Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
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.
Atrial fibrillation can be chronic and sustained, or brief and intermittent (paroxysmal).
Paroxysmal atrial fibrillation refers to intermittent episodes of atrial
fibrillation lasting, for example,
minutes to hours. The heart rate reverts to normal between episodes. In chronic,
sustained atrial fibrillation, the atria fibrillate all of the time. Chronic, sustained
atrial fibrillation is not
difficult to diagnose. Doctors can hear the rapid and irregular heartbeats using
a stethoscope. Abnormal heartbeats also can be felt by taking a patient's pulse.
EKG (electrocardiogram)
An electrocardiogram (EKG) is a brief recording of the heart's
electrical discharges. The irregular EKG tracings of atrial fibrillation are easy to recognize
provided atrial fibrillation occurs during the EKG.
Holter monitor
If episodes of atrial fibrillation occur intermittently, a standard EKG performed at the
time of a visit to the doctor's office may not show atrial fibrillation. Therefore, a Holter
monitor, a continuous recording of the heart's rhythm for 24 hours, often is
used to diagnose intermittent episodes of atrial fibrillation.
Patient-activated event recorder
If the episodes of atrial fibrillation are infrequent, a 24-hour Holter recording may not
capture these sporadic episodes. In this situation, the patient can wear a
patient-activated event recorder for 1 to 4 weeks. The patient presses a button
to start the recording when he or she senses the onset of irregular heartbeats
or symptoms possibly possible caused by atrial fibrillation. The doctor then analyzes the
recordings at a later date.
Echocardiography
Echocardiography uses ultrasound waves to produce images of the heart's chambers and valves and the lining
around the heart (pericardium). Conditions that may accompany atrial
fibrillation such as
mitral valve prolapse, rheumatic valve diseases, and pericarditis (inflammation of
the "sack" surrounding the heart) can be detected with echocardiography.
Echocardiography also is useful in measuring the size of the atrial chambers.
Atrial size is an important factor in determining how a patient responds to
treatment for atrial fibrillation. For instance, it is more difficult to achieve and maintain a
normal heart rhythm in patients with enlarged atria.
Transesophageal echocardiography (TEE)
Transesophageal echocardiography
(TEE) is a special echocardiographic technique that involves taking pictures of
the atria using sound waves. A special probe that generates sound
waves is placed in the esophagus (the food pipe connecting the mouth to the stomach).
The probe is located at the end of a long flexible tube that
is inserted through the mouth into the esophagus. This technique brings the probe very
close to the heart (which lies just in front of the esophagus). Sound waves generated by
the probe are bounced off of the structures within the heart, and the reflected
sound waves are used to form a picture of the heart. TEE is very accurate for
detecting blood clots in the atria as well as for measuring the size of the atria.
As previously discussed, blood may clot in the atria during atrial
fibrillation, and pieces of
the clot may dislodge and travel to the brain, causing a stroke. Doctors are
especially concerned about blood clots dislodging during or after cardioversion
(the conversion of atrial fibrillation back into a normal heart rhythm with either drugs or
electrical shocks). Moreover, doctors believe that resumption of atrial
contractions after successful cardioversion increases the likelihood that pieces of
clot will dislodge. For these reasons, anticoagulation (thinning) of blood
usually is done prior to cardioversion. This prevents new clot from forming
while the old clot dissolves or solidifies so that pieces cannot break off. If
no clots are detected in the atria by TEE, the risk of stoke after cardioversion
is believed to be lower. Thus, some doctors use TEE to determine the risk of
stroke following cardioversion. Studies are underway to determine whether
patients with a normal TEE (no blood clots) need to have their blood thinned prior
to cardioversion.
Other tests
High blood pressure and signs of heart failure can be ascertained
(determined) during a physical examination of the patient. Blood tests are
performed to detect abnormalities in blood oxygen and carbon dioxide levels,
electrolytes, and thyroid hormone levels.
