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. 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. 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.
Unlike angina, a heart attack results in permanent damage of the heart
muscle. After a heart attack, the damaged portion of the heart is left with a
scar. If the amount of heart muscle damage and the area of scarring are small,
the performance of the heart as a pump will not be significantly impaired.
However, repeated heart attacks or a heart attack with extensive heart muscle
damage, can weaken the heart and cause
heart failure. People with
heart failure experience shortness of breath, tolerate exercise poorly, and lack
vigor because their weakened heart muscle cannot pump enough blood to keep their
bodies healthy and active.
What is cerebral vascular disease?
Cerebral vascular disease is caused by the
reduced supply of blood to the brain. Examples of cerebral vascular disease
include ischemic strokes, hemorrhagic strokes, and transient ischemic attacks
and are discussed below.
Ischemic stroke
An ischemic stroke is the sudden and permanent death of brain cells that
occurs when the flow of blood to a part of the brain is blocked and oxygen
cannot be delivered to the brain. Depending on the part of the brain that is
affected, strokes can result in weakness or paralysis of the arms, legs, and/or
facial muscles, loss of vision or speech, and difficulty walking.
Ischemic strokes most commonly occur when clots form in small arteries within
the brain (known as thrombosis of the artery) that have been previously narrowed
by atherosclerosis. The resulting strokes are called lacunar strokes because
they look like small lakes. In some cases, blood clots can obstruct a larger
artery going to the brain, such as the carotid artery in the neck, causing more
extensive brain damage than lacunar strokes.
A second less common type of ischemic stroke occurs when a piece of a clot
breaks loose, for example, from the carotid artery or heart, travels through the
arteries, and lodges in an artery within the brain. This type of stroke is
referred to as an embolic stroke and occurs commonly as a result of an irregular
heart rhythm such as atrial fibrillation, that causes blood clots to form within
the heart.
Hemorrhagic stroke
A hemorrhagic stroke occurs when a blood vessel in the brain ruptures, and
blood leaks into the surrounding brain tissue. A hemorrhagic stroke, like an
ischemic stroke, causes the death of tissue by depriving the brain of blood and
oxygen. The accumulation of blood from the hemorrhage also can put pressure on
adjacent parts of the brain and damage them as well.
A subarachnoid hemorrhage is a rupture of a blood vessel that is located
between the outer surface of the brain and the inside of the skull. The blood
vessel at the point of rupture often has been weakened by the development of an
aneurysm (an abnormal ballooning of the wall of the blood vessel). Subarachnoid
hemorrhages usually cause a sudden, severe headache and often are complicated by
additional neurological problems, such as paralysis, coma, and even death.
Transient ischemic attack (TIA)
A transient ischemic attack (TIA) often is
referred to as a mini-stroke. TIAs are caused by the temporary reduction in flow
of blood (ischemia) to the brain and is most often caused by a clot that
spontaneously forms in a carotid artery. Patients with TIA's often have narrowed
(or, less often, ulcerated) carotid arteries due to atherosclerosis. TIAs
typically last 2 to 30 minutes, although symptoms sometimes can last 24 hours
and can produce problems with vision, dizziness, weakness of the arms or legs,
and trouble speaking. A TIA is different from a stroke in that it does not cause
permanent death of brain tissue. Without treatment, however, patients with TIAs
are at high risk for having a stroke with permanent damage to the brain.
When does the coronary atherosclerosis process begin?
Although the coronary arteries are wide open at birth, the atherosclerosis
process begins early in life. Between the ages of 10 and 20, "fatty streaks" are
already being deposited on the inner lining of the coronary arteries. Over the
years, some of these fatty streaks grow into larger cholesterol plaques that can
protrude into the artery lumen and harden the artery walls. Many men and women
between the ages of 20 and 30 typically are unaware that their coronary arteries
are gradually accumulating cholesterol plaques. But by ages 40 to 50, many
people have developed enough atherosclerosis to put them at risk for coronary
heart disease.
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.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
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.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Brain aneurysm (cerebral aneurysm) is caused by microscopic damage to artery walls, infections of the artery walls, tumors, trauma, drug abuse. Symptoms include headache, numbness of the face, dilated pupils, changes in vision, the "worst headache of your life," or a painful stiff neck. Immediate treatment for a brain aneurysm is crucial for patient survival.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
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.
High blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
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.
Smoker's lung photo essay is a collection of pictures and microscopic slides of lung disease caused by cigarette smoking. Smoker's lung refers to the diseases and structural abnormalities in the lung caused by cigarette smoking.
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.
Heart failure is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats.
Heart disease, particularly coronary artery disease is the leading cause of heart attacks. Women are more likely to die from a heart attack than men. High cholesterol, high blood pressure, obesity, and high triglycerides are contributors to heart disease. Some of the common symptoms of a heart attack in women include chest pain, shortness of breath, nausea, feeling faint or woozy, and more. Heart disease can be prevented by lifestyle changes and controlling high blood pressure, cholesterol, weight, and diseases such as diabetes.
A heart attack involves damage or death of part of the heart muscle due to a blood clot. The aim of heart attack treatment is to prevent or stop this damage to the heart muscle. Heart attack treatments included medications, procedures, and surgeries to protect the heart muscle against injury.
Omega-3 fatty acids are essential fats that help decrease one's cholesterol and triglyceride levels as well as reduce the risk of coronary artery disease. Omega-3s are found in salmon, sardines, walnuts, and canola oil. These fats may help reduce the risk of ventricular fibrillation and sudden cardiac death.
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.
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
The importance of a healthy lifestyle in disease prevention is widely understood and most people know that lifestyle changes and choices can be critical to good health. Yet, few practice healthy behaviors that constitute healthy living.
Secondhand smoke can cause illness and disease in nonsmokers. Some of these conditions include lung cancer, heart disease, respiratory illnesses such as asthma, SIDS, bronchitis, and pneumonia. Learn how you can protect yourself and your family from secondhand smoke exposure in the home environment and workplace.
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.
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.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
Smoking increases the risk of heart disease in women and men. Nicotine in cigarettes decrease oxygen to the heart, increases blood pressure, blood clots, and damages coronary arteries. Learn how to quit smoking today, to prolong your life.
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