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

If you sometimes feel your heart beating very fast, you may have supraventricular tachycardia (SVT). It’s caused by an abnormal nerve signal in the heart’s upper chambers (atria). SVT itself is not life-threatening.

Many people with SVT have normal heart rhythms most of the time. Their SVT episodes are short and infrequent. They may feel dizzy or short of breath. Usually treatment isn’t needed.

If you have infrequent SVT, you may be able to:

  • Have fewer SVT episodes by making heart-healthy lifestyle changes.
  • Shorten SVT episodes by simple actions, such as holding your breath for a few seconds, blowing into a straw, or dipping your face into cold water.

Rarely, SVT episodes go on for longer periods. This can weaken the heart muscle, and potentially cause heart failure.

People with frequent SVT can be treated with medication or surgery. Their SVT may be a symptom of serious illness, such as coronary artery disease or lung disease, that needs treatment.

Symptoms

For most people, SVT episodes go away quickly. You may have one or more of these symptoms: 

  • Palpitations (fast or pounding heartbeat) 
  • Anxiety 
  • Dizziness 
  • Shortness of breath 
  • Chest pain 
  • Fainting

Count your pulse rate. By learning to count your pulse rate, you’ll know what is normal for you. You’ll also be able to check whether your heart is beating faster than normal.

To take your pulse:

  • Place 2 fingers of one of your hands gently against the inside of your other wrist, below your thumb. 
  • Count the beats for 10 seconds, then multiply that number by 6. This tells you your beats per minute. 

If you feel that your pulse changes often from its normal rhythm, or notice that your heart is often skipping beats, call your doctor. 

If you feel a rapid heartbeat, have chest pain, trouble breathing, or dizziness call 911 or go to the nearest hospital.

Causes and Risk Factors

Risk factors for developing SVT include: 

  • Using cocaine, methamphetamine, or alcohol
  • Smoking tobacco or marijuana
  • Getting too much caffeine from coffee, tea, cola, chocolate, or other sources
  • Having anxiety and emotional stress 

SVT can occur when a person has a medical condition, such as:

  • Coronary artery disease 
  • Heart failure 
  • Heart sac inflammation (pericarditis) 
  • Wolff Parkinson White syndrome, a structural abnormality of the heart 
  • Lung disease or blood clots in the lungs 
  • Pneumonia
  • Thyroid disorder

Diagnosis

Most often, we check for SVT because you tell us you’re worried about your racing heartbeat. We’ll use one or more of these tests.

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

Ambulatory EKG/ECG detects an SVT episode when it’s most likely to happen, during your daily life. You would wear a monitoring device to record your heart rhythm for a day or up to several weeks.

Echocardiogram uses sound waves to produce images of the heart. We check for structural and functional problems of the heart valves and muscles.

Exercise stress test measures how well the heart works under physical stress. We check for coronary artery disease, which can cause SVT.

Electrophysiologic (EP) study enables us to check for abnormal electrical pathways in the heart that may affect heart rhythm. Using a thin, flexible tube (catheter) we place electrodes into the heart chamber.

Blood and urine tests detect causes of SVT such as thyroid disease or high levels of specific drugs. Blood tests can also detect heart muscle damage.

Home Treatment

Many people with SVT have normal heart rhythms most of the time. Their SVT episodes are short and infrequent. Usually they don’t need treatment and can manage their SVT with self-care methods.

You can use simple methods to help slow your heart rate and shorten SVT episodes. These are called vagal maneuvers because they stimulate the vagus nerve, which adjusts the heart rate. You can:

  • Hold your breath for a few seconds
  • Blow through a straw
  • Cough
  • Dip your face in cold water

If these methods don’t work, try:

  • Lying down 
  • Relaxing 
  • Breathing deeply, especially as you breathe in

Usually your heartbeat will slow on its own.

We will also recommend that you avoid:

  • Using cocaine, methamphetamine, or alcohol
  • Smoking tobacco or marijuana
  • Getting too much caffeine from coffee, tea, cola, chocolate, or other sources

Treatments

People with frequent SVT can be treated with medication or surgery. Their SVT may be a symptom of serious illness, such as coronary artery disease or lung disease, which also needs treatment.

Medical procedures

These methods can be used to end an SVT episode or prevent them in the future.

Electrical cardioversion. You receive low-voltage electrical shock through paddles or patches on your chest. The shock converts your irregular heart rhythm back to normal. 

Radiofrequency catheter ablation. This is used to stop abnormal electrical signals that trigger SVT. We will:

1. Insert a thin flexible tube (catheter) into a vein, usually in the groin or upper thigh.

2. Carefully thread the catheter through the blood vessels and into the heart. 

3. Direct precise radio waves, from an electrode on the catheter’s tip, to disable the heart cells that were sending abnormal electrical signals.

Pacemaker. In rare cases, an electronic device called a cardiac pacemaker is placed into the heart. The pacemaker overrides the heart’s electrical signals and maintains normal heart rhythm.

Medication

To stop a long-lasting SVT episode, we can inject medication directly into a vein to slow the heart rate. 

To prevent SVT episodes, we can prescribe medications (in pill form). These include atenolol (Tenormin), metoprolol (Lopressor), diltiazem (Cardizem), digoxin (Lanoxin), propafenone (Rhythmol), and flecainide (Tambocor).

Lifestyle Recommendations

You can help reduce your SVT episodes by making heart-healthy lifestyle changes. We can help you with resources and support. 

These are the key changes:

  • If you smoke, stop. Quitting tobacco can quickly reduce your risk of stroke and heart attack. Do not smoke marijuana. Recent research shows that it raises risks for some heart conditions. Ask your doctor about resources to help you quit.
  • Exercise on most days.
  • Limit your use of caffeine, alcohol, salt, and high-fat foods.
  • Learn to manage your stress and anxiety. Practice relaxation, meditation, or breathing methods.
  • Lose weight (if needed).

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 have other symptoms that concern you, your first contact will typically be with your personal physician, 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 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 develop a treatment plan that is right for you.

If you have been seen before by a cardiologist 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 you have a weakened heart muscle, I may refer you to our Heart Failure Care Management Program. The nurse or pharmacist Care Manager will adjust your medications to help improve the function of your heart. We also have a series of classes to learn about Heart Failure

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
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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