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

Heart disease is treated with many types of drugs, including:
  • Statins
  • Antiarrhythmic medications (heart rhythm regulators)
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Beta blockers
Usually, people who are on heart medication must take multiple medications for their lifetime.

Types

Type

Action

Drug Names

Statins are the most commonly prescribed type of heart medication.

  • Prevent heart attack and stroke.
  • Reduce LDL (“bad” cholesterol) and triglycerides in the blood.
  • Reduce inflammation in blood vessels.
atorvastatin (Lipitor)
simvastatin (Zocor)
fluvastin (Lescol)
lovastatin (Mevacor)
pitavastatin (Livalo)
pravastatin (Pravacol)
rosuvastatin (Crestor)

Nonstatin cholesterol-lowering drugs

  • Lower cholesterol. 
niacin, colestid, cholestyramine,
fenofibrate (Lofibra, Tricor),
gemfibrozil (Lopid)

Heart rhythm regulators

  • Control abnormal heartbeats.
  • Help the heart beat efficiently. 
digitalis (Digoxin, Lanoxin, Digitoxin) Other types:
amiodarone (Cordarone, Pacerone),
ropafenone, sotalol, mexiletine,
dofetilide, dronedarone, disopyramide (Norpace),  
ibutilide (Corvert),
procainamide (Procan, Procanbid),
quinidine (Quinaglute)

Anticoagulants

  • Help keep blood clots from forming.
  • Prevent occurrence (or recurrence) of stroke
Warfarin (Coumadin) is most commonly prescribed.
Others include:
dabigatran (Pradaxa)
apixaban (Elquis)
rivaroxaban (Xarelto)
heparin (administered
intravenously)
enoxaparin (Lovenox)
dalteparin (Fragmin)
tenzaparin (Innohep) 
Aspirin may be used as an anticoagulant.

Clot buster

  • Emergency medication given at the hospital for stroke or heart attack.
  • Dissolve blood clots in the brain or heart to minimize damage from stroke or heart attack.
Tissue plasminogen activator (tPA) is most commonly prescribed. Other clot-buster drugs include: alteplase (Activase)
reteplase (Retavase, Rapilysin)
streptokinase (Kabikinase, Streptase) tenecteplase (TNKase) 
urokinase (Abbokinase)

Antiplatelet agents

  • Prevent platelets (clotting agents in the blood) from grouping together to form blood clots.
  • Help prevent plaques from from forming in blood vessels.
  • Prescribed after heart, attack, stroke, angioplasty, or bypass surgery, and for chest pain, coronary artery disease, and other heart disease. 
clopidogrel (Plavix)
prasugrel (Effient)
ticagrelor (Brilinta)
dipyridamole (Permole, Persantine)

Aspirin

  • Prevent blood clots from forming.
  • Reduce inflamation linked to heart disease.
  • Prescribed after heart attack, stroke,coronary artery disease, angioplasty, or bypass surgery.
People who have heart attack symptoms are advised to chew aspirin while waiting for emergency help to arrive.

Angiotensin-converting enzyme (ACE) inhibitors

  • Lower blood pressure by relaxing and widening blood vessels.
  • Improve blood flow through the body.
  • Ease heart’s workload.
  • Prescribed for high blood pressure, heart failure, diabetes, or to limit damage after heart attack.
benazepril (Lotensin)
captopril (Capoten)
lisinopril (Prinivil, Zestril);
moexipril (Univasc)
perindopril (Aceon)
quinapril (Accupril)
trandolapril (Mavik)

Angiotensin II receptor blockers (ARBs)

  • Reduce angiotensin II, which causes blood vessel constriction and thickening of the heart and blood vessel walls.
  • Lower blood pressure and improve blood flow.
  • Prescribed tor high blood pressure, heart failure, and for those who can’t tolerate ACE inhibitors.
candesartan (Atacand)
eprosartan (Teveten)
irbesartan (Avapro)
losartan (Cozaar)
olmesartan (Benicar)
telmisartan (Micardis)
valsartan (Diovan)

Beta blockers

  • Lower blood pressure.
  • Slow heart rate by inhibiting epinephrine (hormone).
  • Reduce force of heartbeat.
  • Widen blood vessels to improve blood flow.
  • Prescribed for chest pain, high blood pressure, heart failure, arrhythmia, and dangerous tachycardia.
  • Used to prevent heart attack and prevent sudden death after heart attack.
acebutolol (Sectral)
atenolol (Tenormin)
bisoprolol (Zebeta)
metoprolol (Lopressor)
nadolol (Corgard)
nebivolol (Bystolic)
carvedilol (Coreg)
propranolol (Inderal)

