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 flutter is a condition in which the heart beats in a rapid yet organized rhythm. It is a common type of tachycardia (fast heart rhythm) that results from the upper chambers of the heart beating too fast.

The upper chambers of the heart are called atria. Normally, the heartbeat begins in the upper right chamber (right atrium), where the sinus node releases electrical impulses that cause the heart to contract. These impulses move through the atria to an area called the atrioventricular (AV) node. The AV node is found in the center of the heart between the atria and the lower heart chambers (ventricles).

The AV node receives the electrical signal from the atria and transmits the signal to the ventricles. The electrical signal stimulates the ventricles to contract, thus pumping blood to the lungs and the rest of the body.

With atrial flutter, the electrical signal takes an abnormal path in the right atrium and moves in a large circular motion. The atrium begins beating at a rapid rate of 250 to 350 beats per minute. The atrium contracts out of sync with the ventricles, causing less blood to be pumped to the ventricles and out to the body.

Atrial flutter is not the same as atrial fibrillation, a related and more common heart rhythm disorder. With atrial flutter, the heart beats rapidly, but in a regular, organized rhythm. With atrial fibrillation, however, the rapid heart rhythm is disorganized and chaotic. Patients with atrial flutter may also have atrial fibrillation.

Atrial flutter can last minutes, hours, days, or weeks, and it may spontaneously stop on its own. However, treatment is often needed to help restore and maintain a normal heart rhythm and lower the risk of blood clots and other possible complications.

Additional References:


Atrial flutter is often caused by certain medical conditions, such as heart disease. It can also occur in people without a history of heart problems. Causes of atrial flutter include:

  • Heart surgery. Previous heart surgery can cause scarring of the atrium, which interferes with the heart’s electrical conduction system.
  • Heart conditions. Damage from heart diseases or heart abnormalities is a common cause of atrial flutter. These diseases and abnormalities include coronary artery disease (narrowing or blockage of the heart arteries), heart failure, cardiomyopathy (disease of the heart muscle), high blood pressure, and heart valve abnormalities.
  • Other medical conditions. Certain diseases elsewhere in the body can affect the functioning of the heart. For example, long-term lung diseases such as emphysema and chronic obstructive pulmonary disease (COPD) lower oxygen levels in the blood. Other conditions that may cause atrial flutter include an overactive thyroid (hyperthyroidism), a blood clot in the lungs (pulmonary embolism), and diabetes.
  • Certain substances. Long-term use of certain substances can alter how electrical signals transmit through the heart. Substances that may cause atrial flutter include alcohol, caffeine, diet pills, and cold medicines.
  • Aging. Older adults are more likely to develop atrial flutter than younger adults.
  • Gender. Atrial flutter is more common among men than women.


Symptoms of atrial flutter vary depending on how fast the heart rate becomes and whether you have other heart or lung conditions. In some cases, atrial flutter never causes symptoms.

Atrial flutter symptoms include:

  • Heart palpitations (feeling of fluttering or pounding in the chest)
  • Fast, steady pulse
  • Dizziness or lightheadedness
  • Fatigue or weakness
  • Reduced tolerance of physical activity
  • Fainting
  • Chest pain or discomfort
  • Shortness of breath (mild or severe)

More severe complications can occur if atrial flutter is left untreated. Possible complications include:

  • Stroke. Atrial flutter prevents the heart from pumping effectively, causing blood to move more slowly through the heart. Blood clots may form and travel to an artery that supplies blood to the brain, causing a stroke. Call 911 immediately if you experience arm weakness, speech difficulty, or other symptoms of a stroke.
  • Cardiomyopathy. Untreated atrial flutter causes the heart, and therefore the ventricles, to beat fast for long periods of time. The extra workload weakens the heart muscle, a condition called cardiomyopathy. This condition can lead to shortness of breath and other symptoms of heart failure.
  • Atrial fibrillation. Atrial flutter can coexist with atrial fibrillation, the most common type of irregular heart rhythm. Atrial fibrillation causes the atria to contract rapidly and irregularly.


Atrial flutter may be suspected if you experience symptoms of an abnormally fast heart rhythm. We will first talk with you about your medical history and perform a physical exam. Tests to diagnose atrial flutter include:

  • Electrocardiogram (EKG or ECG). This common test measures and records the electrical activity of the heart. Small sticky patches called electrodes are placed on your chest, arms, and legs to provide different views of the heart as each electrical pulse moves through it. The electrodes are attached by wires to a machine that measures the heart’s electrical activity and converts the activity into lines that look like a series of peaks and valleys. Atrial flutter produces a fast but regular heart rhythm, which appears as a distinct “sawtooth” pattern on the EKG.
  • Holter monitor. If you experience symptoms intermittently, a Holter monitor may be needed to diagnose atrial flutter and to determine how frequently the irregular heartbeat occurs. Unlike a standard EKG, which records the heart’s electrical activity for only a few seconds, a Holter monitor constantly records the heartbeat for 24 to 48 hours. Three to 5 electrodes attached to the chest are connected to the monitor, which is carried in a pocket or worn on a belt or shoulder strap.
  • Transthoracic echocardiogram (TTE). A TTE is the most common type of echocardiogram, an ultrasound test that uses sound waves to create a moving picture of your heart as it beats. We move a handheld device called a transducer to various locations on your chest or abdomen to view the size, shape, and functioning of the heart.
  • Electrophysiology (EP) testing. EP testing is a technique for getting a detailed look at the heart’s electrical activity. Electrodes are guided into the heart through a vein to detect abnormal electrical activity in the heart. EP testing can identify the exact location of the abnormal heart rhythm.


