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

Heart failure is a chronic condition. Although treatment usually does not cure heart failure, it can prolong your life and help you to feel better. Treatment for heart failure focuses on lessening symptoms and slowing the progression of the illness. Worsening heart failure may require a hospital stay.

Additional References:

Medications

We will usually prescribe one or more of the following medications:

  • Angiotensin-converting enzyme (ACE) inhibitors relax and widen blood vessels. This makes it easier for the heart to pump blood. They also prevent the buildup of chemicals harmful to the heart and slow the progression of heart failure.
  • Aldosterone antagonists prevent buildup of chemicals harmful to the heart and slow the progression of heart failure.
  • Angiotensin receptor blockers (ARBs) work similarly to ACE inhibitors. They relax and widen blood vessels so blood can be pumped more easily. They are an alternative if you cannot take an ACE inhibitor.
  • Beta blockers help the heart pump more easily and reduce chest pain. They also prevent the buildup of chemicals and slow the progression of heart failure.
  • Diuretics trigger the kidneys to get rid of excess fluid. 
  • Digoxin helps to improve the heart's pumping action.

Devices

Your cardiologist will discuss the benefits and risks of various treatment options with you. Some patients who meet certain criteria may benefit from devices.

Biventricular pacemakers. In some people, the walls of the heart's main pumping chamber (the left ventricle) do not contract at the same time. This makes pumping inefficient, causing heart failure. Biventricular pacemakers force each side of the chamber to contract at the same time. 

  • The devices are surgically placed under the skin of the chest. 
  • Wires from the device run through veins to the inside of the heart. 
  • Small electrical signals trigger heart contractions. 

People with these pacemakers often feel better and live longer. 

Defibrillators. We may recommend a defibrillator if you are at risk of dying suddenly from a severely abnormal heart rhythm. 

  • These devices are surgically placed under the skin of the chest. 
  • Wires run through veins to the heart. 
  • Defibrillators continuously check the heart's rhythm.
In the event of a dangerously abnormal rhythm, the device delivers an electrical shock to return the heart to its normal rhythm. 

Surgery

Heart transplant surgery may be an option if other types of treatment have not helped. A heart transplant involves replacing a diseased heart with a healthy heart obtained from a donor.  Not everyone is a suitable candidate for this surgery.

Things You Can Do to Manage Heart Failure

Exercise for at least 30 minutes a day. If you feel tired, break this up into 5 minute periods of exercise. Your heart will still benefit. Stop exercising and let us know if you:

  • Feel short of breath or dizzy
  • Have chest pain 

Quit smoking. This is the best thing you can do for your health. Smoking damages every part of your body and will worsen your condition and your prognosis. Talk to us about resources to help you stop smoking. 

Avoid or drink less alcohol. Alcohol can worsen or cause heart failure. If you have had problems with drinking in the past, we advise that you not drink any alcohol. If you drink alcohol, please talk with us about specific guidelines for your condition.

Additional References:

Self-Monitoring

There are a number of things you can do to manage your symptoms and slow the progression of your condition.

Monitor your symptoms. Complete a Daily Heart Failure Self-Care Log. Track these heart failure symptoms:

  • Difficulty breathing or shortness of breath
  • Swelling (edema)
  • Fainting
  • Heart rate
  • Blood pressure

Tell us right away if you have changes in these symptoms so we can adjust your treatment plan. 

Monitor your weight. Weigh yourself daily at the same time every day – before breakfast with an empty bladder is best. Wear the same amount of clothes and use the same scale. Record your weight. If you gain more than 2 pounds in 1 day or 4 pounds in 4 days, contact us right away. This may indicate you are retaining too much fluid.

Additional References:

Monitor Salt and Water Intake

Limit salt. The more salt you consume, the more fluid you retain, worsening heart failure symptoms.  

Eat less sodium (salt) each day. Check food labels for salt content. Aim for less than 2,300 mg total per day, or no more than 500 mg total per meal. That leaves about 800 mg for all other snacks, desserts, foods, or drinks during the day. Most restaurant meals, or packaged and snack foods, contain more than this.

A healthy option is to prepare your own food at home from natural ingredients. Use seasonings other than salt. Read food labels and track the amount of salt in the items you eat and drink.

Limit your liquid intake, if necessary. If we have told you to limit fluid, drink a maximum amount of 64 ounces per day (eight 8-ounce glasses). We’ll give you specific guidelines about fluid intake.

Heart Failure Care Management Program

We may refer you to a heart failure care management program. These programs can help you recover and support you in achieving a healthy lifestyle. Participants learn about the process and management of heart failure including:

  • The importance of daily physical activity
  • Heart-healthy eating
  • Self-monitoring (symptoms, daily weight, water and sodium intake, etc.)
  • Medications that protect your heart 

Personal care managers support and guide you as you learn how to live better and healthier with your condition. We may also recommend a home monitoring program. This may require you to use a portable EKG monitor.

Life Care Planning

Life Care Planning is Kaiser Permanente’s name for a process also known as advance care planning. Life Care Planning involves 2 major choices:

  • Selecting someone you trust to make your health care decisions if you are not able to do so.
  • Giving specific instructions about your care in the event of a sudden injury or illness. 

It is best to make these decisions after carefully considering your values, beliefs, and experiences. It is also important to document your wishes. Putting your plan in writing helps those caring for you to accurately remember your wishes so you get the care that you want. You can document your wishes by completing an Advance Health Care Directive (AHCD).

Many of our medical centers offer Life Care Planning classes. We recommend that you bring the person you think will be your health care agent or other family members to the class with you. 

Additional References:

Getting Your Care at Kaiser Permanente

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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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