A second opinion on your coronary angiogram from Dr. Varma can be obtained by sending your angiogram pictures on a CD with (preferably) DICOM image format (AVI, WMP, MPEG4 is also acceptable) to the address of the clinic after notifying Dr Varma on the phone.

Dr. Varma will then view the images. You can fix up a mutually convenient time for a telephonic discussion with him. A second opinion from him can similarly be arranged for other cardiac / lung related investigations such as an echocardiogram, Cardiac CT, Chest CT, Cardiac Magnetic Resonance Imaging, Single Photon Emmiss

ion CT (myocardial viability, stress testing etc). He may sometimes request you for  additional tests or an “in person” consultation for a direct discussion if he feels it is necessary.

A second opinion on your Coronary Angiogram

Is important especially when you have more than one option for treatment and are confused regarding what is best for you. Coronary artery disease can be treated by medications alone, by angioplasty and medications, or bypass surgery and medications. Hybrid procedures involving an angioplasty and bypass surgery may rarely be necessary. There is also a well known inter-observer variability in reporting findings across the world if the same angiogram is reported by more than one specialist.

Generally a significant obstruction of the left main coronary artery needs urgent bypass surgery. Blocks in all the three blood vessels of the heart (triple vessel disease) also requires surgery especially in diabetics. Discrete obstructions in one or two arteries with a good distal run off can be treated by angioplasty and stenting. Mild blocks (of less than 50% loss of luminal diameter) can be treated by medications alone. The assessment of “50%” is done by eyeballing and there is a known inter-observer variability in reporting. A more  objective evaluation of such borderline lesions may require an evaluation of  the fractional flow reserve to determine the hemodynamic significance of the obstruction.

Unbiased advise based on evidence based medicine is a prerequisite for good treatment. A good decision is important for a good long term result as well. It important to remember that the coronary angiogram is only a diagnostic test. It is not a method of treatment. A second opinion that endorses the opinion of your primary health care provider confers a lot of reassurance and peace of mind that the treatment adviced is the most appropriate one. It is not unethical to seek a second opinion. Courtesy demands that a second opinion be obtained after informing the primary health care provider that a second opinion is being sought.