Atrial flutter is a treatable condition. We discuss the treatment options and develop a plan that is right for you. The goals of treatment are to:

  • Restore a normal heart rhythm.
  • Control the heart rate.
  • Prevent future episodes of atrial flutter.
  • Reduce the risk of serious complications such as stroke.

Treatment options for atrial flutter include:

  • Medications. Medications may be used to slow your heart rate down or to try to keep you in the normal rhythm. Whether it is decided to treat atrial flutter with rate control or rhythm control will depend on your symptoms.
  • Medications such as beta blockers, calcium channel blockers, and digoxin are used to slow the heart rate. Drugs called antiarrhythmics are used to try to maintain normal rhythm and are often used along with medications to slow the heart rate.
  • Cardioversion. A low-energy electrical shock is delivered to the heart through paddles or patches on your chest. The procedure is done in the hospital under anesthesia. Although electrical cardioversion can successfully restore a normal heart rhythm, it is not a permanent solution. Electrical cardioversion may cause blood clots and require the use of an anticoagulant for 3 to 4 weeks prior to the procedure.

Another method of cardioversion, called chemical cardioversion, involves a medicine given by mouth or intravenously. Chemical cardioversion may be attempted before electrical cardioversion.

  • Catheter ablation. A catheter with an electrode on the tip is guided into the heart. The electrode sends high-frequency, low-voltage electricity (radiofrequency energy) to the location in the atria where the abnormal electrical circuit exists, destroying the heart tissue that is then unable to conduct the electrical signals that caused atrial flutter.
  • Catheter ablation has a high cure rate for patients with atrial flutter. The procedure may not be an option if you also have atrial fibrillation. There is a low risk of complications, which may include bleeding where the catheter is inserted and damage to the blood vessels. Another very rare risk is heart block, a condition in which the electrical signals from the atria are either slowed or disrupted as they move into the ventricles, resulting in an abnormally slow heartbeat. In severe cases, no electrical signals reach the ventricles. A pacemaker may be implanted to help the heart maintain a normal beat.
  • Blood thinners. Atrial flutter may increase the risk of stroke, especially if you have other stroke risk factors, such as coronary artery disease or age greater than 65. Blood-thinning medicines may be needed to prevent blood clots and reduce your stroke risk.

Lifestyle Management

We will talk with you about keeping your heart healthy through diet and exercise. We also discuss what type of monitoring and follow-up care you need.

Stimulants such as caffeine can trigger atrial flutter, so it is important to avoid these substances. It is also important to consult us before taking any new medications, supplements, or other over-the-counter products.

We will educate you about the possible side effects of medications you take regularly. For example, blood-thinning drugs can increase the risk of bleeding. In addition, the blood thinner warfarin requires a consistent intake of vitamin K-containing foods. If you currently take warfarin, talk with us before making any major changes to your diet.

Your Care with Me

If you think you may be having a heart attack, or if you have chest pain or pressure that lasts more than 5 minutes, call 911 or seek other emergency services immediately.

If you have emergency symptoms as described above, do not use this website to e-mail your doctor, but instead call us immediately.

If you had surgery or a procedure, please call me if you notice any swelling, redness, pain, or discharge at the incision site.

If you are having other symptoms that concern you, your first contact will typically be with your personal physician or your primary cardiologist, who will evaluate your health and symptoms.

If a cardiologist’s care is needed, your personal physician will facilitate the process of scheduling an appointment in the cardiology department. After evaluation by the cardiologist, if you and your cardiologist feel that an evaluation by an electrophysiology (EP) specialist is necessary, you will be referred to our EP service.

If appropriate, your cardiologist might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will develop a treatment plan that is right for you.
If you have been seen before by a cardiologist or a cardiac electrophysiologist outside of Kaiser Permanente, please bring those medical records with you. Also, please bring with you all your containers with any prescription medications and any over-the-counter medications you are taking.

If I have prescribed warfarin, I will refer you to a pharmacist who will monitor and adjust your dose based on regular lab tests to get the best effects and prevent complications. The pharmacist will keep me informed of your condition.

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, which 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.

If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

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

For lab tests, 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. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I 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, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If Surgery or a Procedure Is a Treatment Option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

If you are considering surgery or a procedure or want more information about your heart problem, please review our health tool called “Preparing for Your Procedure” (Emmi). Emmi programs are available for the following cardiology topics:

  • Anesthesia for an Adult
  • Angiogram with Possible Angioplasty
  • Atrial Fibrillation Overview
  • Aortic Valve Replacement
  • Cardiac Catheter Ablation to treat A Fib (Atrial Fibrillation)
  • Cardiac Catheter Ablation (SVT)
  • Cardiac Catheter Ablation (VT)
  • Cardiac Pacemaker
  • Coronary Artery Bypass Surgery (CABG)
  • Defib (Cardiac Resynchronization Therapy Defibrillator)
  • Defib (Implantable Cardioverter Defibrillator)
  • Mitral Valve Repair or Replacement
  • Taking Warfarin (Coumadin®)
  • Ventricular assist device (VAD) 

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.
  • 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.
Learn more about your condition
  • Read about causes, symptoms, treatments, and procedures.
  • 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.

Related Health Tools:

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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