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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Overview

You may feel worried if you have chest pain, whether it happens just once, or often. Chest pain can range from mild and harmless to severe and life-threatening, depending on its cause. For example, mild chest pain can be caused by indigestion. 

If you have a type of chest pain called angina, your heart isn’t getting enough blood flow and oxygen. Most angina is caused by coronary artery disease (CAD). If coronary arteries become completely blocked, a heart attack can occur. 

For men, angina usually feels like pressure or squeezing in the chest. For women, the pain may feel stabbing or pulsating. 

Usually, angina isn’t a health emergency. The pain often goes away when you rest. Treatment and lifestyle changes can reduce your symptoms and protect your heart’s health.

Call 911 immediately or get someone to take you to the nearest hospital if you have severe, intense chest pain, or chest pain with these symptoms:

  • Headache
  • Nausea or vomiting
  • Difficulty breathing
  • Lightheadedness (feeling faint) 

Learning about chest pain can help you take care of yourself or a loved one. Be sure to check with your doctor if you have chest pain or risks for heart disease.

Additional References:

Causes

Many different health problems can cause chest pain. 

Coronary artery disease (CAD) is the main cause of angina, one type of chest pain. Plaques (cholesterol and calcium deposits) can build up in your heart’s blood vessels. Blocked arteries prevent blood flow and oxygen from getting to the heart. 

Less commonly, angina can be caused by coronary artery spasm, in which the artery suddenly contracts.

Chest pain can be a symptom of an illness or condition that isn’t an emergency, but still needs medical care. You may have one of these conditions:

  • Pneumonia
  • Blood clot in the lungs (pulmonary embolism)
  • Collapsed lung
  • Asthma
  • Panic or anxiety attack
  • Acid reflux problems, such as GERD or heartburn
  • Gallbladder or pancreas disease

Injury of the chest muscles or cartilage can also cause chest pain. 

Milder chest pain can be caused by something temporary and harmless, such as indigestion. 

Additional References:

Symptoms

If your chest pain is caused by CAD or other heart problems, you may also have:

  • Shortness of breath
  • Radiating pain from the chest into the left arm or the jaw
  • Worsening pain during exercise or other exertion
  • Nausea or vomiting
  • Fainting
  • Extreme sweating

For women, sensations in the chest can feel like stabbing or pulsing. Men often feel pressure or squeezing sensations.

Call 911 immediately or have someone take you to the nearest hospital if you have severe chest pain, or chest pain and these symptoms:

  • Headache 
  • Nausea
  • Difficulty breathing
  • Lightheadedness (feeling faint)

Do not drive yourself to the hospital. You could endanger yourself or those around you. 

Risk Factors

These are the main risk factors for heart-related chest pain:

  • High cholesterol
  • High blood pressure (hypertension) 
  • Smoking 
  • Obesity or overweight 
  • Diabetes or insulin resistance 
  • Congestive heart failure
  • Family history of coronary artery disease

We’ll talk with you about these factors and may test you for specific risks. 

An inactive lifestyle, with too much sitting and too little exercise, can cause some risk factors or make them worse.

Diagnosis

We will ask you:

  • To describe your chest pain and other symptoms. 
  • About your family history.

We’ll give you a physical exam and may recommend tests.

If you have severe chest pain, you may need to be assessed and treated in the Emergency Room. 

Tests

We may recommend one or more of these tests, to help us pinpoint what’s causing your chest pain. 

Electrocardiogram (ECG/EKG) checks your heart’s electrical activity. 

Echocardiogram uses sound waves to produce an image of your heart muscle. It may reveal heart problems or tissue damage.

Blood tests check for increased levels of enzymes that indicate a heart attack.

Exercise stress test, myocardial perfusion imaging, or stress echocardiography measures how well your heart works under physical stress. 

CT scan or MRI imaging tests of the chest and heart area may reveal cardiac problems. 

Chest X-rays can reveal heart or lung problems.

