Q: My wife had undergone CABG x 2 grafts seven years ago. Now she again has the problem breathing hard and is unable to walk for 20 metres. She again went for an angiogramme and the report said: LCA angio shows LMCA is normal. LAD has total occlusion after septal branch and diagonal is small and filling RCA is dominant and proximal 50-60% stenosis. Distal RCA PDA and PLV are free of disease. Good LV function. Native triple vessel disease. Normal B/L Renal arteries. Plan: Medical management. I would like to know further options.

A:Hard breathing and inability to walk even short distances indicates some problem. This could be simple physical deconditioning, because she has not been exercising or exerting much, or due to lung or heart problem. Heart problems that could produce breathlessness are thickening of the heart muscle due to high blood pressure, blocks in the arteries supplying blood to the heart muscle or a decrease in heart pumping. According to the information provided by you, the heart pumping is normal, the status of one artery (circumflex) and of the grafts is not mentioned. If medical management is advised, you should ask your doctor about cardiac rehabilitation to increase her exercise capacity.