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 are the long-term results after
CABG surgery?
A very small percentage of vein grafts may become blocked within the first
two
weeks after CABG surgery due to blood clotting. Blood clots form in the grafts
usually because of small arteries beyond the insertion site of the graft causing
sluggish blood run off. Another 10% of vein grafts close off between two weeks and
one year after CABG surgery. Use of aspirin to thin the blood has been shown to
reduce these later closings by 50%. Grafts become narrowed after the first five
years as cells stick to the inner lining and multiply, causing formation of scar
tissue (intimal fibrosis) and actual atherosclerosis. After 10 years, only 2/3
of vein grafts are open and 1/2 of these have at least moderate narrowings.
Internal mammary grafts have a much higher (90%) 10 year rate of remaining open.
This difference in longevity has caused a shift in surgical practices toward
greater use of internal mammary and other arteries as opposed to veins for
bypasses.
Recent data has shown that in CABG patients with elevated LDL cholesterol
(bad cholesterol) levels, use of cholesterol-lowering medications (particularly
the statin family of drugs) to lower LDL levels to below 80 will significantly
improve long-term graft patency as well as improve survival benefit and heart
attack risk. Patients are also advised about the importance of lifestyle changes
to lower their chance of developing further atherosclerosis in their coronary
arteries. These include stopping smoking, exercise, reducing weight and dietary
fat, as well as controlling blood pressure and diabetes. Frequent monitoring of
CABG patients with physiologic testing can identify early problems in grafts.
PTCA (angioplasty) with stenting, in addition to aggressive risk factor modification, may
significantly limit the need for repeat CABG years later. Repeat CABG surgery is
occasionally necessary, but may have a higher risk of complication.
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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