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. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
During a pharmacologic stress test, certain medications are administered which stimulate the heart to mimic the physiologic effects of exercise. One of these medications is dobutamine, which is similar to adrenaline. Dobutamine is carefully administered to gradually increase the heart rate and strength of the contractions of the heart muscle. Simultaneously, echocardiography or radionuclide imaging is performed.
Alternatively, a medicine called adenosine is administered, which simulates the physiology of the coronary artery circulation during exercise. Adenosine is combined with radionuclide isotope imaging to provide a very accurate test for the detection of significant CAD. A newer agent, regadenoson (Lexiscan), is often used as it seems to be better tolerated. Pharmacological stress testing is commonly performed in patients who are thought to be at high risk for significant CAD and who are scheduled for major non-cardiac surgical procedures. These patients are often unable to perform exercise stress testing due to the underlying condition for which they require surgery. In this setting, pharmacological stress testing is invaluable in assessing the cardiac risk of patients prior to surgery.
Are there other tests for CAD that are noninvasive?
CT scanning
A new noninvasive test for the detection of CAD is
electron beam computerized tomography (EBCT), or calcium scoring. Unlike the above mentioned stress tests that measure the heart's physiology, EBCT is designed to measure calcium deposits in the coronary arteries.
In patients with CAD, the plaques which make up the blockages contain significant amounts of calcium, which can be detected with the CT scanner and the amount of blockage is calculated by calcium scoring. This test will identify calcium in blockages as mild as 10%-20%, which would not be detected by standard physiological testing. When such mild blockages are detected, however, the only recommended therapy is risk factor modification (cholesterol lowering and cessation of smoking if applicable), and adjunctive use of
aspirin and certain vitamins; such therapy would be advised in all patients with risk factors for CAD, regardless of the results of any noninvasive tests.
Calcium scoring may be very helpful in convincing patients to change their lifestyle or take their medicines, as a score that is not zero implies that the blockage process is starting, and likely will progress unless lifestyle changes are made. It is important to realize that calcification is a function of age, and in younger patients (men under 50, women under 60) the calcium score is less helpful when low.
A more elaborate modality is CT angiography (ultrafast CT). This is a non-invasive (no catheter involved) form of angiogram, but still involves dye exposure and radiation, and is less precise than a coronary angiogram. This is still a rather new modality, and its role is still being defined.
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.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
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.
Premature ventricular contractions (PVCs) are premature heartbeats originating from the ventricles of the heart. PVCs are premature because they occur before the regular heartbeat. There are many causes of premature ventricular contractions to include: heart attack, high blood pressure, congestive heart failure, mitral valve prolapse, hypokalemia, hypoxia, medications, excess caffeine, drug abuse, and myocarditis.
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.
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.
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.
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.
Cholesterol is the most common type of steroid in the body. The treatment of elevated cholesterol involves not only diet but also weight loss, regular exercise, and medications. By understanding your cholesterol profile you can better manage your cholesterol levels.
Regular physical activity can reduce the risk of disease. Regular exercise can also reduce the symptoms of stress and anxiety. There are fitness programs that fit any age or lifestyle.
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.
The heart is a very important organ in the body. It is responsible for continuously pumping oxygen and nutrient-rich blood throughout your body to sustain life. It is a fist-sized muscle that beats (expands and contracts) 100,000 times per day, pumping a total of five or six quarts of blood each minute, or about 2,000 gallons per day.
Cholesterol occurs naturally in the body. High blood cholesterol levels increase a person's risk of developing heart disease, heart attacks, strokes, TIAs, and more. In addition to medication (fibrates, statins, bile acid sequestrants, and niacin), lifestyle changes can be made to lower blood cholesterol levels
Vitamins and exercise can lower your risk for heart attack and heart disease. Folic acid, vitamins, and homocysteine levels are interconnected and affect your risk for heart disease or heart attack. Antioxidants and exercise also play a key role in heart attack and heart disease prevention. Lower your risk factors for heart disease and heart attack by lowering cholesterol, lowering blood pressure, diabetes prevention, and smoking cesssation.
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