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.
What is coronary artery bypass graft (CABG) surgery?
According to the American Heart Association 427,000 coronary artery bypass
graft (CABG) surgeries were performed in the United States in 2004, making it one of the most commonly performed
major operations. CABG surgery is advised for selected groups of patients with
significant narrowings and blockages of the heart arteries (coronary artery
disease). CABG surgery creates new routes around narrowed and blocked arteries,
allowing sufficient blood flow to deliver oxygen and nutrients to the heart
muscle.
How does coronary artery disease develop?
Coronary artery disease (CAD) occurs when atherosclerotic plaque (hardening of the
arteries) builds up in the wall of the arteries that supply the heart. This
plaque is primarily made of cholesterol. Plaque accumulation can be accelerated
by smoking, high blood pressure, elevated cholesterol, and diabetes. Patients
are also at higher risk for plaque development if they are older (greater than
45 years for men and 55 years for women), or if they have a positive family
history for early heart artery disease.
The atherosclerotic process causes significant narrowing in one or more
coronary arteries. When coronary arteries narrow more than 50 to 70%, the blood
supply beyond the plaque becomes inadequate to meet the increased oxygen demand
during exercise. The heart muscle in the territory of these arteries becomes
starved of oxygen (ischemic). Patients often experience chest pain (angina) when
the blood oxygen supply cannot keep up with demand. Up to 25% of patients
experience no chest pain at all despite documented lack of adequate blood and
oxygen supply. These patients have "silent" angina, and have the same risk of
heart attack as those with angina.
When a blood clot (thrombus) forms on top of this plaque, the artery becomes
completely blocked causing a heart attack.
When arteries are narrowed in excess of 90 to 99%, patients often have
accelerated angina or angina at rest (unstable angina). Unstable angina can also
occur due to intermittent blockage of an artery by a thrombus that eventually is
dissolved by the body's own protective clot-dissolving system.
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.
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 disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Aortic dissection is a small tear in the large blood vessel that leads from the heart and supplies blood to the body. There are two types of aortic dissection, type 1 and type 2. Signs and symptoms of aortic dissection include a tearing or ripping pain, nausea, sweating, weakness, shortness of breath, sweating, or fainting. Treatment depends on the type of aortic dissection, and the severity of the tear in the aorta.
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.
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.
The aorta is the large blood vessel that leads from the heart and carries
blood to the rest of the body. The aorta originates at the aortic valve at the
outlet of the left ventricle of the heart. It ascends in the chest to an arch
where blood vessels branch off to supply blood flow to the arms and head. It
then begins to descend through the chest and into the abdomen, where it splits
into two iliac arteries that provide blood flow to the legs. Along its descent,
more small arteries branch out to supply blood to the stomach, intestine, colon,
kidneys, and the spinal cord.
The aorta has a thick wall, with three layers of muscle that allow the blood
vessel to withstand the high pressure that is generated when the heart pumps
blood to the body. The three layers are the tunica intima, tunica media, and the
tunic adventitia. The intima is the inside layer that is in contact with the
blood, the media is in the middl...
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