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.
The glycoprotein IIb/IIIa inhibitors such as abciximab (Reopro) and
eptifibatide (Integrilin) prevent aggregation of platelets by inhibiting the
glycoprotein receptors on the platelets. They are the most potent anti-platelet
agents, approximately 9 times more potent than aspirin, and three times more
potent than the thienopyridines. The glycoprotein IIb/IIIa inhibitors are also
the most expensive anti-platelet agents. The currently FDA-approved glycoprotein
IIb/IIIa inhibitors have to be given intravenously. They usually are given along
with aspirin and heparin. They are quick acting; their maximal anti-platelet
effects are achieved within minutes of infusion. These inhibitors have become
important in the treatment of patients with heart attacks, patients with
unstable angina, and patients undergoing PTCA with or without stenting. Numerous
studies have shown that glycoprotein IIb/IIIa inhibitors:
Decrease the size of the blood clot blocking the
coronary arteries, thus improving blood flow, limiting damage to heart muscle,
and improving survival among patients with heart attacks
Decrease the incidence of heart attacks and improve
survival among patients with unstable angina
Prevent the formation of blood clots inside coronary stents and in
coronary arteries unblocked by PTCA, thus decreasing the incidence of heart
attacks and improving survival, specifically, when given intravenously at the time of PTCA and
stenting and followed by oral aspirin and clopidogrel
The major risk of glycoprotein IIb/IIIa inhibitors is bleeding. Therefore,
patients on heparin, aspirin, and glycoprotein IIb/IIIa inhibitors have to be
monitored closely for bleeding. Recent studies have demonstrated equal efficacy
of abciximab and eptifibatide. Eptifibatide is shorter acting than abciximab. In
the event of major bleeding, the anti-platelet effect of eptifibatide can be
reversed within hours of stopping the intravenous infusion, while the
anti-platelet effect of abciximab will last much longer. Sometimes, transfusions
of platelets are necessary to treat major bleeding due to abciximab.
An uncommon side effect of glycoprotein IIb/IIIa inhibitors is
the development of low platelet counts (thrombocytopenia). Thrombocytopenia
can increase the risk for bleeding and, in rare instances, may actually cause blood to
clot. Thus, patients receiving glycoprotein IIb/IIIa inhibitors should have
their platelet counts monitored closely.
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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