Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In adults, three conditions are known to cause aortic stenosis.
Progressive wear and tear of a bicuspid valve present since birth (congenital).
Wear and tear of the aortic valve in the elderly.
Scarring of the aortic valve due to
rheumatic fever as a child or young adult.
Bicuspid aortic valve is the most common cause of aortic stenosis
in patients under age 65. Normal aortic valves have three thin leaflets
called cusps. About 2% of people are born with aortic valves that
have only two cusps (bicuspid valves). Although bicuspid valves
usually do not impede blood flow when the patients are young,
they do not open as widely as normal valves with three cusps. Therefore,
blood flow across the bicuspid valves is more turbulent, causing
increased wear and tear on the valve leaflets. Over time, excessive
wear and tear leads to calcification, scarring, and reduced mobility
of the valve leaflets. About 10% of bicuspid valves become
significantly narrowed, resulting in the symptoms and heart problems of aortic
stenosis.
The most common cause of aortic stenosis in patients 65 years of age and over is called "senile calcific aortic stenosis." With aging, protein collagen of the valve leaflets is destroyed, and calcium is deposited on the leaflets. Turbulence across the valve increases causing scarring, thickening, and stenosis of the valve once valve leaflet mobility is reduced by calcification. Why this aging process progresses to cause significant aortic stenosis in some patients but not in others is unknown. The progressive disease causing aortic calcification and stenosis has nothing to with healthy lifestyle choices, unlike the calcium that can deposit in the coronary artery to cause heart attack.
Rheumatic fever is a condition resulting from untreated infection
by group A streptococcal bacteria. Damage to valve leaflets from
rheumatic fever causes increased turbulence across the valve and
more damage. The narrowing from rheumatic fever occurs from the
fusion (melting together) of the edges (commissures) of the valve
leaflets. Rheumatic aortic stenosis usually occurs with some degree
of aortic regurgitation. Under normal circumstances, the aortic
valve closes to prevent blood in the aorta from flowing back into
the left ventricle. In aortic regurgitation, the diseased valve
allows leakage of blood back into the left ventricle as the
ventricular muscles relax after pumping. These patients also have some degree
of rheumatic damage to the mitral valve. Rheumatic heart disease is a relatively uncommon occurrence in the United States, except in people who have immigrated from underdeveloped countries.
Low blood pressure, also referred to as hypotension, is blood pressure that is so low that it causes symptoms or signs due to the low flow of blood through the arteries and veins. Some of the symptoms of low blood pressure include light-headedness, dizziness, or even fainting if not enough blood is getting to the brain. Diseases and medications can also cause low blood pressure. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidneys; the organs do not function normally and may be permanently damaged.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle.
Angina can be caused by coronary artery disease or spasm of the coronary
arteries. EKG, exercise treadmill, stress echocardiography, stress thallium, and cardiac
catheterization are important tests used in the diagnosis of angina.
Fainting, also referred to as blacking out, syncope, or temporary loss of consciousness has many causes. Often a person will have signs or symptoms prior to the fainting episode. Diagnosis and treatment depends upon the cause of the fainting or syncope episode.
Heart valve disease occurs when the heart valves do not work the way they should. Symptoms of valve disease include shortness of breath, weakness or dizziness, discomfort in your chest, palpitations, swelling of your ankles, feet or abdomen, and rapid weight gain.
Sudden cardiac arrest is an unexpected, sudden death caused by sudden cardiac arrest (loss of heart function). Causes and risk factors of sudden cardiac arrest include (not inclusive): abnormal heart rhythms (arrhythmias), previous heart attack, coronary artery disease, smoking, high cholesterol, Wolff-Parkinson-White Syndrome, ventricular tachycardia or ventricular fibrillation after a heart attack, congenital heart defects, history of fainting, and heart failure, obesity, diabetes, and drug abuse. Treatment of sudden cardiac arrest is an emergency, and action must be taken immediately.
Endocarditis, a serious infection of one of the four heart valves is caused by growth of bacteria on one of the heart valves; leading to an infected massed called a "vegetation." The infection can be caused by having bacteria in the bloodstream after dental work, colonoscopy, or other similar procedures. Endocarditis symptoms include fever, fatigue, weakness, chills, aching muscles and joints, night sweats, edema in the legs, feet, or abdomen, malaise, shortness of breath and small skin lesions. Treatment for endocarditis is generally aggressive antibiotic treatment.
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