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.
While anti-platelet agents and anti-coagulants prevent the formation of blood
clots, they cannot dissolve existing blood clots and hence cannot be relied upon
to open blocked arteries rapidly. Clot-dissolving drugs (also called
fibrinolytic or thrombolytic medications) actually dissolve blood clots and can
rapidly open blocked arteries. Intravenous administration of clot-dissolving
drugs such as tissue plasminogen activator (TPA) or TNK can open up to 80% of
acutely blocked coronary arteries. The earlier these drugs are administered, the
greater the success at opening the artery and the more effective the
preservation of heart muscle. If clot-dissolving drugs are given too late (more
than six hours after the onset of the heart attack), most of the muscle damage
already may have occurred.
If a hospital does not have a catheterization laboratory with the ability to
perform PTCA, or if there are logistic reasons why PTCA will be delayed,
clot-dissolving drugs can be promptly administered to achieve reperfusion. PTCA
then may be performed in patients who fail to respond to the clot-dissolving
drugs. (If prompt PTCA and stenting are available, it has been demonstrated that
they are preferable to clot-dissolving drugs to open arteries.)
Clot-dissolving drugs increase the risk of bleeding enough so that some patients cannot be
treated with them, for example, patients with recent surgery or major trauma,
recent stroke, bleeding ulcer, or other conditions that increases the risk of
bleeding.
Coronary angiography and percutaneous transluminal coronary angioplasty
Coronary angiography and percutaneous transluminal
coronary angioplasty (PTCA) is the most direct method of opening a blocked coronary artery.
The procedures are performed in the catheterization laboratory in a hospital.
Under x-ray guidance, a tiny plastic catheter with a balloon on its end is
advanced over a guide wire from a vein in the groin or the arm and into the
blocked coronary artery. Once the balloon reaches the blockage, it is inflated,
pushing the clot and plaque out of the way to open the artery. PTCA can be effective
in opening up to 95% of arteries. In addition, the angiogram (x-ray pictures
taken of the coronary arteries) allows evaluation of the status of the other
coronary arteries so that long-term treatment plans may be formulated.
For optimal benefits, coronary angiography and PTCA should be
performed as soon as possible. Most cardiologists recommend that the time
interval between the patient's arrival at the hospital and the deployment of
the angioplasty balloon to open the artery should be less than 60-90 minutes.
For best results, the coronary angiogram and PTCA should be performed by an
experienced cardiologist in a well-equipped cardiac catheterization laboratory.
The cardiologist is considered experienced if he or she performs more than 75
such procedures a year. The catheterization laboratory personnel are considered
experienced if the facility performs more than 200 such procedures a year.
It also is important that there be a surgical team to perform immediate open-heart
surgery (coronary artery bypass grafting) in the event that PTCA is unsuccessful
in opening the blocked artery or if there is a serious complication of
PTCA. For example, in a small number of patients, PTCA cannot be performed because
of technical difficulties in passing the guide wire or the balloon across
the narrowed arterial segment. Open-heart surgery also will be necessary if
there is a serious complication such as coronary artery injury during PTCA or an
abrupt closure of the coronary artery shortly after PTCA. These complications may occur in
one to two percent of patients.
The most serious complication of PTCA is an abrupt closure of the coronary
artery within the first few hours after PTCA. Abrupt coronary artery closure
(that can lead to further heart damage) occurs in five percent of patients after simple
balloon angioplasty (without stenting). Abrupt closure is due to a combination
of tearing (dissection) of the inner lining of the artery, blood clotting at the
site of the balloon, and constriction (spasm) or elastic recoil of the artery at
the site where the balloon is inflated. Individuals at an increased risk for
abrupt closure include women, patients with unstable angina, and patients having
heart attacks.
The risk of abrupt closure of the coronary arteries can be reduced if:
Aspirin is given during or after PTCA to prevent blood
clotting. In fact, virtually all patients are maintained on aspirin
indefinitely after PTCA to prevent arterial clots.
Anticoagulants such as intravenous heparin are given
during PTCA to further prevent blood clotting.
Combinations of nitrates and calcium channel blockers are used to minimize coronary artery spasm (see discussion that
follows).
Coronary artery stents are deployed to minimize
coronary artery closure.
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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