A middle aged man who owns a petty shop in a small town of south India came to us for stable angina .His RCA looked like this.
Normally if one coronary artery is obstructed the other comes to the rescue .It seems , this RCA do not trust it’s sibling LAD . See how it self supports its own territory .(The most fascinating and mysterious aspect of coronary circulation is the collateral circulation. LAD has big brother attitude . . . it hesitates to help others while RCA is more philanthropic , we know it sends prompt collateral to LAD whenever it is distressed !)
However , there is one advantage of such self-sustenance of RCA (Intra coronary/homo-collaterals ) . If the RCA has to live at the mercy of LAD it runs a risk of neglect at times of distant LAD ischemia as well !
Management
Single vessel disease , total occlusion , long segment lesion , still the PDA is protected and the vital postero- basal area of heart perfused well ! What to do ?
Scientific cardiologists would like to meddle this RCA with multi-pronged guide-wires and other weapons . Non -scientific cardiologists would send him home with medicines . This patient preferred the later ! In the process he saved a lakh , which I believe was meant for his daughter’s education . He profusely thanked me for not hijacking his hard earned money for frivolous reasons . I said he should thank his collaterals and not me , for getting his money back !
Dr.S.Venkatesan MD 