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Who said coronary collateral circulation can not support excercise ?

Posted Feb 03 2011 12:46pm

Coronary collateral circulation is probably the most poorly understood circulation than any other.This  is ignorance at it’s best ,  in spite of the life saving potential  of this circulation. A popular  (mis )perception is  coronary collaterals  can support only  resting blood flow and it would  struggle  to compensate at times of exertion. This is based on few case studies and not based on large , authentic scientific data.

Does this reasoning mean  , coronary  collaterals   can never / ever be complete  ?

If we believe so   . . .we are grossly underestimating the power of  nature .(In fact , mankind  was humiliated by the nature  time and again !)

Lessons  from  a unique patient we have  encountered.

Here is an example of total LAD/LCX  occlusion with good collateral  from  RCA. He was having  stable  angina on medical  management . This patient  was not only  asymptomatic and was also negative for exercise  stress test at moderate work load .

 

 

 

 

 

 

 

 

 

 

 

There was an  intense debate about the management  when this angiogram was presented in the cath meeting .


 

 

 

 

 

 

 

 

 

 

    Most of the cardiologists believed so !  But they had no answers why his stress test was negative.
  • The other argument for CABG was one can not allow a patient with a functionally single coronary  artery (RCA) However good is the collateral circulation.This at least  has some logic. not the first one !
  • One more suggestion was to quantitate  and map the real extent of ischemia by PET scanning and then decide about revascularisation.
  • One critical opinion was , since he was doing well with medical management what was the need to do coronary  angiogram at all ?

Any answers  . . .

He  ultimately went on to receive CABG (By popular opinion ) , but the point here is the collaterals were  good enough to support exertion.We have  documented quiet a few similar patients with collateral circulation supporting exercise.

What  happened to the collaterals  and (of course ) the patient after surgery ?

I will post you the  curious story soon   . . .

Final message

Coronary  collateral circulation , if well developed  can provide hemo-dynamically useful support even at times of exertion *

* The existing literature  is  biased against this concept. It generalizes all grades of collaterals into a single   entity. It is better  if we  spend more time to understand the nuances of coronary collateral circulation .

This is the  message from our observation. Do not ever believe whatever is published as facts in scientific literature. Observe, analyse , create your own inference ,  and concepts. Mainstream cardiologists would brand it unscientific  , Simply ignore it . Many times it is rewarding  to our patients.


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