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.
Sutures are removed from the chest prior to discharge and from the leg (if
the saphenous vein is used) after 7 to 10 days. Even though smaller leg veins
will take over the role of the saphenous vein, a certain degree of swelling
(edema) in the affected ankle is common. Patients are advised to wear elastic
support stockings during the day for the first four to six weeks after surgery and to
keep their leg elevated when sitting. This swelling usually resolves after about
six to eight weeks. Healing of the breastbone takes about six weeks and is the primary
limitation in recovering from CABG surgery. Patients are advised not to lift
anything more than 10 pounds or perform heavy exertion during this healing
period. They are also advised not to drive for the first four weeks to avoid any
injury to the chest. Patients can return to normal sexual activity as long as
they minimize positions that put significant weight on the chest or upper arms.
Return to work usually occurs after the six week recovery, but may be much sooner
for non-strenuous employment.
Exercise stress testing is routinely done four to six weeks after CABG surgery and
signals the beginning of a cardiac rehabilitation program. Rehabilitation
consists of a 12 week program of gradually increasing monitored exercise lasting
one hour three times a week. Patients are also counseled about the importance of
lifestyle changes to lower their chance of developing further CAD. These include
stopping smoking, reducing weight and dietary fat, controlling blood pressure
and diabetes, and lowering blood cholesterol levels.
What are the risks and complications
of CABG surgery?
Overall mortality related to CABG is 3-4%. During and shortly after CABG
surgery, heart attacks occur in 5 to 10% of patients and are the main cause of
death. About 5% of patients require exploration because of bleeding. This second
surgery increases the risk of chest infection and lung complications. Stroke
occurs in 1-2%, primarily in elderly patients. Mortality and complications
increase with:
age (older than 70 years),
poor heart muscle function,
disease
obstructing the left main coronary artery,
Mortality may be higher in women, primarily due to their
advanced age at the time of CABG surgery and smaller coronary arteries. Women
develop coronary artery disease about 10 years later than men because of
hormonal "protection" while they still regularly menstruate (although in women
with risk factors for coronary artery disease, especially smoking, elevated
lipids, and diabetes, the possibility for the development of coronary artery
disease at a young age is very real). Women are generally of smaller stature
than men, with smaller coronary arteries. These small arteries make CABG surgery
technically more difficult and prolonged. The smaller vessels also decrease both
short and long-term graft function.
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.
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