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.
Medicines used to treat angina reduce the heart muscle demand for oxygen in
order to compensate for the reduced blood supply. Three commonly used classes of
drugs are the nitrates, beta blockers and
calcium blockers.
Nitroglycerin
(Nitro-Bid) is an example of a nitrate. Examples of beta blockers include
propranolol (Inderal) and atenolol (Tenormin). Examples of calcium blockers
include nicardipine (Cardene) and
nifedipine (Procardia, Adalat). Unstable angina is
also treated with aspirin and the intravenous blood thinner heparin. Aspirin
prevents clumping of platelets, while
heparin prevents blood clotting on the
surface of plaques in a critically narrowed artery. When patients continue to
have angina despite maximum medications, or when significant ischemia still
occurs with exercise testing, coronary arteriography is usually indicated. Data
collected during coronary arteriography help doctors decide whether the patient
should be considered for percutaneous coronary intervention, or percutaneous
transluminal angioplasty (PTCA), whereby a small balloon is used to inflate the
blockage. Angioplasty (PTCA) is usually followed by placement of a stent or coronary artery
bypass graft surgery (CABG) to increase coronary artery blood flow.
Angioplasty can produce excellent results in carefully selected patients. Under
x-ray guidance, a wire is advanced from the groin to the coronary artery. A
small catheter with a balloon at the end is threaded over the wire to reach the
narrowed segment. The balloon is then inflated to push the artery open, and a
steel mesh stent is generally inserted.
CABG surgery is performed to relieve angina in patients who have failed
medical therapy and are not good candidates for angioplasty (PTCA). CABG surgery is ideal for
patients with multiple narrowings in multiple coronary artery branches, such as
is often seen in patients with diabetes. CABG surgery has been shown to improve
long-term survival in patients with significant narrowing of the left main
coronary artery, and in patients with significant narrowing of multiple
arteries, especially in those with decreased heart muscle pump function.
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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