Question: Dear Doctor, Greetings of the Day, My brief history is: • I am 63 year old male and working person at XXXXXXX level. • I had a stent angioplasty – PTCA to RAMUS in Sept 2008. • Latter after 6 month I become Diabetic patient too. • Further 4.5 years went well. • The issues like fatigues, chest pains, short of breath erupted from XXXXXXX 2012. • I continued with medicines given by the family doctor in consultation with the cardiologist. • In XXXXXXX 2013 I had angiography for increased fatigue, chest pains, short of breath etc. • The stent status is OK. But our doctor said there is 90 % blockage in non dominant RCA for which we cannot do anything except medication. LCA, LCX have minor blockages. • Further to the same, every after 2.5 month this problem i.e. fatigue, chest pains, short of breath etc. gets erupted. • 3 weeks back I have done CT Angiography, 2 D Cardiogram, Helium Stress Test. All tests are OK except 90 % blockage in non dominant RCA & LCA, LCX have minor blockages. • The Cardiologist said there is no problem, but my family doctor says these are heart related problem only. Now the case is hanging. • I would like to send the scanned copies of above reports, but there is no provision on your website. These report will give you better feed back. • I am still facing these problems, in fact I am getting exhausted even after morning bath etc. Even I walk to a distance of one kilometer, I get tired and if continue it , I get chest pains. My family doctor says these are angina pains. My another or further queries to this Respectable Advisor would be : They should not concentrate only on condition or status of Stent fixed in RAMUS in 2008. Till now my experience with various labs, cardiologist is that they concentrate on stent condition and while concentrating on the same the other parameters are getting ignored. What is the role of Non Dominant RCA [which is having a block of around 90 %] in blood supply to the respective part of heart. Though it is non dominant , whether it is giving me the trouble like heavy fatigue, Chest Pains, Short of Breath. Many times I had to breath from mouth rather than nose particularly while walking or taking bath. The calcium Index shows 207 which is far more. I am very much concerned as these complaints have become my everyday affair and affecting my daily work. Since I am working as mentor / advisor for a Swedish company, I can not ignore my responsibilities as because of these issues. If need be I am ready to pay further fees, but I would request for a detailed expert opinion. Once again the reports are enclosed for your ready reference. Just sharing : 10 days back, I read an article written by Dr. B.K.Goel where in he mentioned that many cardiologist comes to opinion or conclusion in one or two minutes after reading the reports. They do not go in depth or study the report in details. This is what I experienced in Pune. Hence approached you. Please advice. Thanks in advance. With Best Regards, XXXX Pune Cell No. +91 0000 E-Mail : YYYY@YYYY

Many Thanks Dr.Benard, I have already uploaded my reports while sending the query, however once again the same are getting uploaded.

Hello Dr. Benard Shehu, Greetings of the Day and Thanks for your fast advice. Accordingly I will talk to my family doctor as well the cardiologist. One query has remained un answered. This is for my own interest and understanding. I am conveying the same again. "What is the role of Non Dominant RCA [which is having a block of around 90 %] in blood supply to the respective part of heart. Though it is non dominant , whether it is giving me the trouble like heavy fatigue, Chest Pains, Short of Breath. Many times I had to breath from mouth rather than nose particularly while walking or taking bath." With Best Regards, XXXX Pune / India

Many Thanks Dr.Benard, Jus last question. I have talked two cardiologist and both are strongly hesitant to touch this Non Dominant RCA having 90 % Blockage. What could be the reason ? when I asked "Why", they just says "its not necessary" , One cardiologist this RCA is small and we can not insert the stent. Or should I take this case to other cardiologist. Please advice. Regards, XXXX