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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 You may have heart palpitations, if you feel like your heart is:

  • Pounding (beating very hard) 
  • Racing (beating too fast)
  • Skipping beats
  • Flip-flopping 
  • Fluttering

Many people have heart palpitations at times. Usually they are not related to a serious heart problem. Most palpitations are caused by premature atrial contractions (PACs) or premature ventricular contractions (PVCs). These are early, extra beats that occur just before the main heartbeat.

To find out whether you have harmless palpitations or a heart problem, make an appointment with your doctor. Your checkup will include a physical exam, medical history, and diagnostic tests, if needed.


Heart palpitations are unusual sensations in the heart. You may feel pounding, racing, or skipped beats, for example. You probably feel symptoms in your chest and possibly in your neck or throat. 

If your palpitations are common types due to PACs or PVCs, you may feel:

  • As if your heart “skipped” a beat, followed by a strong heartbeat (as if the heart stopped briefly, then restarted).
  • One or 2 strong “thumps” in the heart.
  • Lightheaded or woozy for a second.

These symptoms can be more noticeable when you:

  • Are lying down at night.
  • Have just finished a meal.
  • Are sitting quietly.

People with PACs or PVCs probably have them throughout the day without noticing. They’re usually harmless, though possibly annoying.

Less common symptoms may signal a heart problem. One worrisome symptom is fast-paced heartbeats that also:

  • Occur one right after another, in a row (not just one beat). 
  • Have a regular or irregular rhythm.
  • Last for a few moments or continue for many minutes or hours.

Call 911 or go to the nearest hospital if you have any of the following symptoms along with heart palpitations:

  • Chest pain 
  • Feeling faint or dizzy 
  • Breathing difficulty 
  • Sweating, especially “cold sweat”
  • Feeling confused or disoriented 
  • Back, neck, stomach, or jaw pain or tightness

These symptoms can signal a serious heart condition or a medical emergency.

Additional References:


Various conditions can cause heart palpitations.

If you have common palpitations, several factors can make your symptoms stronger. These include:

  • High stress and anxiety
  • Pregnancy
  • Overuse of stimulants, such as coffee, tea, cola, alcohol, and chocolate 
  • Smoking tobacco or marijuana
  • Overactive thyroid gland
  • Medications, such as pseudoephedrine (Sudafed), or albuterol asthma inhalers (not steroid types) 

If you have the less common fast-beat palpitations, you may have a heart arrhythmia. Several heart conditions can cause arrhythmias. We can determine whether you have one of these arrhythmias:

  • Atrial fibrillation
  • Supraventricular tachycardia
  • Ventricular tachycardia

Palpitations can be caused by digestive disorders, including:

  • Simple indigestion
  • Gastroesophageal reflux disease (GERD)
  • Gallstones

Rarely, palpitations are caused by asthma or chronic obstructive pulmonary disease (COPD).  


During your checkup we’ll ask about your medical history, any medications or supplements you’re taking, and your symptoms. To help us understand your palpitations, we may ask: 

  • Do you feel fluttering or a racing heartbeat? 
  • Does it feel like your heart skipped a beat?
  • Does your heartbeat feel regular or irregular during palpitations? (Don't worry if you don’t know for sure.) 
  • How long do your palpitations usually last?
  • Do palpitations usually occur at specific times of day, or after meals or other events? Do you notice a pattern?
  • Do you have other symptoms along with heart palpitations?

We’ll also listen to your heart with a stethoscope. We’ll check for any irregularities in your heart rhythm.

We may ask you to track your palpitations. You’d write down when they occur, how long they last, exactly what they feel like, and any other symptoms.

If needed, we’ll recommend additional tests. These may include:

  • Chest X-ray to check your heart’s size and structure.
  • Electrocardiogram (EKG or ECG) to check your heart’s electrical activity.
  • Holter or event monitor to evaluate your heart’s rhythm. You’d wear this device for 24 hours or up to several weeks. 
  • Blood tests to detect low blood count (anemia), thyroid problems, or abnormal electrolytes (levels of salt and potassium in the blood). 


Your treatment will depend on the cause of your palpitations.

If your test results show that you have low blood count or thyroid level, we will treat that first.

Palpitations due to PACs or PVCs aren’t dangerous. We’ll explain why they occur. 

If you have this type of palpitation, you may be able to reduce symptoms by:

  • Avoiding stimulants like caffeine, alcohol, or decongestants.
  • Using relaxation methods such as meditation or breathing (if your palpitations are linked to stress).
  • Quitting smoking if you smoke, including tobacco or marijuana. Let us know if you want help with quitting. 
  • Eating a healthy, nutritious diet.

If we find you have a heart problem, we’ll talk with you about treatment options, including medications or surgery.

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.

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

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he 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 create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, 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.

For general medical advice, our Appointment and Advice line is available 24 hours a day, 7 days a week.

If you have more immediate concerns or issues while my office is closed, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

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 (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®)

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:

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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