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.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Anti-platelet agents are medications that prevent blood clots from forming
by inhibiting the aggregation of platelets. Platelets are fragments of cells
that circulate in the blood. Platelets begin the formation of blood clots by
clumping together (a process called aggregation). Platelet clumps are then
strengthened and expanded by the action of clotting factors (coagulants) that
result in the deposition of protein (fibrin) among the platelets. Aggregation of
platelets occurs at the site of any injury or laceration, but it also occurs at
the site of rupture of cholesterol plaques in the walls of coronary arteries.
Formation of clots at the site of an injury or laceration is desirable because
it prevents excessive loss of blood, but formation of clots inside coronary
arteries blocks the arteries and causes heart attacks.
There are three types of anti-platelet agents -- aspirin, thienopyridines, and
the glycoprotein IIb/IIIa inhibitors. These agents differ in their mode of
action, anti-platelet potency, speed of onset of action, and cost. For
more, please read the Anti-Platelet
Medication article.
Aspirin
Aspirin inhibits the activity of the enzyme cyclo-oxygenase inside platelets.
Cyclo-oxygenase is an enzyme whose activity is necessary for the formation of a
chemical, thromboxane A2, that causes platelets to aggregate. Aspirin, by
inhibiting the formation of thromboxane A2, which prevents platelets from aggregating
and thereby prevents the formation of blood clots.
Aspirin alone has its greatest impact on improving survival among patients
with heart attacks. Numerous studies have shown that aspirin reduces mortality
(by 25%) when given to patients with heart attacks. Aspirin is easy to use, safe
at the low doses used for anti-platelet action, fast acting (with an onset of
action within 30 minutes), and cheap. Aspirin is given at a dose of 160 mg to
325 mg immediately to almost all patients as soon as a heart attack is recognized. It
also is continued on a daily basis indefinitely after the heart attack. The only
reason for not using aspirin is a history of intolerance or allergy to aspirin.
Aspirin is taken daily following a heart attack to reduce the risk of another heart
attack. (Preventing further heart attacks is called secondary prevention, while preventing
the first heart attack is called primary prevention). The ideal daily dose
of aspirin for secondary prevention has not been established. Some doctors recommend
160 mg; others recommend 81 mg. The reason for this difference has to
do with aspirin's occasional long-term side effect of bleeding (for example from
stomach ulcers). Even though the risk of major bleeding with long-term, moderate
dose aspirin (325 mg/day) is low (less than 1one percent), this risk can be
lowered slightly by using an even lower dose (160 or 81 mg/day).
Aspirin also benefits patients with forms of coronary heart disease other
than an acute heart attack. Aspirin has been shown to reduce heart attacks and
improve survival in the following patients:
Aspirin improves survival among patients with unstable
angina. Patients with unstable angina experience chest pains at rest or with
minimal exertion. These patients have critically narrowed coronary arteries
and are at imminent risk of having a heart attacks.
Aspirin improves survival among patients with stable
exertional angina. (These are patients who experience chest pain only with
exertion.)
Aspirin prevents formation of blood clots at the site
of the PTCA (see below).
Aspirin prevents the formation of blood clots that can
occlude surgical bypass grafts. (Occlusion of bypass grafts can lead to heart
attacks.)
Aspirin in low doses (81 mg/day) has been shown to prevent first heart
attacks (primary prevention)
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.
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.
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.
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.
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.
Fabry disease (Fabry's disease, alpha-galactosidase-A) is a genetic disorder with symptoms such as burning sensations in the hands, small-raised reddish-purplish blemishes on the skin, fever, decreases sweating, and GI difficulties. Fabry disease patients are at increased risk of heart attack, heart disease, kidney failure, and stroke. Symptoms of Fabry disease can be treated with medication.
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.
Biologic rhythms, or biorhythms, are how our bodies respond to the regular phases of the sun, moon, and seasons. A medical chronobiologist studies how the "body clock" or biorhythms affect diseases and how the body clock responds to treatment of diseases and conditions at different times of the 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.
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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