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

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Overview

We use the cardiac catheterization (heart cath or angiography) procedure to look at your heart’s chambers, valves, blood vessels, and blood flow. This helps us diagnose and treat your heart condition. 

We also use it to assess whether you may have:

  • Heart failure
  • Congenital heart disease
  • Heart valve abnormalities
  • Chest pain (angina)
  • Recent heart attack

If we find that your arteries are blocked or severely narrowed, we may do a procedure called percutaneous coronary intervention (PCI). This can improve blood flow to the heart. Your PCI may include an angioplasty, placing a stent, or both.

Angioplasty. A tiny balloon is inserted through the catheter and inflated to open an artery. Angioplasty can help decrease your chest pain and often lower your risk for a heart attack. Sometimes we place a wire mesh cylinder (stent) to hold the artery open.

How It Is Performed

During a cardiac catheterization, the cardiologist will:

  • Give you medication to help you relax. Most people don’t feel any pain during the procedure.
  • Place a small, thin, flexible tube (catheter) into a blood vessel (in your groin, arm, chest, or neck) and guide it to your heart. 
  • Put dye through the catheter to make it easier to see the heart, arteries, and any blockage or narrowing. 
  • Carefully review the images on a video screen. 

If you have no blockages, or if vessel narrowing is not severe, your procedure will be complete at this point.

If one or more arteries are blocked or severely narrowed, your cardiologist:

  • Will treat it with percutaneous coronary intervention (PCI), which usually includes angioplasty.
  • May decide to stop your angiography, and do it at a later time.

If the artery can’t be opened with angioplasty, you may need coronary artery bypass graft (CABG) surgery at some point. 

Percutaneous coronary intervention (PCI, or angioplasty)

PCI is a procedure done to open narrowed or blocked arteries in the heart. During the first part of the procedure (cardiac catheterization), we:

  • Insert a long, thin tube (catheter) into an artery in your groin or arm.
  • Gently guide it into the blood vessels in your heart. 

Once the catheter reaches a blocked artery, we:

  • Inflate a balloon on the catheter’s tip. This stretches the artery and pushes the blockage to the side. 
  • May place a hollow mesh tube (stent) inside the artery. This keeps it open and allows blood to flow through.

The stent stays in the artery and allows plaque that has built up to be moved away. For some patients, we use a medication-coated stent (drug-eluting stent). This helps remove plaque and prevent future blockage.

You may have a stent with or without medication, or may not need a stent at all.

Risks

People usually do well during cardiac catheterization and angioplasty. Complications are unlikely, but may be slightly higher for angioplasty.

Benefits of these procedures far outweigh the risks for most people. All surgical procedures have some risks. Risks related to cardiac catheterization include:

  • Bleeding where the catheter is inserted
  • Bleeding that may require a blood transfusion
  • Bruising
  • Allergic reaction to medication or dye 
  • Infection
  • Damage to blood vessel
  • Tear to the artery (small risk)

These conditions may occur after the procedure:

  • Artery closes after being opened (restenosis)
  • Need for an additional procedure or coronary artery bypass graft surgery (CABG)
  • Heart attack 
  • Stroke

Talk with your heart care team about your questions. We welcome the opportunity to discuss your concerns as well as how the procedure may benefit your heath

Additional References:

How You Prepare

Please follow these important steps before your heart catheterization:

  • Confirm your appointment by calling the Cardiac Scheduling Center. Call the day before your procedure, or on Friday if your procedure is scheduled for Monday.
  • Do not eat or drink anything after midnight the night before your procedure. 
  • Take your medication in the morning, unless you have been told otherwise, with a sip of water only.
  • Shower or bathe and brush your teeth the morning of your procedure.
  • Arrange to have someone drive you home after your procedure. You won’t be allowed to drive yourself.
  • Leave valuables at home.

