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.
The treatment of atrial fibrillation is multi-faceted and involves
reversing the
factors that cause atrial fibrillation,
slowing the heart rate with medications,
preventing
strokes,
converting atrial fibrillation to a normal heart rhythm with medications or
electrical shock,
preventing the recurrence of atrial fibrillation with medications, and
using procedures (for example, pacemakers, defibrillators, surgery) to prevent episodes
of atrial fibrillation.
Reversing the risk factors that cause atrial fibrillation
An important first step in the treatment of atrial fibrillation is to uncover
and correct conditions (such as hyperthyroidism or use of stimulant drugs) that
can cause atrial fibrillation. These steps include:
Stopping the use of stimulant drugs and excessive
alcohol intake
Controlling high blood pressure
Correcting hyperthyroidism (too much thyroid hormone)
and low blood oxygen levels
Controlling heart failure and treating the diseases of the heart and the
lungs that can cause atrial fibrillation
Slowing the heart rate with medications
Having excluded or corrected the factors that cause
atrial fibrillation, the next
step when the ventricles are beating too rapidly usually is to slow the rate at
which the ventricles beat.
Available medications. Patients with atrial fibrillation and healthy AV nodes usually
have ventricles that beat rapidly. Medications are necessary to slow down the
rapid heart rate. Medications to slow the heart rate in atrial fibrillation include:
These medications slow the heart rate by retarding conduction of
the electrical discharges through the AV node. These medications, however, do
not usually convert atrial fibrillation back into a normal rhythm. Other drugs or treatments are
necessary to achieve a normal heart rhythm.
Benefits of controlling the rate. In patients with rapid ventricle
contractions as a result of atrial fibrillation, slowing the rate of ventricular contractions
improves the heart's efficiency in delivering blood (by allowing more time
between contractions for the ventricles to fill with blood) and relieves the
symptoms of inadequate flow of blood - dizziness, weakness, and shortness of
breath.
With chronic, sustained atrial fibrillation, doctors may decide to leave some patients in
atrial fibrillation
provided that their heart rates are under control, the output of blood from the
ventricles is adequate, and their blood is adequately thinned to prevent
strokes. This form of treatment is called rate control therapy (see below).
Limitations of medications for controlling the heart rate. In patients
with diseased AV nodes, ventricular contractions may be slower than patients who
have normal AV nodes. Moreover, some elderly patients with atrial fibrillation are extremely
sensitive to medications that slow the rate of ventricular contractions, usually
because of a diseased AV node. In these patients, the heart rate can become
dangerously slow with small doses of medications to slow the heart. This
condition is referred to as tachycardia-bradycardia syndrome, or "sick sinus
syndrome." Patients with tachycardia-bradycardia syndrome need medications to
control the fast heart rate and a pacemaker to provide a minimum safe heart
rate.
Medications used in slowing atrial fibrillation generally cannot convert
atrial fibrillation to a normal rhythm. Therefore these patients are at risk for the formation of
blood clots in the heart and strokes and will need prolonged blood thinning with
anticoagulants like warfarin
(Coumadin).
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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