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

Valvular heart disease is when one or more of your heart valves don’t function properly. Most people with valvular disease can be treated successfully.

Normally, the valves open and close tightly with each heartbeat. This allows the heart to pump blood in only one direction, so it flows toward your lungs and then to the rest of your body.

You have 4 heart valves located within the 4 chambers of your heart. The upper chambers are called atria, and the lower chambers are called ventricles. 

Valves that don’t work properly can leak, allowing blood to back up in the wrong direction (regurgitation or insufficiency). Valves that are stiff may not allow enough blood to get through the opening (stenosis).

If your heart valve problem is: 

  • Severe, you may have severe shortness of breath. 
  • Mild, you may have no symptoms.

Lifestyle changes and medication may be enough to control your symptoms. Sometimes heart valve repair or replacement surgery is needed. 

Your care team may include a cardiologist and heart surgeon.

Types

The 4 heart valves are:

  • Aortic 
  • Mitral
  • Pulmonary
  • Tricuspid 

Valvular heart disease occurs when one of the heart valves does not open and close normally and causes your heart to work harder. Over time, this could damage your heart. 

The common types of valvular problems are:

  • Regurgitation or insufficiency. This occurs when the valve does not close tightly. The blood leaks backward rather than flowing forward.
  • Stenosis. This can happen when the flaps thicken, fuse, or stiffen. The heart valve cannot open fully, so not enough blood can get through the opening.

Aortic valve stenosis and mitral valve regurgitation or insufficiency are the most common disorders of the valves.

Mitral stenosis happens when the flaps of the mitral valve thicken, fuse, or stiffen. The heart valve cannot open all the way, so not enough blood can get through the valve, which makes your heart work harder. Eventually, this may lead to a backup of blood into the lungs, heart failure, or blood clots.

Mitral valve prolapse happens when the leaflets, or flaps, of the valve do not close tightly and become floppy. Most of the time, there are no symptoms and no treatment is needed. In some cases, there is a backflow of blood from the left ventricle upward into the left atrium (mitral regurgitation), which can cause symptoms. 

If you start to have symptoms of mitral regurgitation with the prolapse, or if the heart enlarges, you will need heart surgery to either repair or replace the valve.

Pulmonary regurgitation is very common after repair of the valve for pulmonary stenosis. It is also common after surgery for Tetralogy of Fallot, a congenital heart condition in which not enough oxygen is circulating in the blood.

Symptoms

Many people with heart valve problems will have no symptoms. Other people will develop symptoms slowly as the heart valve(s) worsen. 

The common symptoms are:

  • Shortness of breath
  • Chest pain
  • Irregular heart rhythms or palpitations
  • Blood clots
  • Stroke
  • Lightheadedness or fainting
  • Leg swelling

Causes

The cause of heart valve defects that are present at birth (congenital) is not known. Most other heart valve diseases are caused by one or more of these conditions.

Atherosclerosis. Over time, calcium buildup can cause wear and tear of the valve's leaflets. (This is like hardening of the arteries.) 

Heart attack. Heart attack can injure the muscle that controls the valve’s opening and closing.

Heart failure. Along with high blood pressure, heart failure can lead to an enlarged heart and cause a valve to leak.

Untreated strep throat or other infections with strep (rheumatic fever). These can damage the heart valve (rheumatic heart disease).

Valve infection (endocarditis). This condition:

  • Usually occurs in people who already have an abnormal heart valve or abnormal blood flow through the valve.
  • Enters your body through needles, syringes, or intravenous (IV) devices, such as PICC lines and catheters.
  • Can occur after dental, rectal, prostate, or bladder procedures.

Radiation treatment to the chest for cancer. This can cause damage that may not show symptoms for many years.

Other causes of heart valve defects include:

  • Immune diseases, such as lupus
  • Diet medicines, such as the combination medication of fenfluramine and phentermine (fen-phen)
  • Trauma (rare)
  • High blood pressure
  • Pulmonary regurgitation, which is common after pulmonary stenosis repair surgery
  • Specific tumors and carcinoid syndrome 
Additional References:

Prevention

You can lower your risk for valvular heart disease by following these guidelines.

Treat strep throat promptly. Contact us if you have strep throat symptoms, such as a red and painful throat, fever, or white spots on your tonsils. If we prescribe antibiotics, please take all your medication as directed. 

Practice good dental hygiene. Brush and floss your teeth every day. Have your teeth cleaned at the dentist's office regularly. Preventing bacteria buildup on your teeth and gums reduces your risk of heart valve infection.

Take antibiotics when recommended. We may recommend antibiotics before specific dental or surgical procedures if you are at risk for endocarditis (infection of the heart valve) and have:

  • An artificial heart valve.
  • Specific congenital (present at birth) heart defects or partially repaired congenital defects.
  • A history of infective endocarditis.
  • Valve problems after a heart transplant.

