

Occasionally, a procedure and/or surgery can be postponed until you are healthier and have recovered from your hospitalization. Then I will refer you to the appropriate service and they will follow up with you once you are discharged from the hospital.

If you are considering a procedure or surgery, please take a moment to go to the “Tools & Classes” tab above and select the “Prepare for Your Procedure - Emmi” link. There you can watch videos about different procedures.

Related Health Tools:

Interactive Programs
Prepare for Your Procedure

See more Health Tools »

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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