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.
What might the doctor find in patients
with aortic stenosis?
The carotid arteries carry blood from
the aorta to the brain and are the closest arteries to the aortic
valve that can be felt by the doctor examining the neck. Patients
with significant aortic stenosis have a delayed upstroke and lower
intensity of the carotid pulse which correlates with the severity
of narrowing. Aortic valve stenosis causes significant turbulence
to blood flowing during contraction of the left ventricle resulting
in a loud murmur. The loudness of the murmur does not, however,
correlate with the severity of stenosis. Patients with mild stenosis
can have loud murmurs, while patients with severe stenosis and
heart failure may not pump enough blood to cause much of a murmur.
How is aortic stenosis diagnosed?
Electrocardiogram (EKG):
An EKG is a recording
of the heart's electrical activity. Abnormal patterns on the EKG
can reflect a thickened heart muscle and suggest the diagnosis
of aortic stenosis. In rare instances, electrical conduction
abnormality can also been seen.
Chest x-ray: A
chest x-rayusually shows a normal heart shadow. The aorta above
the aortic valve is often enlarged (dilated). If heart failure
is present, fluid in the lung tissue and larger blood vessels
in the upper lung regions are often seen. A careful inspection
of the chest x-ray sometimes reveals calcification of the aortic
valve.
Echocardiography: Echocardiography uses ultrasound waves to obtain images of the
heart chambers, valves, and surrounding structures. It is a useful non-invasive tool, which helps doctors diagnose aortic valve disease. An
echocardiogram can show a thickened, calcified aortic valve
which opens poorly. It can also show the size and functioning
of the heart chambers. A technique called
Doppler can be used
to determine the pressure difference on either side of the aortic
valve and to estimate the aortic valve area.
Cardiac catheterization:
Cardiac catheterization is the gold standard in evaluating aortic
stenosis. Small hollow plastic tubes (catheters) are advanced
under x-ray guidance to the aortic valve and into the left ventricle.
Simultaneous pressures are measured on both sides of the aortic
valve. The rate of blood flow across the aortic valve can also
be measured using a special catheter. Using these data, the aortic
valve area can be calculated. A normal aortic valve area is 3
square centimeters. Symptoms usually occur when the aortic valve
area narrows to less than 1 square centimeter. Critical aortic
stenosis is present when the valve area is less than 0.7 square
centimeters. In patients over 40 years of age, x-ray contrast agents
can be injected into the coronary arteries (coronary angiography)
during cardiac catheterization to evaluate the status of coronary
arteries. If significant narrowing of the coronary arteries is
found, coronary artery bypass graft surgery (CABG) can be performed
during aortic valve replacement surgery.
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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