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.
Coronary artery stents are small hollow cylinders that can be deployed over the
angioplasty balloons and left within the coronary arteries to keep the arteries
open. Stents help prevent abrupt closure of arteries shortly after PTCA.
They also prevent restenosis (recurrent narrowing of the arteries) several months after
PTCA.
Coronary stents decrease the risks of arterial dissections, elastic recoil,
and artery spasm that can occur after PTCA and cause re-occlusion of the artery.
Studies have shown that the incidence of abrupt coronary artery closure after
PTCA has declined dramatically with the introduction of coronary stents.
Coronary stents also help to keep the coronary arteries open in the
longer-term. After a successful PTCA, as many as 30-40% of patients will develop
recurrent narrowing (restenosis) at the site of inflation of the balloon,
usually within six months following PTCA. Restenosis may or may not be accompanied
by symptoms such as angina. Thus, restenosis often is detected by exercise
stress tests performed four to six months after PTCA. The widespread use of coronary
stents has reduced this incidence of restenosis by as much as 50%. The recent
introduction of coated stents (stents that are coated with chemicals to further
reduce restenosis) has reduced the incidence of restenosis to well under 10% and
has been a major improvement in treatment.
Patients with coronary artery stents usually are maintained on full doses of
daily aspirin. For the first 4-12 weeks after the placement of stents, patients
are given an additional anti-platelet drug such as ticlopidine or clopidogrel
because the metal surface of the stents may promote the formation of blood clots
in the first several weeks after the stent is inserted. With the newer medicated
stents, aspirin and clopidogrel are continued for a year or longer.
Nitrates
Nitroglycerin is the most common nitrate used in the treatment of heart attacks. It
can be given sublingually (under the tongue), as a spray, as a paste applied
over skin, and intravenously. Intravenous nitroglycerine has a rapid onset
of action and is commonly used in the initial (first 48 hours) treatment of
heart attacks. Nitroglycerine is a vasodilator (blood vessel dilator), which opens
arteries by relaxing the muscular wall of the artery. Nitroglycerine dilates
coronary arteries as well as other blood vessels throughout the body. By dilating
blood vessels, nitroglycerine lowers blood pressure, decreases the work
that the heart must do, lowers the demand by the heart for oxygen, prevents
coronary artery spasm, improves blood flow to the heart muscle, and potentially
minimizes the size of the heart attack. Nitroglycerine is especially helpful in
patients with heart attacks who also have heart failure or high blood pressure.
The common side effects of nitrates are headaches and low blood pressure. Low
blood pressure can cause weakness, dizziness, and, sometimes, even fainting.
Nitrates should not be given in patients who have taken medicines for erectile
dysfunction such as sildenafil (Viagra) and vardenafil
(Levitra) in the
preceding 24 hours, since severe low blood pressure may result. Nitrates should
not be given in patients who have taken tadalafil (Cialis) in
the preceding 36-48 hours
because the effects of Cialis last longer than either sildenafil or
vardenafil .
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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