74 year old with history hypertension, coronary artery disease and congestive heart failure presenting after a recent ventricular fibrillation arrest. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 143 ml/m2 (normal range: 65+/-11), the LVEDV is 284 ml (normal range 109+/-23), the LV end systolic volume index is 114 ml/m2 (normal range 18+/-5), the LVESV is 226 ml (normal range 31+/-10), the LV mass index is 65 g/m2 (normal range 67+/-11), and the LV mass is 129 g (normal range 114+/-24). There is global hypokinesis with additional thinning and akinesis of the basal to mid inferior and inferoseptal walls. There is transmural late gadolinium enhancement involving most of the inferior and inferoseptal walls in a pattern consistent with prior myocardial infarction. These segments are unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and is likely to be viable.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 64 ml/m2 (normal range 69+/-14), the RVEDV is 127 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 80 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild protruding atheroma in the descending aorta. 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 mild bilateral atelectasis or consolidation at the base of the lungs. 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. Severe LV dilation with severely reduced systolic function (LVEF 20%).2. There is a transmural myocardial infarction involving much of the usual territory of the right coronary artery. This territory is unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and is likely to be viable. 3. Normal RV size with moderately reduced systolic function (RVEF 37%).4. Severe left atrial dilation. 5. Mild protruding atheroma in the descending aorta. 