Control your cholesterol and risks for heart disease. If you use tobacco or marijuana, quit. It is one of the best things you can do for your health. We have resources to help you quit. 

Also, follow these healthy living guidelines:

  • Exercise regularly. 
  • Take cholesterol-lowering medicines, if necessary.
  • Eat a heart-healthy, low-fat diet.
  • Control your blood pressure.
  • Maintain your ideal weight if possible.
  • Manage your blood sugar if you have diabetes.

Diagnosis

We can use a chest X-ray, echocardiogram, or other tests to diagnose your heart valve problem. 

Physical exam. We use a stethoscope to listen for a clicking sound or a heart murmur. Having a heart murmur does not necessarily mean that you have an abnormal valve. Most murmurs are found in people with normal valves and are called “innocent murmurs.”

Electrocardiogram (EKG/ECG). We check your heart rate, heart rhythm, and the size of the heart chambers.

Exercise stress test. 

Chest X-ray. We check whether you have an enlarged heart (hypertrophic cardiomyopathy) or if your valve is hard (calcified) or stiff.

Echocardiogram. This test uses sound waves to create images of the heart as it beats. We can assess the size and shape of your heart valves and heart muscle, how well your heart pumps blood, and any stiffness or leakage of your valves.

Cardiac catheterization. We check your heart valves’ function and measure any leakage. 

Transesophageal echocardiogram (TEE). This test gives us a better picture of your heart. 

Stress echocardiogram. This test shows whether a heart valve problem is affecting your heart’s ability to work hard. This test is performed before and after you exercise, usually on a treadmill.

Cardiac MRI. These detailed images of your heart help us determine the type of surgery you may need.

Treatments

Our treatment recommendations will depend on your symptoms, which valve is involved, and the severity of your heart valve problem.

Medications may be necessary to control your symptoms and improve blood flow through the heart:

  • Diuretics get rid of excess water.
  • Beta blockers help slow the heart rate, control palpitations, and improve blood flow.
  • ACE inhibitors lower blood pressure and relax and widen the blood vessels. This helps the heart beat more easily.
  • Calcium channel blockers and vasodilators allow blood to flow more easily.
  • Digoxin helps reduce shortness of breath and control irregular heart rate.
  • Blood thinners (anticoagulants) prevent and treat blood clots.

Surgery to repair or replace the valve may be needed in some cases. We might consider replacement of the valve with a mechanical or a bioprosthetic valve (made from human, cow, or pig tissues). Sometimes a leaky valve can be surgically repaired.  

Balloon valvotomy. This is usually the treatment of choice for mitral stenosis. During a cardiac catheterization, a balloon is inserted and inflated for a short time to stretch open the valve. The procedure is lower risk than surgery and has a high success rate.

Additional References:

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, but instead call us immediately.

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 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 together we will create 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 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.

I may order additional tests to be completed at a subsequent visit. I may also prescribe medications, and I will talk to you about how to take the medications. 

If I prescribe nitroglycerin for you, keep a fresh prescription (filled within the past 6 months) with you at all times. If you have chest pain or discomfort, sit down and rest, and take the nitroglycerin as directed. If your chest pain does not get better in 5 minutes, call 911.

If you have had a recent heart attack, heart surgery, or a procedure on your heart, I may refer you to our MULTIFIT cardiac rehabilitation program or other cardiac classes or programs to help you with your recovery. The nurse or pharmacist care manager will contact me regularly about your health. A good place to start is by attending a heart health class. 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 improve the function of your heart. We also have a series of classes to learn about heart failure.

Contacting Me

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.

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

If you have urgent 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.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Seek immediate medical care if:

  • You are having chest pain more often than usual.
  • You feel lightheaded or dizzy, or feel you might faint.

If you had surgery or a procedure, please call me if you notice any swelling, bleeding, redness, pain, or discharge at the incision site.

Take your medication exactly as prescribed. If you are having problems with or have any questions about any of the medications I have prescribed for you, let me know. Do not stop taking them without notifying me.

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

If you are considering surgery, 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 related to your problem:

  • Anesthesia for an Adult
  • Aortic Valve Replacement
  • Mitral Valve Repair or Replacement
  • Taking Warfarin (Coumadin®)

Emmi programs are also available for the following cardiology topics:

  • Angiogram with Possible Angioplasty
  • Atrial Fibrillation Overview
  • Cardiac Catheter Ablation (SVT)
  • Cardiac Catheter Ablation (VT)
  • Cardiac Pacemaker 
  • Coronary Artery Bypass Surgery (CABG)
  • Defib (Cardiac Resynchronization Therapy Defibrillator)
  • Defib (Implantable Cardioverter Defibrillator)

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.

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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