52 year old female with history of hypertension, coronary artery disease s/p multiple PCI, dyslipidemia and sarcoidosis presenting for cardiac evaluation. MEDICATIONS: aspirin, amlodipine, clopidogrel, rosuvastatin, hydrochlorothiazide, isosorbide mononitrate, losartan and metoprolol First Pass PerfusionDuring hyperemia, the patient has a perfusion defect involving the basal inferior wall, the mid anteroseptal, anterior, anterolateral, inferior, and inferoseptal walls, and the entire LV apex. The perfusion defect is in the usual territory of the LAD and RCA.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 59 ml/m2 (normal range: 65+/-11), the LVEDV is 100 ml (normal range 109+/-23), the LV end systolic volume index is 59 ml/m2 (normal range 18+/-5), the LVESV is 35 ml (normal range 31+/-10), the LV mass index is 40 g/m2, and the LV mass is 69 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 108 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. There is communication between the left and right atria, likely consistent with patent foramen ovale. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The aortic valve is thickened and calcified with evidence of flow acceleration. Correlation with echo suggested to further quantify/ determine severity of aortic valve sclerosis/ stenosis.Mitral ValveThe mitral valve opens widely and there is at least mild, eccentric, mitral regurgitation. The anterior leaflet of the mitral valve was thickened and possibly calcified.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a large lymph node (22mm) in the left axilla. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.
1. Large perfusion defect/ "ischemia" noted in LAD and RCA territory.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 55%).5. Thickening/ calcification noted on aortic and mitral valves. 6. Small patent foramen ovale is note.7. Large left axillary lymph node noted.When compared to the prior study from 2/2009, there is no longer late gadolinium enhancement present.Findings conveyed to Dr. DeCara.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.