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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An electrocardiogram (EKG or ECG) test measures and records the heart’s electrical activity. With each heartbeat, an electrical pulse moves through the heart. It causes the heart muscle to contract and pump blood out to the body.

An EKG can detect an irregular heartbeat (arrhythmia), heart failure, and other heart problems. If you’re being treated for a heart condition, an EKG can show us how well treatment is working. 

The test shows:

  • How quickly the heart beats
  • Whether the heart rhythm is consistent or irregular
  • Timing and strength of the heart’s electrical signals 

An EKG provides important information about your heart’s electrical conduction system. This helps us determine next steps for your care.

Why It Is Done

We recommend an EKG when we hear abnormal sounds while listening to your heartbeat with a stethoscope. 

We also use EKG to learn whether your symptoms indicate a heart problem. 

Your symptoms may include:

  • Chest pain
  • Dizziness or fainting
  • Weakness or fatigue
  • Heart palpitations (sensations of fluttering, skipping a beat, beating too fast or too hard)
  • Shortness of breath

Different heart problems cause specific changes in the heart’s electrical activity. EKG can detect:

  • Coronary artery disease. Blocked or narrowed heart arteries that reduce blood flow to the heart.
  • Heart attack, as it’s happening, or damage from a past attack.
  • Arrhythmia. The heartbeat is too slow, too fast, or irregular.
  • Heart failure. The heart does not pump as forcefully as it should.
  • Cardiomyopathy. The heart muscle is thickened or enlarged.
  • Congenital heart defects. These abnormalities develop before birth.
  • Heart valve disease. One or more heart valves do not work properly.
  • Pericarditis. The membrane sac around the heart is inflamed.
  • Long QT syndrome. Sudden, dangerous arrhythmias occur in response to exercise or intense emotion.

If you have a family history of heart disease and are middle-aged, you may have EKGs as part of your routine checkups. It’s especially important if you have a parent or sibling that developed heart disease at a young age.

How It Is Performed

When we perform an EKG, it:

  • Senses your heart’s electrical activity through small sticky patches called electrodes.
  • Sends electrical signals from the electrodes to an EKG machine.
  • Converts the signals into lines that show each part of the heartbeat. These lines (waves) look like peaks and valleys.

We view EKG waves on a monitor or paper printout. The 3 major waves are:

  • P wave, the first wave, shows electrical activity of the heart’s upper chambers (the atria).
  • QRS wave, the second and largest wave, shows electrical activity of the heart’s lower chambers (the ventricles). The ventricles are the heart’s major pumping chambers.
  • T wave, the final wave, shows the heart returning to a resting state between beats.

We examine the waves’ size and shape and the time between them. This tells us whether the heart is keeping a steady beat.


The resting 12-lead EKG is the most common type. Usually, we place 12 electrodes on your chest, arms, and legs.

This standard EKG can only detect heart problems that occur during the test. It shows us a “snapshot” of 40 to 50 heartbeats. The test can miss a heart problem that comes and goes, or happens only during exercise.

To check for intermittent heart problems, we use mobile (ambulatory) EKGs. You wear a small, portable EKG monitor as you sleep, eat, exercise, and go through your normal day. 

Mobile EKG monitors

Holter (continuous) monitor. It constantly records the heartbeat over 24 to 48 hours. This provides a record of about100,000 heartbeats for every 24-hour period.

Event monitor. This monitor records the heartbeat only during symptoms. It’s used if your symptoms occur less than once a day. You may wear it for 2 weeks or longer.

Other types of EKG

Signal-averaged electrocardiogram (SAECG). A computer records and averages 100s of small electrical signals that follow the QRS wave. This test helps us detect whether you are at risk for a life-threatening irregular heartbeat.

Stress test. We may ask you to take this test if your symptoms occur when you exercise.

How You Prepare

Be sure to carefully follow the instructions your doctor gives you to prepare for your EKG. The instructions will cover:

  • Medications to take or stop taking
  • When to stop eating or drinking, if necessary
  • Other activities and substances to avoid before the test
  • Bathing and other preparations

Also wear comfortable walking or running shoes and loose clothing.

