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

Cardioversion is a procedure we can use to correct abnormal heartbeat disorders. It can resolve or improve these problems:

  • Arrhythmias. These are irregular heart rhythms that can prevent the heart from pumping blood properly.
  • Ventricular tachycardia. Cardioversion can be used in an emergency, when a person’s rapid heartbeat reaches dangerous levels.

Usually, cardioversion restores normal heartbeat. Without treatment, some arrhythmias can lead to heart failure, stroke, or heart attack.

Cardioversion is different than defibrillation. That procedure delivers an electric shock to the heart to restore regular heartbeat. It is used only in emergency situations, such as sudden cardiac arrest. Cardioversion uses a much milder electric shock to the heart. 

Types

The 2 types of cardioversion are electrical and pharmacologic.

Electrical cardioversion delivers small electrical shocks to your heart through electrodes. These are attached to your chest and sometimes below your shoulder blade This is the most common type of cardioversion procedure.

Electrical cardioversion can also be delivered through paddles placed directly on the heart muscle during open-heart surgery. 

Pharmacologic (“chemical”) cardioversion uses medications that correct the heart’s rhythm. They may be taken orally (by mouth) or given in a hospital through an intravenous (IV) line. This type of cardioversion is also known as antiarrhythmic medication.

When cardioversion fails to permanently correct abnormal heart rhythm, we can use an implantable cardiac defibrillator (ICD). We surgically implant this device in the chest. 

The ICD continuously monitors your heart’s rhythm. If a life-threatening arrhythmia occurs, the ICD delivers a small electrical shock to the heart. 

You may need an emergency cardioversion if you have an abnormal heartbeat and severe symptoms, such as:

  • Chest pain 
  • Shortness of breath
  • Dizziness
  • Pounding heart

Before Your Procedure

Follow the instructions your doctor will give you on how to prepare for the procedure, including:

  • Taking or stopping medications  
  • Bathing or showering
  • Eating and drinking

Be sure to bring a list of the medications you’re taking. Download the My KP Meds app on your mobile device. This makes it easier to have your medication information with you.

Some arrhythmias, including atrial fibrillation, can result in blood clots forming in your heart. To prevent a clot from possibly causing a stroke, we may prescribe blood-thinning medication (anticoagulant) for 3 to 4 weeks before cardioversion.

Before your procedure we may check for blood clots in your heart using a test called transesophageal echocardiogram (TEE).

Arrange for someone to drive you home after your cardioversion, since you’ll be drowsy from the sedative medication.

How It Is Performed

You’ll lie on your back on a hospital bed or table. We’ll place:

  • An intravenous (IV) line in your arm to deliver fluids, sedatives, and other medications.
  • Small electrode patches on your skin to monitor your heart.

Once you have fallen asleep:

  • The cardioversion machine will send small shocks to your heart until normal heart rhythm is restored. 
  • You will not feel any pain.

The procedure takes just a few minutes. 

Results

Most of the time, cardioversion successfully restores a normal heartbeat. Sometimes a person’s abnormal heart rhythm returns after a few minutes or days. They may need a repeat procedure.

About half of the time, irregular heart rhythm returns within a year of having cardioversion. This is more likely for people who’ve had abnormal heart rhythms for years. For these people, we either:

  • Repeat the cardioversion with antiarrhythmic medication.
  • Use another method to treat the cause of the abnormal heart rhythm.

Risks

Cardioversion has several risks. These include:

  • Blood clots that may break off in the heart, enter the bloodstream, and possibly cause stroke.
  • A different and possibly more severe abnormal heart rhythm may develop.
  • Skin burns or bruises that may occur at the electrode patch sites.

After Your Procedure

You will wake up from anesthesia soon after your procedure. After a short time in a recovery area, you’ll be able to go home.

A family member or other person should drive you home. You’ll be sleepy from the sedative medication for several hours.  

Follow the instructions your doctor gives you on:

  • Taking medications.
  • Eating and drinking.
  • Returning to normal activities, including driving and working.

You may need to continue taking anticoagulant medications for a month or more after cardioversion, or possibly indefinitely. 

While taking anticoagulants, call 911 if you:

  • Cough up blood or pink, foamy mucus and you have trouble breathing.
  • Vomit blood or what looks like coffee grounds.
  • Pass maroon-colored or very bloody stools.

The area on your chest where electrodes were placed may feel sore for a few days.

Be sure to keep your follow-up appointments.

Lifestyle Changes

We’ll talk with you about lifestyle changes to help maintain and improve your heart health. These include:

  • Get regular physical activity and improve your fitness.
  • Avoid caffeine and alcohol.
  • Quit smoking tobacco or marijuana, if you smoke (or don’t start).
  • Eat plenty of heart-healthy foods, including fresh fruits and vegetables, whole grains, lean meats, and beans (legumes).
  • Limit fats and salt in your meals and snacks.
  • Lose weight, if you are overweight.

We can offer you resources and support for making these lifestyle changes. 

Usually it’s best to start with one change that you’re confident you can do and is important to you, then build your progress from there. Each positive change you make can help prevent future problems with abnormal heart rhythm.

Additional References:

When to Call Us

Call 911 anytime you think you need emergency care, including if you have signs of a stroke. Signs include: 

  • Sudden numbness or weakness in your face, arm, or leg, especially if on only one side.
  • New problems with walking or balance.
  • Sudden changes in vision.
  • Sudden, severe headache that’s different from past headaches.
  • Slurred speech.
  • New problems with confusion, speaking, or understanding what others are saying.

Call us now or seek immediate medical care if:

  • You have new severe bruises or blood spots under your skin.

Contact us if you have any questions, concerns, or are having problems.

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 (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 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.

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:

Classes and Coaching
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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