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

It can be frightening to realize that you or someone you care about could have a heart attack. Learning about your heart can help you prevent a heart attack. Knowing what to do in case of an attack can minimize heart damage.

Heart attacks are most often caused by coronary artery disease (CAD). Blocked arteries caused by plaques prevent blood flow and oxygen from getting to the heart. This can cause chest pain. However, some people who have CAD do not have symptoms.

Heart attack triggers can include:

  • High blood pressure
  • Severe infection
  • Major emotional distress

If you think you’re having a heart attack, you should seek immediate medical care. 

If you have chest pain, or know that you have heart disease risks, talk with your doctor. Together, you can make a treatment and prevention plan to protect your heart.

Symptoms

Heart attack symptoms can vary from person to person, and are often different for men than for women. Symptoms can include the following.

Chest pain with all these factors:

  • Lasts longer than 5 minutes.
  • Doesn’t go away when you rest or take nitroglycerin.
  • Feels like pressure, tightness, squeezing or crushing, intense burning, or aching.

You may also have these symptoms, especially if you are a woman:

  • Pain that moves from your chest to your back, shoulder, arm, neck, jaw, or teeth 
  • Difficulty breathing
  • Extreme sweating or “cold sweat”
  • Dizziness, or feeling faint or unusually weak
  • Nausea or vomiting
  • Fast or irregular heartbeat
  • Sense of coming doom

If you think you may be having a heart attack:

  • Stop what you are doing.
  • Sit or lie down.
  • Take nitroglycerin (if you have a prescription). Place 1 tablet (0.4 mg) under your tongue. Let it dissolve. Do not chew or swallow it. Do not take nitroglycerin if you have taken Viagra, Levitra, or Cialis in the past 72 hours (3 days).
  • Continue to put 1 nitroglycerin tablet under your tongue every 5 minutes until your symptoms are relieved.
  • Chew 1 adult-strength (325 mg) uncoated aspirin tablet or 4 baby aspirins (81 mg each), if you are not allergic to aspirin and are not already taking daily aspirin.

If your symptoms go on for longer than 5 minutes, get medical help:

  • Call 911 first.
  • Call someone to take you to the nearest hospital.
  • Do not drive yourself. You could endanger yourself and others around you.

Getting medical care within an hour of a heart attack can save your life and minimize damage to your heart.

Additional References:

Causes and Risk Factors

Heart attacks are most often caused by coronary artery disease (CAD). CAD occurs when plaques (cholesterol and calcium deposits) build up in your heart’s blood vessels (arteries). 

When these arteries are clogged or blocked, the heart receives less blood flow and oxygen. This can cause chest pain. Some people with CAD don’t have chest pain or other symptoms.

When triggered by physical or emotional stress, a plaque can break open and form a clot. This can suddenly and totally block an artery, immediately causing a heart attack.

Risk of having a heart attack is higher for men and for women over age 55 or in menopause.

Other factors that increase heart attack risk include:

  • Family history of early heart disease (before age 45)
  • High cholesterol
  • High blood pressure
  • Inactive lifestyle (too much sitting and too little physical activity)
  • Smoking tobacco or marijuana, or other tobacco use
  • Diabetes
  • Overweight
Additional References:

Diagnosis

Along with starting treatment, in the Emergency Room we’ll use tests to confirm whether you’re having (or just had) a heart attack. These may include:

  • Electrocardiogram (ECG/EKG) to check your heart’s electrical activity.
  • Brief physical examination of your heart, lungs, and abdomen.
  • Blood tests to check for heart muscle damage.
  • Chest X-ray.

If your physical exam and test results show you didn’t have a heart attack, we may still need to find the cause of your chest pain. We may order more blood tests or have you take a stress test before you go home.

Treatments

The treatment you receive in the Emergency Room will be based on:

  • How long ago your chest pain started.
  • Your ongoing symptoms.
  • The severity of the attack and what areas of your heart are affected.
  • Your blood test results.
  • Your electrocardiogram (ECG/EKG) results.

We will probably:

  • Place a catheter into your vein (IV).
  • Give you oxygen.
  • Give you medication to dissolve the blood clot. 

If needed, we may also give you medications to:

  • Relieve pain. 
  • Lower your heart rate and blood pressure.

These medications may include:

  • Aspirin
  • Beta blockers
  • Statins
  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB)
  • Antiplatelets (if you have a stent)

Please tell us if you are taking antacids. Some medicines that reduce stomach acid shouldn’t be taken with antiplatelet medications.

We may also give you nitroglycerin. If you have taken Viagra, Levitra, or Cialis within 72 hours (the past 3 days), tell your physicians or nursing staff immediately. Interactions between these medicines and nitroglycerin can cause death.

Other Treatments

You may be admitted to the hospital or transferred to another hospital. You may need immediate cardiac catheterization and angioplasty, or bypass surgery, to open or repair a blocked artery.

Cardiac catheterization and angioplasty. In these procedures, we:

  • Insert a long, thin tube (catheter) into a large artery in your leg or arm and guide it into the heart’s arteries. 
  • Use imaging techniques to check for blockages.
  • Open a blocked artery by expanding a small balloon (angioplasty) that was attached to the catheter. 
  • Keep the artery open with a small wire-mesh tube (stent).

Coronary artery bypass graft (CABG) surgery may be needed, if we cannot open the blockage with angioplasty. This surgery creates 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. 

Recovery in the Hospital

We may recommend that you stay in the hospital to recover from the heart attack. We’ll give you home recovery instructions when your stay is completed.

Your hospital stay may be a few days to a week. This will depend on:

  • The type of heart attack you’ve had.
  • Treatments you receive. 
  • Your general health before the heart attack.

Use hospital resources to enhance your recovery. You may see physical, occupational, and respiratory therapists. We may have you take a stress test. The results will help us advise you on when to safely restart physical activity at home.

Recovery at Home

Before you leave the hospital, we’ll give you information on safely resuming your usual activities. 

Allow yourself plenty of time to regain strength and energy. Start slowly. 

If you don’t have chest pain or other complications, you’ll probably return to normal life within a few weeks. This includes driving. Ask us about when it will be safe to resume having sex.

You may be able to return to work in 2 to 6 weeks. This will depend on the demands of your work and the severity of your heart attack.

We will help you prevent another heart attack and protect your heart’s health. We’ll also give you instructions on taking your medications. Together, we’ll create a heart-healthy lifestyle plan

Lifestyle Recomendations

We strongly recommend that you join our home-based cardiac rehabilitation program. Your care manager and doctor will support you as you recover. 

Our rehabilitation program will help you make and stick with heart-healthy lifestyle changes. It’s never too late to make these key changes.

If you smoke tobacco or marijuana, stop. Your heart attack risk goes down within 24 hours after your last cigarette. Let us know if you want help with quitting.

Exercise and keep active. Walking is the best exercise. Take a brisk 30-minute walk (or the equivalent) most days of the week.

Maintain a healthy weight. Lose weight, if needed.

Eat healthily and enjoy your food. Include plenty of fresh fruits and vegetables, whole grains, legumes, and lean meats. Avoid high-fat foods. 

Get help if you have stress, depression, or anxiety

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:

Interactive Programs
Podcasts
Prepare for Your Procedure
Videos

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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