If you’re having a stress test, let us know if you:

  • Have arthritis, hip problems, or other joint problems that make it difficult to exercise.
  • Have diabetes and feel your blood sugar is low. Bring your glucose monitor to check before and after the test. 
  • Use an inhaler for asthma or other breathing problems. Bring it with you to the test. 

What to Expect

Knowing what to expect during an electrocardiogram (EKG) can help you feel more comfortable and ease any anxiety you may have about this test. 

Standard electrocardiogram

Before the test, we:

  • Clean areas on your chest, arms, and legs. We may trim men’s body hair, if needed.
  • Attach small sticky patches (electrodes) to these areas. Usually, 12 patches are used. This provides 12 different views of the heart, as each electrical pulse moves through it.

During the 10-minute test, you lie still on a table. We may ask you to hold your breath for a short time.

Afterward, you can return to your normal activities. You may notice a mild rash from the patches. This goes away without treatment.

Signal-averaged electrocardiogram (SAECG)

Procedures are the same as for a standard EKG. This test takes about 20 minutes to complete.

Standard stress test

During this 15-minute test, electrode patches on your skin send electrical signals from your heart to an EKG machine. It records and measures heart activities during exercise stress. We also monitor your blood pressure.

You exercise on a treadmill or stationary bike until you either:

  • Reach a certain heart rate
  • Need to stop because of pain or fatigue

We ask you how tired you feel and track this on a number scale. It’s normal to perspire, breathe faster, and feel your heart beat more quickly. 

We stop the test if you tell us you have:

  • Chest pain or discomfort
  • Dizziness
  • Severe shortness of breath
  • Discomfort in your jaw or arm
  • Drop in blood pressure
  • Serious irregular heartbeats

If you’re unable to exercise, we use a drug that mimics how the heart responds to exercise. The medicine may cause nausea, dizziness, headache, or flushing. Tell us if you have these or other symptoms. Usually they go away in a few minutes.

What to Expect: Mobile EKG

We’ll attach a Holter or event monitor to you in our office. You’ll wear it for 24 to 48 hours, then return it to our office.

We also ask you to:

Keep a diary of all your activities and symptoms while wearing the monitor. Write down when you:

  • Start and end an activity, using the monitor’s clock. This includes time spent exercising, sleeping, eating, having a bowel movement, and taking medicine.
  • Feel a strong emotion, such as fear or anger.

When you have symptoms (heart palpitations, dizziness, or others):

  • Push the “event marker” button on the monitor. 
  • Write down how long the symptom lasts.

Later, we’ll compare your diary to your monitor results to learn what activity or emotion may be triggering symptoms.

For an event monitor, the process is similar. You may wear this monitor for days or weeks, until you have symptoms. Some monitors automatically detect and record an irregular heartbeat.

Call us during or immediately after you have symptoms. You can send the monitor recording to us using your mobile phone.


After analyzing your EKG, we’ll talk with you about the results and next steps.

A normal test result can include:

  • A heart rate between 60 and 100 beats per minute
  • A consistent, even heartbeat
  • Normal changes in heart rate during activity and sleep

An abnormal test result can include:

  • Fast, slow, or irregular heartbeats
  • Delayed ventricular pumping action, due to slowed electrical signal


EKG has no risks. The electrodes are safe and do not produce electricity.

If you wear an Holter monitor, avoid metal detectors, high-voltage areas, electric blankets, microwave ovens, electric toothbrushes, and magnets. These can interfere with signal recording.

Stress testing is generally safe. There are some risks linked to exercise or the medication we use to increase the heart rate. These include:

  • Irregular heartbeat, which typically goes away quickly with rest.
  • Severe chest pain.
  • Low blood pressure, which causes fainting or dizziness. This may result in a fall.
  • Shortness of breath and wheezing caused by the medication used for a pharmacologic stress test (symptoms may last several hours).
  • Heart attack (rare).

After your stress test, call 911 or go the nearest hospital if you have:

  • Chest pain
  • Trouble breathing

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

If you are having other symptoms that concern you, your first contact will typically be with your personal physician or your primary cardiologist, 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 together we will 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.

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.

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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