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. 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.
Aortic stenosis is abnormal narrowing of the aortic valve. A number of conditions cause disease resulting in narrowing of the aortic valve. When the degree of narrowing becomes significant enough to impede the flow of blood from the left ventricle to the arteries, heart problems develop.
The basic mechanism is as follows:
The heart is a muscular pump with
four chambers and four heart valves.
The upper chambers, the right
atrium and left atrium (atria - plural for atrium), are thin walled
filling chambers.
Blood flows from the right and left atria across
the tricuspid and mitral valves into the lower chambers (right
and left ventricles).
The right and left ventricles have thick
muscular walls for pumping blood across the pulmonic and aortic
valves into the circulation.
Heart valves are thin leaflets of
tissue which open and close at the proper time during each heart
beat cycle.
The main function of these heart valves is to prevent
blood from flowing backwards.
Blood circulates through the arteries to provide oxygen and other nutrients to the body, and then returns with carbon dioxide waste through the veins to the right atrium; when the ventricles relax, blood from the right atrium passes through the tricuspid valve into the right ventricle.
When the ventricles contract, blood from the right ventricle is pumped through the pulmonic valve into the lungs to reload on oxygen and remove carbon dioxide.
The oxygenated blood then returns to the left atrium and passes through the mitral valve into the left ventricle.
Blood is pumped by the left ventricle across the aortic valve into the aorta and the arteries of the body.
The flow of blood to the arteries of the body is impaired when aortic stenosis exists. Ultimately, this can lead to heart failure. Aortic stenosis occurs three times more commonly in men than women.
Low blood pressure, also referred to as hypotension, is blood pressure that is so low that it causes symptoms or signs due to the low flow of blood through the arteries and veins. Some of the symptoms of low blood pressure include light-headedness, dizziness, or even fainting if not enough blood is getting to the brain. Diseases and medications can also cause low blood pressure. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidneys; the organs do not function normally and may be permanently damaged.
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.
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.
Fainting, also referred to as blacking out, syncope, or temporary loss of consciousness has many causes. Often a person will have signs or symptoms prior to the fainting episode. Diagnosis and treatment depends upon the cause of the fainting or syncope episode.
Heart valve disease occurs when the heart valves do not work the way they should. Symptoms of valve disease include shortness of breath, weakness or dizziness, discomfort in your chest, palpitations, swelling of your ankles, feet or abdomen, and rapid weight gain.
Sudden cardiac arrest is an unexpected, sudden death caused by sudden cardiac arrest (loss of heart function). Causes and risk factors of sudden cardiac arrest include (not inclusive): abnormal heart rhythms (arrhythmias), previous heart attack, coronary artery disease, smoking, high cholesterol, Wolff-Parkinson-White Syndrome, ventricular tachycardia or ventricular fibrillation after a heart attack, congenital heart defects, history of fainting, and heart failure, obesity, diabetes, and drug abuse. Treatment of sudden cardiac arrest is an emergency, and action must be taken immediately.
Endocarditis, a serious infection of one of the four heart valves is caused by growth of bacteria on one of the heart valves; leading to an infected massed called a "vegetation." The infection can be caused by having bacteria in the bloodstream after dental work, colonoscopy, or other similar procedures. Endocarditis symptoms include fever, fatigue, weakness, chills, aching muscles and joints, night sweats, edema in the legs, feet, or abdomen, malaise, shortness of breath and small skin lesions. Treatment for endocarditis is generally aggressive antibiotic treatment.
An angiogram is an X-ray image of blood
vessels after they are filled with a contrast material. An angiogram of the
heart, a coronary angiogram, is the "gold standard" for the evaluation of
coronary artery disease (CAD). A coronary angiogram can be used to identify the exact location and severity of CAD.
How is a coronary angiogram performed?
Coronary angiography is performed with the use of local
anesthesia and intravenous sedation, and is generally not significantly uncomfortable.
In performing a coronary angiogram, a doctor inserts a small
catheter (a thin hollow tube with a diameter of 2-3 mm) through the skin into an
artery in either the
groin or the arm.
Guided with the assistance of a
fluoroscope (a special x-ray viewing instrument), the catheter is then advanced to the opening of the
coronary arteries (the blood vessels supplying blood to the heart).