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. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
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.
Coronary atherosclerosis is the hardening and narrowing of the arteries that supply blood to the heart muscle. Coronary atherosclerosis is the major cause of heart attacks. Heart attacks are the major cause of sudden unexpected death among otherwise healthy adults in the prime of their lives. Heart attacks are also a significant cause of heart failure (due to weakened heart muscle) in this country. Heart failure considerably decreases a person's longevity and quality of life. In dollar terms, coronary heart disease is costly. The total cost of coronary artery bypass surgery, coronaryangioplasty and stenting, medications, and hospitalizations exceeds 50 billion dollars annually.
Coronary atherosclerosis, and hence heart attacks, are preventable. A person can significantly lower his or her risk of heart attack by lowering high blood pressure, controlling diabetes, stopping cigarette smoking, losing excess weight, exercising regularly, and lowering the levels of bad "LDL" cholesterol and increasing the level of the good "HDL" cholesterol in the blood. In recent years, other risk factors for coronary atherosclerosis have been identified. These include a high serum homocysteine level and certain subtypes of LDL cholesterol. The following is a comprehensive review of the causes of atherosclerosis and heart attacks, and the means for their treatment and prevention.
What is atherosclerosis?
Atherosclerosis is a gradual process whereby hard cholesterol substances (plaques) are deposited in the walls of the arteries. Cholesterol plaques cause hardening of the artery walls and narrowing of the inner channel (lumen) of the artery. Arteries carry blood that is enriched with oxygen and nutrients to the vital organs such as the brain, heart, kidneys, and liver. Arteries also transport blood to other tissues such as the fingers, toes, nerves, bones, skin, and muscles. Healthy arteries can deliver an ample supply of blood to the organs and tissues. In contrast, arteries that are narrowed by atherosclerosis have difficulty delivering blood to the parts of the body they supply. For example, atherosclerosis of the arteries in the legs causes poor circulation in the lower extremities. Poor circulation in the lower extremities can lead to pain while walking or exercising, deficient wound healing, and/or leg ulcers. Atherosclerosis can also cause the complete blockage of an artery from a blood clot. This complete blockage interrupts oxygen supply and results in tissue injury or death. Thus, the blockage of an artery that furnishes blood to the brain can lead to a stroke (death of brain tissue). Likewise, the blockage of the arteries to the heart can result in a heart attack (death of heart muscle), also called myocardial infarction (MI).
The 2013 ACCF/AHA guidelines for treatment of a heart attack are summarized as follows:
Ideally, transport patient to a PCI capable hospital; if not PCI capable, transfer patient as soon as possible and less than 120 min; if anticipated transfer is more than 120 min, give fibrinolytic agent within 30 min of arrival
Send to cath lab
PCI (Percutaneous Coronary Intervention) also termed stenting or stent placement
If reocclusion occurs or perfusion fails in a patient given a fibrinolytic, arrange transfer to a PCI capable facility; for other patients treated with a fibrinolytic, transfer to a PCI facility within about 3-24hrs
If step 5 occurs, step 3 should follow at a PCI capable facility were either medical therapy, a PCI or a CABG should be done Patients who are not candidates for PCI therapy usually undergo medical or surgical (CABG) therapy. For a more detailed presentation of the medical treatments and CABG, read the heart attack treatment article.