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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Hypertrophic cardiomyopathy means that the heart muscle is unusually thick. Many people with this condition live long and active lives. They need to follow specific precautions to stay healthy. We usually recommend regular follow-up visits as well.

Often, people with hypertrophic cardiomyopathy: 

  • Have no symptoms or serious health problems. 
  • May not be diagnosed.

Over time, hypertrophic cardiomyopathy can: 

  • Reduce the heart’s ability to pump blood. 
  • Cause heart failure.

In some people, thickened heart muscle doesn’t allow enough blood and oxygen to reach the heart. This can cause chest pain.

The heart’s electrical system can also be affected, causing abnormal or irregular heartbeats (arrhythmias). This can be life-threatening.

A genetic disorder causes most cases of hypertrophic cardiomyopathy. The condition develops during the teen years. Hypertrophic cardiomyopathy affects about 1 in 500 adults.


There are 2 types of hypertrophic cardiomyopathy.

Obstructive hypertrophic cardiomyopathy. The heart muscle crowds into the lower heart chambers (ventricles). This slows down the ability of the ventricles to pump blood. This type can also cause heart valves to malfunction and leak blood (mitral regurgitation).

Nonobstructive hypertrophic cardiomyopathy. The heart muscle isn’t thick enough to crowd the heart chambers. But muscle stiffness prevents the heart chambers from completely filling with blood. The heart may be unable to effectively pump blood to the body. 

Additional References:


Many people with hypertrophic cardiomyopathy don’t have symptoms. 

Call us to make an appointment if you have:

  • Shortness of breath 
  • Chest pain
  • Fainting or dizziness 
  • Heart palpitations (racing or fluttering heart) 
  • Swelling in your ankles or legs
  • Sudden weight gain

Call 911 for emergency help immediately if you have:

  • Severe chest pain 
  • Extreme sweating, especially “cold sweat” 
  • Pain that moves from your chest into your shoulders, arms, jaw, or neck 
  • Extremely fast or irregular heartbeat 
  • Sudden difficulty breathing 

Causes and Risk Factors

A genetic disorder causes most cases of hypertrophic cardiomyopathy. You are at risk if members of your family have this heart problem.

Unlike most heart problems, hypertrophic cardiomyopathy isn’t directly linked to lifestyle choices.

Possible Complications

 Possible complications of hypertrophic cardiomyopathy include:

  • Abnormal heartbeat (atrial fibrillation) 
  • Heart failure 
  • Heart valve problems 

Atrial fibrillation is the most dangerous complication. It can cause stroke, heart failure, or worsening symptoms. If you are at risk for atrial fibrillation, we’ll prescribe medication to prevent or control it.

We can also prevent or treat heart failure and other complications. 

We recommend regular follow-up care for anyone who has hypertrophic cardiomyopathy.


Because hypertrophic cardiomyopathy often has no symptoms, it can be difficult to diagnose. If one of your immediate family members has hypertrophic cardiomyopathy, tell us.

We also check for hypertrophic cardiomyopathy if you tell us you’re short of breath.

During your visit, we will ask about your:

  • Medical history and your family’s history of heart disease. 
  • Symptoms, if any, and how long you’ve had them.

We’ll listen to your heart with a stethoscope to check for an abnormal heartbeat. We may also use one or more of these tests:

  • Echocardiogram, to produce an image of your heart muscle. 
  • Electrocardiogram (ECG/EKG), to check your heart’s electrical activity.
  • Exercise stress test, to check how well your heart works under stress. 
  • Chest X-ray, to produce a photographic image of your heart.
  • Cardiac catheterization, which uses contrast dye along with imaging, to produce detailed images of your heart and its blood flow. 


You may not need treatment if:

  • You have no symptoms.
  • Your doctor determines that you’re not at risk for atrial fibrillation or heart failure.

Whether you have symptoms or not, it’s important to have regular checkups if you have hypertrophic cardiomyopathy.

If you need treatment, medications or procedures can improve your symptoms and reduce your risk for complications.


Several types of medication can manage hypertrophic cardiomyopathy, including:

  • Beta blockers, to improve blood flow, relieve symptoms such as chest pain and shortness of breath, and prevent heart failure.
  • Calcium channel blockers, if beta blockers alone aren’t effective, or if you can’t tolerate them.
  • Antiarrhythmic medications (disopyramide, amiodarone), to normalize heart rhythms.
  • Anticoagulants, to prevent the formation of blood clots.

You’ll usually need to continue taking medications for hypertrophic cardiomyopathy throughout your life.

Other Treatments

If medications aren’t effective for you, you may need a medical procedure. 

Myectomy (or myomectomy). In this open-heart surgery, we remove part of the overgrown heart muscle. Usually we remove tissue from the wall (septum) between the 2 lower heart chambers (ventricles). This improves blood flow.

Septal ablation (or septal reduction). In this nonsurgical procedure, we inject alcohol into the artery in the wall between the lower heart chambers. This reduces the size of the walls and improves blood circulation.

Pacemaker implantation. We surgically implant a pacemaker, to keep your heartbeat steady and strong.

Implantable cardioverter-defibrillator (ICD). An ICD device monitors your heart’s rhythm. If an abnormal heartbeat (arrhythmia) occurs, the ICD delivers a small electric charge. This restores your heart’s normal rhythm.

We use ICDs for people with arrhythmias that could cause sudden cardiac death, or who have cardiac arrest or fainting episodes. We also consider ICD for people with any of these risk factors:

  • Strong family history of sudden death. 
  • Drop in blood pressure with exercise.
  • Abnormal heart rhythms when tested with Holter or event monitors.

Mitral valve repair or replacement. We repair heart valve leaks, to improve blood flow in the heart.

Lifestyle Recommendations

Most people with hypertrophic cardiomyopathy can live long and productive lives. However, you may need to make significant lifestyle changes to stay healthy. If you need support, please talk with us.

It’s important for you to take these precautions throughout your life.

Avoid strenuous exercise and contact sports. Talk to your doctor about the level of aerobic exercise that’s safe for you.

Quit smoking or don’t start. Smoking tobacco can make hypertrophic cardiomyopathy worse and increase your heart disease risk. Do not smoke marijuana. Recent research shows that it raises risks for some heart conditions. Ask your doctor about resources to help you quit.

Limit your use of alcohol. Drinking alcohol can weaken your heart.

Keep taking your medication (if prescribed). Take your medicine exactly as prescribed throughout your life.

Stay hydrated. Drink plenty of water, especially on hot days. The only exception is if your doctor gives you other instructions about drinking water and fluids. Be careful not to get overheated.

Weigh yourself every day. If you notice a sudden weight gain (a few pounds or more), call your doctor.

Coping and Support

Hypertrophic cardiomyopathy can cause changes in blood circulation. As with other heart problems, this can result in weakness and mood changes. 

People with hypertrophic cardiomyopathy have higher risks for depression, anxiety, and other mental health concerns. If you feel frightened or hopeless, talk to us. We can connect you with counselling or other medical help. 

Additional References:

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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