Endoscopy produces images of your stomach and esophagus. They may reveal problems such as gastroesophageal reflux disorder (GERD). 

Treatments

We will treat the condition or problem that’s causing your chest pain. 

If you have angina due to CAD, we may prescribe one or a combination of these medications. 

Nitrates improve blood flow by relaxing the blood vessels. We usually prescribe nitroglycerin to treat angina.

Beta blockers lower heart rate and blood pressure. This reduces the heart’s workload and can help prevent sudden death. Beta blockers include metoprolol (Lopressor, Toprol XL) and atenolol (Tenormin).

Calcium channel blockers relax the blood vessels, lower blood pressure, and improve blood flow to the heart. These drugs include: amlodipine (Norvasc), nifedipine (Procardia), and diltiazem (Cardizem).

Statins help lower cholesterol and fight CAD. Medications include simvastatin (Zocor), atorvastatin (Lipitor), and lovastatin (Mevacor).

Aspirin helps prevent blood clots and reduce heart attack risk.

Angiotensin-converting enzyme (ACE) inhibitors reduce the production of angiotensin, which causes blood vessels to contract and raises blood pressure. ACE inhibitors include lisinopril (Prinivil) and captopril (Capoten).

If your chest pain is caused by:

  • Pneumonia, we’ll prescribe antibiotics and pain medication.  
  • Asthma and coughing, we may recommend asthma or antiallergy medications.
Additional References:

Other Treatments

If your heart problem is severe, we may recommend blood thinners given intravenously (IV). Or you may need one of these procedures, or surgery.

Cardiac catheterization or angiogram. We use this procedure to check for coronary artery blockages. We will:

  • Insert a long, thin tube (catheter) into an artery, usually in the upper thigh. 
  • Inject a contrast solution (iodine) into the heart arteries.
  • Use imaging to look for blockages.

Coronary angioplasty (also called percutaneous coronary intervention, or PCI). We use this to widen a narrow artery and improve blood flow to the heart. We will:

  • Insert a long, thin tube (catheter) into an artery, usually in the upper thigh.
  • Guide the catheter, which carries a small balloon, into your narrowed coronary artery.
  • Expand the balloon within the artery to widen it.

Usually, we also place a small wire-mesh tube (stent) in the artery to keep it open. This is called coronary artery stenting.

Coronary artery bypass graft (CABG) surgery. If other angina treatments haven’t worked for you, we may consider this surgery. We create a new pathway (bypass) for blood to flow around the narrow or blocked part of an artery. We will:

  • Take a healthier blood vessel from another part of the body.
  • Attach (graft) the healthy vessel onto the artery. 

Lifestyle Recommendations

If you have frequent chest pain, see your doctor regularly for checkups, regardless of the cause of your pain. Also, always take your medications as prescribed.

If you have angina or other heart-related chest pain, your doctor and care team will help you make a heart-healthy living plan. We can connect you with health coaches, classes, and other resources.

Your plan will include these keys to heart health.

Exercise and keep active. Walking is the best exercise. Avoid intense exercise or physical work. Ask for help with home tasks like carrying boxes or yard work. 

Maintain a healthy weight. Lose weight, if needed.

Eat healthily and enjoy your food. Include fresh fruits and vegetables, whole grains, legumes, and lean meats. You can also use these tips:

  • Avoid high-fat and fried foods. 
  • Eat enough to feel satisfied, but don’t overeat. 
  • Take a brief rest after each meal.

Keep your blood sugar within your normal range, if you have diabetes or insulin resistance. 

Quit smoking or don’t start. This includes smoking tobacco or marijuana. Let us know if you want help with quitting.

Practice relaxation and stress reduction methods, such as mindfulness meditation.

Get treatment for depression or anxiety, if needed.


Additional References:

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.

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.

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.

Related Health Tools:

Classes and Coaching
Interactive Programs
Podcasts
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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