Chest X-rays reveal enlargement of the
heart, heart failure, and other diseases of the lung.
Exercise treadmill testing
(a continuous recording of the EKG during exercise) is a useful
screening study
for detecting severe coronary artery disease.
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.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
An arrhythmia is an abnormal heart rhythm. With an arrhythmia, the heartbeats may be irregular or too slow (bradycardia), to rapid (tachycardia), or too early. When a single heartbeat occurs earlier than normal, it is called a prmature contraction.
Hyperthyroidism is an excess of thyroid hormone resulting from an overactive thyroid gland. Symptoms can include increased heart rate, weight
loss, depression, and cognitive slowing. Treatment is by medication, the use of
radioactive iodine, thyroid surgery, or reducing the dose of thyroid hormone.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
COPD (chronic obstructive pulmonary disease) is a disorder that persistently obstructs bronchial airflow. COPD mainly involves three related conditions, chronic bronchitis, chronic asthma, and emphysema. Symptoms of COPD include chronic cough, shortness of breath, frequent respiratory infections, wheezing, morning headaches, and pulmonary hypertension. Treatment of COPD is focused on the related condition(s).
Mitral valve prolapse (MVP) is also also known as "click murmur syndrome" and "Barlow's syndrome." Mitral valve prolapse is the most common heart valve abnormality. Signs and symptoms of mitral valve prolapse include: fatigue, palpitations, chest pain, anxiety, and migraine headaches. Echocardiography is the most useful test for mitral valve prolapse. Most patients do not need any treatment, however, patients with severe prolapse may need treatment.
Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia, and sinus brachycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-White-Parkinson syndrome, brachycardia, or heart blocks. Treatment is dependant upon the type of heart rhythm disorder.
Pulmonary edema (swelling or fluid in the lungs) can either be caused by cardiogenic causes (congestive heart failure, heart attacks, abnormal heart valves) or noncardiogenic causes such as ARDS, kidney failure, high altitude, pneumothorax, pleural effusion, aspirin overdose, pulmonary embolism, and infections. The treatment of pulmonary edema depends on the cause of the condition.
Pericarditis is the inflammation of the pericardial sac that surrounds the heart. The causes of pericarditis include injury from heart attack, heart surgery, trauma; viral or fungal infection, HIV, tumors, mixed connective tissue disease, metabolic disease, medication reactions, or idiopathic. Treatment for pericarditis is generally medication, however, sometimes surgery is necessary.
When a portion of the brain loses blood supply, through a blood clot or embolus, a transient ischemic attack (TIA, mini-stroke) may occur. If the symptoms do not resolve, a stroke most likely has occurred. Symptoms of TIA include: confusion, weakness, lethargy, and loss of function to one side of the body. Risk factors for TIA include vascular disease, smoking, high blood pressure, high cholesterol, and diabetes. Treatment depends upon the severity of the TIA, and whether it resolves.
Rheumatic fever is a disease that sometimes occurs after a group A streptococcal infection of the throat. Symptoms and signs include carditis, polyarthritis, Aschoff bodies, rash, Sydenham's chorea, and fever. Treatment for rheumatic fever involves eliminating the bacteria with penicillin, erythromycin, or azithromycin. Further treatment focuses on alleviating the symptoms brought on by the body's immunologic response to the bacteria.
Heart attacks are the major causes of unexpected, sudden death among men and women. A heart attack is also a significant cause of heart failure. Learn the risk factors for heart attack such as high blood pressure, diabetes, and other heart conditions. Lowering your risk factor, lifestyle changes, and in some cases medication are the most effective way of preventing a heart attack.
Stroke is the third leading killer in the United States. Some of the warning signs of stroke include sudden confusion, trouble seeing with one or both eyes, dizziness, loss of balance, and more. Stroke prevention and reatable risk factors for stroke include lowering high blood pressure, quit smoking, heart disease, diabetes control and prevention.
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