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.
The resting electrocardiogram (EKG) is a recording of the electrical activity
of the heart, and can demonstrate signs of oxygen starvation of the heart
(ischemia) or heart attack. Often, the resting EKG is normal in patients with
coronary artery disease and angina. Exercise treadmill tests are useful
screening tests for patients with a moderate likelihood of significant coronary
artery disease (CAD) and a normal resting EKG. These stress tests are about 60
to 70% accurate in diagnosing significant CAD.
If the stress tests do not reveal the diagnosis, greater accuracy can be
achieved by adding a nuclear agent (thallium or Cardiolite) intravenously during
stress tests. Addition of thallium allows nuclear imaging of the blood flow to
different regions of the heart, using an external camera. An area of the heart
with reduced blood flow during exercise, but normal blood flow at rest,
signifies significant artery narrowing in that region.
Combining echocardiography (ultrasound imaging of the heart muscle) with
exercise stress testing (stress echocardiography) is also a very accurate
technique to detect CAD. When a significant blockage exists, the heart muscle
supplied by this artery does not contract as well as the rest of the heart
muscle. Stress echocardiography and thallium stress tests are both at least 80%
to 85% accurate in detecting significant coronary artery disease.
When a patient cannot undergo exercise stress test because of nervous system
or joint problems, medications can be injected intravenously to simulate the
stress on the heart due to exercise and imaging can be performed with a nuclear
camera or ultrasound.
Cardiac catheterization with angiography (coronary arteriography) is the most
accurate test to detect coronary artery narrowing. Small hollow plastic tubes
(catheters) are advanced under x-ray guidance to the openings of the two main
heart arteries (left and right). Iodine contrast, "dye," is then injected into
the arteries while an x-ray video is recorded. Sometimes, an exercise study is
then done to determine whether a moderate narrowing (40 - 60%) is actually
causing ischemia and, therefore, requires treatment.
A newer modality, high speed CT scanning angiography has recently become
available. This procedure uses powerful x-ray methods to visualize the arteries
to the heart. Its role in the evaluation of CAD is currently being evaluated.
For more, please read the CT Scanning
Angiography article.
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.
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.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Aortic dissection is a small tear in the large blood vessel that leads from the heart and supplies blood to the body. There are two types of aortic dissection, type 1 and type 2. Signs and symptoms of aortic dissection include a tearing or ripping pain, nausea, sweating, weakness, shortness of breath, sweating, or fainting. Treatment depends on the type of aortic dissection, and the severity of the tear in the aorta.
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.
A heart attack is a layperson's term for a sudden blockage of a coronary artery. This photo essay inlcudes graphics, pictures, and illustrations of diseased heart tissue and the mechanisms that lead to coronary artery disease, and possible heart attack.
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