Calcium channel blockers

  • Prevent calcium from entering heart and blood vessel cells.
  • Lower blood pressure, widen blood vessels, and slow heart rate.
  • Prescribed for high blood pressure, chest pain, and arrhythmia.
aamlodipine (Norvasc, Lotrel)
bepridil (Vascor)
diltiazem (Cardizem, Tiazac)
felodipine (Plendil)
nicardipine (Cardene)
nifedipine (Procardia, Adalat)
nimodipine (Nemotop)
nisoldipine (Sular)
verapamil (Calan, Isoptin, Verelan, Covera)

Diuretics

  • Flush excess fluid and salt through the urine.
  • Reduce blood pressure and heart's workload, and relieve fluid buildup in the body and lungs.
  • Prescribed for heart failure, high blood pressure and for kidney, liver, and other health problems.
bumetanide (Bumex)
eplerenone (Inspra)
furosemide (Lasix)
hydrochlorothiazide
(Microzide, Esidrix)
metolazone (Zaroxolyn)
spironolactone (Aldactone)
torsemide (Demadex)

Vasodilators (nitrates)

  • Relax and open blood vessel, improve blood flow, lower blood pressure, and ease heart workload.
  • Prescribed for high blood pressure, chest pain, and congenital heart failure.
  • Prescribed for people who can’t tolerate ACE inhibitors or ARBs.
hydralazin (Apresoline)
isosorbide dinitrate (Isordil)
minoxidil (Rogaine,
Regaine, Avacor,
Loniten, Mintop)
nesiritide (Natrecor)

Side Effects

Because heart medications have a wide range of treatment purposes, they can also cause a range of side effects. These can include:

  • Bleeding from the nose or gums
  • Frequent urination
  • Blurry vision
  • Breathing difficulty or shortness of breath
  • Fatigue and weakness
  • Fluid retention, weight gain, and/or swollen ankles
  • Skin rashes 

You may develop chest pain or rapid or irregular heartbeat. 

We will help you manage any side effects.

Drug interactions can cause severe problems. Be sure to tell us about all medications and over-the-counter herbal products and supplements you are taking.

Do not stop taking any medication prescribed for your heart without talking to us first.

Lifestyle Changes

We recommend keeping these precautions in mind while taking heart medications.

If you are pregnant, or planning to become pregnant, talk with your doctor. Some heart medications may affect your pregnancy, so follow these guidelines: 

  • Statins must not be taken unless you are using an effective birth control method.
  • Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARBs) should not be taken at all during pregnancy. Vasodilators must be used instead. 

Anticoagulant medications can cause bleeding episodes. We may direct you to:

  • Avoid playing contact sports.  
  • Use a soft-bristled toothbrush. 
  • Apply pressure if you get a small cut. If it doesn’t stop bleeding within 10 minutes, call for help or go to the nearest Emergency Room.

Aspirin increases the risk of abdominal bleeding and stomach ulcers.

Before any dental work, tell your dentist if you are taking:

  • Anticoagulant medication.
  • Antiplatelet medication. Also, talk with your doctor, who may have you use an anticoagulant mouthwash before dental work.

Keep required testing appointments. You may need to be tested regularly while taking specific medications. For example, if you are taking ACE inhibitors or ARBs, your kidney function and blood pressure will be checked regularly.

Before operating heavy machinery, if taking antiarrhythmic medication, be sure about how the drug will affect you.

Medications and Your Meals

Follow these guidelines on mealtimes and foods to avoid while you’re taking heart medications:

  • Calcium channel blockers should be taken at mealtimes.
  • Statins should not be taken with grapefruit or grapefruit juice.
  • Warfarin should not be taken with alcohol. Also, foods that contain high amounts of vitamin K, such as spinach and broccoli, should either be avoided or eaten every day in small amounts. It’s important to keep your intake of vitamin K consistent.
  • ARBs should not be taken with high-salt or high-potassium foods. Bananas and salt substitutes are high in potassium, for example. 

Also, follow all the instructions you’ve been given about taking medications with meals. Be sure to take your heart medications exactly as prescribed.

You can help improve and support your heart’s health by choosing your food wisely. These are the basic guidelines:

  • Eat mostly plant-based foods, including vegetables and fruits, whole grains, vegetable oil, nuts, and legumes.
  • Reduce your intake of meat and other animal products.
  • Avoid processed foods and other foods with added salt, sugar, or unhealthy fats.
Additional References:

Your Care with Me

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

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 specialty 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.

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.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

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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