Instructions for specific medications:

  • Insulin or other diabetes medications. Do not take these on the morning of your procedure, unless instructed otherwise.
  • Glucophage (Metformin). Do not take it the day of your procedure. After your procedure, we’ll tell you when to start this medication again.
  • Warfarin. Stop taking it 3 to 5 days before your procedure.
  • Pradaxa. Stop taking it 2 to 3 days before your procedure.
  • Sildenafil, tadalafil, vardenafil (Viagra, Levitra, and Cialis) for erectile dysfunction. Do not take any of these for 2 to 3 full days before the procedure.

You will be given exact medication instructions before and after your procedure. If you have any questions, please ask us.

What to Expect

Knowing what to expect will help your procedure go more smoothly.

After you are admitted to the hospital, you may have:

  • Additional lab work
  • An EKG/ECG
  • An IV catheter placed in your hand or arm
  • Other tests to help prepare for your procedure

Your appointment time is not the scheduled time of your procedure. Necessary testing and shifting schedules may affect your actual procedure time. Consider bringing music or a book with you to help you relax while you wait.

Depending on your procedure, you may need to stay overnight at the hospital. Bring personal items for staying a night or more at the hospital.

You can expect to be seen by several members of our cardiac care team during your stay. 

After Your Procedure

After the procedure, we will:

  • Remove the catheter.
  • Close the insertion site. We’ll use either stitches, a special seal, or both. For example, if the catheter was placed through the groin or wrist, the pressure seal will be placed over that area for at least a few hours. 

You may need to lie flat for 2 to 12 hours, to allow the area to close and to prevent bleeding. The amount of time will vary based on where the catheter was placed.

You will stay in the hospital for at least 2 to12 hours for observation. You may need to stay overnight or up to 2 days based on your condition. We will make sure that you are comfortable and healing normally.

Results

The procedure allows you to find out what, if any, heart condition(s) you may have, and whether one or more arteries were opened using angioplasty or stent placement. 

Follow-Up Care

After the procedure, you will:

  • Begin taking daily medication to protect your heart health, if needed. 
  • Have a follow-up appointment soon after you go home from the hospital.

For some people, next steps involve additional procedures or surgery.

Kaiser Permanente has cardiac programs and resources to help you manage your heart health. Our health professionals can answer your questions about:

  • Taking medications.
  • Eating for heart health.
  • Making lifestyle changes for heart health. 

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 I prescribe nitroglycerin for you, keep a fresh prescription (fil you have emergency symed 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 help improve the function of your heart. We also have a series of classes to help you learn more about heart failure.

Contacting Me

Let me know right away if you: 

  • Are having difficulty breathing or shortness of breath, more often than usual.
  • Feel lightheaded or dizzy, or feel you might faint.
  • Have a weight gain of more than 2 pounds in one day or 5 pounds in one week.
  • Have swelling in your ankles, feet, or abdomen.
  • Have increasing fatigue or tiredness.
  • Are coughing or wheezing, especially when you are lying flat.
  • Notice a fast or uneven heartbeat.

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 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.

If you are experiencing a serious problem or an emergency, call 911  or go to the nearest Emergency Room.

If you think that you might be having a heart attack, act quickly. Getting medical attention right away – within 1 hour – can save your life and lessen the amount of heart muscle that gets damaged.

  • Call 911 emergency services before you call anyone else if your symptoms are not relieved in 3 to 5 minutes by nitroglycerin and rest.
  • Stop what you are doing.
  • Sit or lie down.
  • Take nitroglycerin. If you have not taken Viagra, Levitra, or Cialis in the past 72 hours, and you have a prescription for nitroglycerin, place one nitroglycerin tablet (0.4 mg) under your tongue. Let it dissolve. Do not chew or swallow the pill.
  • Continue to put one nitroglycerin tablet under your tongue every 5 minutes until your symptoms are relieved or until the ambulance arrives.
  • Do not drive yourself to the Emergency Department.
  • Chew one adult strength (325 mg) uncoated aspirin tablet or four “baby” aspirins (81 mg each) if you have them, are not allergic to aspirin, and are not already taking daily aspirin.

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.

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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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